What are the adenoids (the third tonsil)?
The adenoids are a lymphoid structure located at the back of the nose, between the nasal cavity and the throat. Unlike the tonsils, which can be seen on either side of the throat, the adenoids are not visible without a special examination. In children they play an important role in immune defence during the first years of life, yet they often become problematic when they enlarge or become infected.
What is adenoiditis?
Adenoiditis is inflammation or infection of the adenoids, most often occurring in children between 1 and 7 years of age. It may be acute or chronic and is frequently associated with recurrent upper respiratory tract infections.
Causes (aetiology)
- Viral infections: adenovirus, rhinovirus, influenza viruses
- Bacterial infections: Streptococcus pyogenes, Haemophilus influenzae, Moraxella catarrhalis
- Crowded environments, exposure to tobacco smoke, allergies and a weakened immune system all increase the risk of adenoiditis.
Main symptoms of adenoiditis
- Chronically blocked nose (the child breathes only through the mouth)
- Mouth held open all the time, particularly during sleep
- Snoring at night and restless sleep
- Apnoea (pauses in breathing during sleep)
- Nasal discharge (pus, yellow secretions)
- Noisy and laboured breathing
- Nasal-sounding voice (hyponasality)
- Recurrent otitis (ear infections)
- Delayed speech or hearing development (as a consequence of middle ear problems)
How do the adenoids affect a child's development?
Adenoids that are enlarged or repeatedly infected can have a negative effect on:
- Sleep quality (leading to chronic fatigue)
- Hearing (due to dysfunction of the Eustachian tubes)
- Language and speech development
- Facial and skull growth (adenoid facies: open mouth, narrow nose, protruding upper jaw)
- Behaviour and concentration (due to the lack of restful sleep)
How is adenoiditis diagnosed?
- Medical history and physical examination
- Examination by nasopharyngoscopy (a camera device used to view the adenoids)
- X-ray of the nasopharynx (often used to assess the size)
- Audiometry or tympanometry to check hearing and middle ear function
- Consultation with an ENT specialist (otorhinolaryngologist)
Treatment of adenoiditis
🔹 In acute cases:
- Antipyretics (paracetamol/ibuprofen)
- Nasal rinsing with saline solution or salt water spray
- Antibiotics in the case of bacterial infection (on prescription)
- Topical corticosteroids in selected cases (to reduce swelling)
🔹 In chronic cases or in the case of persistent enlargement:
- Adenoidectomy – surgical removal of the adenoids
- Performed in hospital, usually as a day procedure (without an overnight stay)
- Recommended when there is:
- Severely impaired breathing through the nose
- Apnoea during sleep
- Recurrent otitis
- Delayed speech or hearing problems
After surgery – what to expect
- The child may have a mild sore throat for a few days
- It is important to drink plenty of fluids and eat soft foods
- Recovery usually takes 5–7 days
- Snoring and mouth breathing normally improve within a few weeks
Conclusion
Adenoiditis is a very common condition, yet it is often overlooked. If your child snores, breathes through the mouth or has frequent nose or ear infections, it is important to have the adenoids assessed. Removing the adenoids can significantly improve a child's quality of life and overall development.
📌 Advice for parents: Do not wait for the symptoms to resolve on their own. A simple consultation with an ENT specialist can prevent larger problems in the future.