Adenoid Hypertophy

What Is It, Causes, Symptoms, Diagnosis, Treatment, Removal, and More

Author: Jessica Rivas

Editors: Ahaana Singh, Lisa Miklush, PhD, RN, CNS

Illustrator: Jillian Dunbar


What is adenoid hypertrophy?

Adenoid hypertrophy, also known as enlarged adenoids, refers to the unusual growth of the adenoids. The adenoids are small masses of lymphatic tissue located in the upper airway, between the nose and the back of the throat. Along with the tonsils, the adenoids form part of the lymphatic system, which works to defend the body against microbes, absorb nutrients, maintain proper fluid levels, and eliminate certain waste products. The anatomical position of the adenoids allows them to help fight infection by preventing germs from entering the body through the mouth or nose. 

Most commonly, enlarged adenoids occur in children under the age of 5. After this point, the adenoids usually begin to shrink in size and do not play as significant of a role in the immune response.

What causes adenoid hypertrophy?

Tonsils and adenoids trap germs that enter the body and can become enlarged as a consequence of their inflammatory response. The main infectious causes of adenoid hypertrophy occur from viral infections, such as the Epstein–Barr virus, or bacterial infections, such group A Streptococcus. Chronic adenoid inflammation may result from recurring acute infections or persistent infection. 

In some cases, allergies and irritants can also cause adenoid hypertrophy. When allergens or irritants come in contact with the adenoid tissue, the adenoids have a similar inflammatory response through which they can become enlarged. Additionally stomach acid caused by gastroesophageal reflux (also known as acid reflux), can irritate adenoid tissue, triggering inflammation and the enlargement of the adenoids.

Although adenoid hypertrophy most commonly occurs in children, adults with increased exposure to pollution or smoking may also be predisposed to adenoid enlargement due to irritation. In some instances, adenoid hypertrophy may also be associated with sinus tumors, lymphomas, and HIV infection.

What are the signs and symptoms of adenoid hypertrophy?

Adenoid hypertrophy can result in a variety of signs and symptoms, mainly affecting the airways and surrounding structures. However, most individuals will have minor enlargement and appear asymptomatic. In cases of more severe enlargement, a common occurrence is nasal obstruction, which refers to the partial or complete blockage of the nasal airway. Such obstruction often leads to mouth breathing, or the unconscious tendency to breathe through the mouth instead of the nose. This can lead to bad breath, dry mouth, cracked lips, and nasal congestion. Nasal obstruction may also cause a blockage of the Eustachian tubes, which connects the middle ear to the nasopharynx (upper throat and the back of the nasal cavity). A blockage of the Eustachian tubes can often result in ear infections, such as otitis media (infection of the middle ear), or a cough. It can also lead to the obstruction of sleep, resulting in restlessness, increased snoring, and, in some cases, sleep apnea, a condition in which breathing momentarily stops while asleep. Persistence of symptoms can ultimately lead to adenoid facies.

What are the adenoid facies?

Adenoid facies refers to the atypical appearance of facial features, and can result from persistent adenoid hypertrophy. Commonly, adenoid facies is known as “long face syndrome”, and is characterized by a long, lean face with an open mouth. With adenoid facies, individuals typically present with increased mouth breathing, an arched palate, underdeveloped upper jaw bones (i.e. hypoplastic maxilla), a short upper lip, elevated nostrils, and dental crowding of the front teeth. It most commonly occurs in children and often presents with chronic nasal obstruction.

How do you diagnose adenoid hypertrophy?

Adenoid hypertrophy is typically diagnosed through physical examination and a review of an individual’s medical history. Chronic mouth breathing, persistent middle ear infections, or sleep problems often suggest the possibility of adenoid hypertrophy. If symptoms indicate possible adenoid enlargement, a healthcare practitioner will examine the nose and throat by using a special mirror in the mouth or a nasopharyngoscopy. A nasopharyngoscopy consists of inserting a flexible tube, called an endoscope, through the nose in order to visualize the adenoids. In some cases, diagnosis may require imaging techniques such as CT scans or X-rays.

What is the treatment for adenoid hypertrophy?

Most individuals with adenoid hypertrophy are asymptomatic and may not require treatment. In symptomatic cases, treatment focuses on resolving the underlying cause of the adenoid enlargement. Bacterial infections will usually be treated with a specific antibiotic course depending on the causative agent. Unlike bacterial infections, viral infections do not respond to antibiotics and will usually resolve themselves within 5 to 7 days. Allergic reactions can be treated with intranasal corticosteroids, oral steroids, or oral antihistamines. Meanwhile, treatment for acid reflux mainly focuses on lifestyle and diet modification, as well as the use of antacids or acid-suppressing medications. 

In cases of severe or persistent enlargement, surgical removal of the adenoids (also known as an adenoidectomy), may be required. Similarly, if an individual presents with persistent otitis media or a buildup of fluid in the middle ear (i.e. middle ear effusion), adenoidectomy may also be required. Although adenoidectomy requires general anesthesia, it can be performed on an outpatient basis with typical recovery times between 48 and 72 hours.

At what age can adenoids be removed?

The surgical removal of the adenoid, or adenoidectomy, is usually performed between 1 and 7 years of age upon recommendation of an ear, nose, and throat specialist. Most of the time, surgical removal is not required and the adenoids will shrink as the child grows older.

What are the side effects of having your adenoids removed?

Adenoid removal is generally not considered to be a high-risk surgery and healthy children usually have a low risk of complications. However, the most common temporary side effects are nose or mouth bleeding, bad breath, sore throat, fever, nausea, and vomiting. Other, less common, side effects include problems with swallowing (dysphagia), ear pain, or permanent changes in vocal quality. If an individual presents with persisting side effects, medical attention may be required.

What are the most important facts to know about adenoid hypertrophy?

Adenoid hypertrophy refers to the enlargement of the adenoid tissue, which is located in the upper airway between the nose and the back of the throat. Enlargement occurs most commonly in children under the age of 5 and is usually the result of bacterial or viral infections. In some cases, allergens, irritants, and acid reflux can also lead to adenoid hypertrophy. Most of the time adenoid hypertrophy is asymptomatic, but symptoms and signs can include mouth breathing, middle ear infections, bad breath, nasal obstruction, and sleep obstruction. Treatment generally focuses on resolving the underlying cause. If there is chronic infection or persisting symptoms, surgical removal of the adenoids may be required after a proper evaluation by a specialist.

Related links

Clinical Reasoning: Pediatric ear, nose, and throat conditions
High Yield: Nasal, oral, and pharyngeal diseases
Lymphatic anatomy and physiology
Sleep apnea
Streptococcus pyogenes (Group A Strep)

Resources for research and reference

Bhandari, N., Don, D. M., & Koempel, J. A. (2018). The incidence of revision adenoidectomy: A comparison of four surgical techniques over a 10-year period. Ear, Nose, & Throat Journal, 97(6): E5–E9. DOI: 10.1177/014556131809700601

Bowers I, Shermetaro C. (2020). Adenoiditis. In StatPearls. StatPearls Publishing. Retrieved November 23, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK536931/

Koca, C. F., Erdem, T., & Bayındır, T. (2016). The effect of adenoid hypertrophy on maxillofacial development: an objective photographic analysis. Journal of Otolaryngology - Head & Neck Surgery, 45(1): 48. DOI: 10.1186/s40463-016-0161-3

Niu, X., Wu, Z-H., Xiao, X-Y., & Chen, X. (2018). The relationship between adenoid hypertrophy and gastroesophageal reflux disease: A meta-analysis. Medicine, 97(41): e12540. DOI: 10.1097/MD.0000000000012540

Pathak, K., Ankale, N. R., & Harugop, A. S. (2019). Comparison Between Radiological Versus Endoscopic Assessment of Adenoid Tissue in Patients of Chronic Adenoiditis. Indian Journal of Otolaryngology and Head & Neck Surgery, 71: 981-985.

Poddębniak J. & Zielnik-Jurkiewicz, B. (2019). Impact of adenoid hypertrophy on the open bite in children. Polish Journal of Otolaryngology, 73(4): 8-13. DOI: 10.5604/01.3001.0013.1536

Rout, M. R., Mohanty, D., Vijaylaxmi, Y., Bobba, K., & Metta, C. (2013). Adenoid Hypertrophy in Adults: A case Series. Indian Journal of Otolaryngology and Head & Neck Surgery, 65(3): 269-274. DOI: 10.1007/s12070-012-0549-y