Adenoid Hypertrophy · What Is It, Causes, Symptoms, Diagnosis, Treatment, Removal, and More

Adenoid hypertrophy, also known as enlarged adenoids, refers to the unusual growth of the adenoid tissue. The adenoids are small masses of lymphatic tissue located in the upper airway, in the back of the throat. Together with the tonsils, the adenoids form a ring of lymphoid tissue around the throat, and their main job is to prevent pathogens from the food we eat or the air we breathe from entering the body through the mouth or nose.   

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

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 as Streptococcus pyogenes, also known as group A strep. 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 can become inflamed and enlarged. Additionally, stomach acid caused by gastroesophageal reflux disease (GERD), 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.  

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 on their own within 5 to 7 days. Allergic reactions can be treated with intranasal corticosteroids, oral steroids, or 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, called an adenoidectomy, may be required. Similarly, if an individual presents with persistent otitis media or a build-up of fluid in the middle ear (i.e., middle ear effusion), adenoidectomy may also be required to prevent these complications. Although adenoidectomy requires general anesthesia, it can be performed on an outpatient basis with typical recovery times between 48 and 72 hours.