Adenoiditis

Overview

Adenoiditis is inflammation (swelling) and infection of the adenoids — small pads of tissue at the back of the inside of the nose. They are part of the body’s immune system, helping to trap germs in childhood. When the adenoids swell, they can block the nose and cause symptoms like a stuffy nose, sore throat, and trouble breathing.

Yes, adenoiditis is common in children, especially between the ages of about 1 and 7. It is less common in teenagers and adults because the adenoids naturally shrink with age.

It most often affects children who are exposed to infections at school or daycare. Children with allergies, a weakened immune system, or exposure to tobacco smoke may have a higher risk. Adults can still get it, but it is uncommon.

Symptoms

Common symptoms

• Stuffy or blocked nose
• Running nose with clear or thicker mucus
• Sore throat or scratchy throat
• Pain or a feeling of fullness behind the nose
• Breathing through the mouth, snoring, or noisy breathing
• Mild fever

Symptoms in children

• Difficulty breathing through the nose
• Mouth breathing, especially at night
• Snoring or pauses in breathing during sleep
• Ear pain, earaches, or complaints of hearing difficulty
• A 'hot potato' or muffled voice
• Fussiness, trouble eating, or poor sleep

Symptoms in older adults

• Adenoiditis is rare in adults because the adenoids usually shrink. If an adult has similar symptoms, they are more likely due to other conditions such as allergies, sinusitis, or voice disorders. A healthcare professional should evaluate any persistent nasal or throat symptoms in an adult.

Causes

Main causes

• Most often a viral infection, such as the same viruses that cause colds and flu
• Sometimes a bacterial infection can cause adenoiditis, often following a viral cold
• Repeated infections can lead to long-term (chronic) inflammation of the adenoids

Risk factors

• Age under 7 years
• Regular contact with many other children, for example in school or daycare
• Allergies that cause nasal inflammation
• Exposure to tobacco smoke or indoor air pollutants
• A weakened immune system due to illness or certain medicines

When to see a doctor

See a doctor urgently if:

• If your child is having trouble breathing, you should call emergency services immediately
• If your child has a fever that won't come down, seems very unwell, or shows signs of dehydration, contact a healthcare professional the same day
• If your child has severe ear pain or new hearing loss, see a provider within 24 hours

Book a routine appointment if:

• If symptoms last longer than about 10 days or worsen after the first week
• If mouth breathing or snoring interferes with daily activities or school
• If ear symptoms or hearing problems are happening repeatedly (more than once every few months)
• If you have questions about managing your child's symptoms at home

Diagnosis

A healthcare professional will ask about your child's symptoms and medical history, look in the ears, nose, and throat, and feel the neck for swollen glands.

Tests that may be done

• A quick nasal or throat swab to check for bacteria or viruses
• A flexible camera (nasal endoscopy) to view the adenoids (in certain cases)
• In rare cases, a small X-ray of the head and neck

What to expect at your appointment

The examination is usually quick and painless. Your child may need to sit on your lap or be held gently so the doctor can see the back of the nose. Some children may have a brief gag or cough when the doctor uses a small instrument. The doctor will explain what they are doing and try to make it as comfortable as possible.

Treatment

Treatment depends on whether the inflammation is caused by a virus or bacteria, and how severe or frequent the episodes are. Many mild cases improve on their own with rest and fluids. If a bacterial infection is likely, a healthcare provider may prescribe antibiotics. Combined with home care, most people recover without lasting problems.

Self-care at home

• Give your child plenty of fluids, such as water or warm clear drinks, to prevent dehydration
• Use a cool-mist humidifier in the bedroom to keep the air moist
• Try a gentle salt-water nose rinse for older children and adults (ask your pharmacist how to do this safely)
• Encourage rest and quiet activities; avoid exposure to tobacco smoke
• For older children and adults, gargling with warm salt water may soothe a sore throat (for children old enough to gargle safely)

Medical treatments

Medical treatment may include pain and fever relief, which you can discuss with a pharmacist or healthcare provider. If a bacterial infection is diagnosed, antibiotics will be prescribed, and it is important to finish the course even if symptoms improve. If allergies are contributing, a healthcare provider may recommend a nasal spray. Children with repeated episodes or complications may be referred to an ear, nose, and throat (ENT) specialist for further assessment.

When is surgery considered?

A surgery called adenoidectomy (removing the adenoids) may be offered if the adenoids become enlarged and cause serious problems, such as difficulty breathing while sleeping, repeated ear infections with hearing loss, or if antibiotic treatment fails and the condition keeps coming back. The surgery is performed under general anesthetic, and most children go home the same day. Many children have fewer infections afterward, as the condition often resolves as the child grows.

Living with this condition

During an episode of adenoiditis, encourage your child to rest and drink plenty of fluids. Use a humidifier at night. Keep their nose clear with gentle saline sprays or rinses, especially before feeding and sleeping. Avoid exposing them to smoke and dusty places.

Lifestyle tips

• Keep the home free of cigarette smoke and strong chemical smells
• Make sure your child gets enough sleep and has a balanced diet to support their immune system
• Encourage regular handwashing at home and daycare to reduce spread of infections
• If allergies are present, work with your healthcare provider to reduce triggers such as dust mites or pollen

Diet and exercise

A healthy balanced diet with plenty of fruits and vegetables supports the immune system. Encourage your child to be physically active when they are well, but during an episode, rest is more important than exercise. Cold water and soft or warm foods can be soothing if swallowing is uncomfortable.

Mental health and emotional wellbeing

Breathing problems and disturbed sleep can make children cranky, tired, and less able to concentrate at school. They might feel frustrated by ongoing symptoms or miss school and activities. Talk to your child about what is happening, keep routines stable, and plan for fun quiet activities during recovery. If you notice low mood, anxiety, or big changes in behavior, speak to your healthcare provider for advice.

Prevention

You cannot always prevent adenoiditis, but you can reduce the number of infections your child gets. Good hygiene, avoiding smoking, and keeping vaccinations up to date help. Breastfeeding (for babies) may also provide important immune support.

Vaccines

Some childhood vaccines protect against infections that can cause adenoiditis, such as the flu vaccine. Ask your healthcare provider about recommended vaccinations for your child.

Screening programmes

There is no routine screening test for adenoiditis. It is diagnosed based on symptoms and a doctor's examination.

Complications

If left untreated

• Recurring middle ear infections (otitis media) leading to temporary or long-term hearing loss
• Glue ear (fluid in the middle ear) affecting speech and language development
• Obstructive sleep apnea (breathing stops briefly during sleep) causing poor sleep, daytime tiredness, and behavior changes
• Sinusitis (inflammation of the sinuses) because blocked drainage
• Rarely, the infection can spread to nearby tissues, causing a deep neck abscess (collection of pus)

Long-term outlook

For most children, adenoiditis improves with time and the adenoids gradually shrink as they get older. Even when episodes are frequent, treatment — including medicines and, if needed, an operation — is very effective. With good support at home, most children recover fully and have no long-term health problems.

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