What is it?
The adenoids sit behind the nose and the tonsils on either side of the throat; both are lymphoid tissue. In childhood they work as part of the immune system and go through a period of growth. When that growth reaches a size that narrows the airway, breathing through the nose becomes harder and breathing shifts to the mouth.
The typical picture is this: the child snores at night, sleeps with the mouth open, changes position often and wakes up tired. A blocked nose during the day, a nasal-sounding voice, bad breath and poor appetite can go with it. A feeling of fullness in the ears and repeated middle ear problems are linked to the adenoids sitting next to the Eustachian tube.
A dentist notices these children through the mouth: dry, inflamed gums at the front, a coated tongue, a narrow high palate, lips that stay apart at rest. These findings do not make the diagnosis. The adenoids cannot be seen by looking into the mouth; assessing them requires the nose and the area behind it to be examined directly, and that is the job of the ear, nose and throat specialist.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
Natural growth with age
Lymphoid tissue reaches its largest size in the pre-school years and tends to shrink towards the teenage years. A child's airway is narrow as well, so the same size produces more symptoms at this age.
- 02
Repeated upper respiratory infections
Frequent nose and throat infections keep the tissue constantly stimulated. Tissue that enlarges with each episode may not return to its earlier size between episodes.
- 03
Allergy
Allergic rhinitis keeps the lining of the nose swollen and keeps the lymphoid tissue stimulated. Without the allergy being brought under control, it is harder for the blockage to ease.
- 04
Environmental factors and reflux
Exposure to cigarette smoke, and stomach contents reaching the throat, can cause ongoing irritation in the upper airway. On that ground, enlargement of the tissue settles in more easily.
How does it progress?
- Grade 1
Tonsils that narrow the passage only slightly
The tonsils stay within their beds and do not clearly narrow the throat. Symptoms are mostly limited to periods of infection.
- Grade 2
Growth that spills beyond the bed
The tonsils spill out beyond their beds. Snoring can start at night, although breathing during the day is usually comfortable.
- Grade 3
Clear narrowing
Most of the throat passage is closed off. Snoring becomes regular, mouth breathing carries on during the day as well, swallowing slows down and meals take longer.
- Grade 4
Almost complete closure
The tonsils come close to the midline. Pauses in breathing during sleep, a mouth that stays open all day and difficulty feeding can be seen; assessment is not put off.
How is it treated?
The place to go with this picture is the ear, nose and throat specialist. At the examination the throat and the nose are assessed; because the adenoids cannot be seen through the mouth, a look with a fine endoscope through the nose, or a side-view X-ray, may be needed. If pauses in breathing during sleep are described, a sleep study may be requested. In this picture the dentist's role is limited to noticing the signs, recording the marks they leave inside the mouth and pointing you to the right address.
The ear, nose and throat specialist may prefer to start with medicines and monitoring. Sprays used inside the nose, allergy treatment and regular follow-up of infections are tried for a while. In many children the tissue shrinks with age and the symptoms ease. Which medicine is used in this period, at what dose and for how long, is up to that specialist.
If the symptoms continue, if there are pauses in breathing during sleep, or if repeated infections are affecting daily life, removing the adenoids and the tonsils may come up. Both that decision and the extent of the operation are made by the ear, nose and throat specialist. What can be done on the dental side is to plan the timing of an orthodontic assessment for a narrow palate and the bite, once the airway has been sorted out.
- Seeing breathing stop during sleep
- Difficulty swallowing and saliva pooling in the mouth
- Difficulty breathing together with a change in the voice
- A tonsil enlarging on one side, or a hard swelling in the neck that does not go away
How is it prevented?
- Watch how your child sleeps; snoring every night and sleeping with the mouth open are not accepted as normal.
- Do not forget allergic symptoms once the season passes; a blocked nose that carries on needs to be assessed.
- Prevent exposure to cigarette smoke in the home.
- Note the dates and the length of repeated throat infections; you will be asked about this when a decision is being made.
Frequently asked questions
- Do the adenoids shrink on their own?
- In many children the lymphoid tissue shrinks towards the teenage years and the symptoms ease. But if the airway stays narrow during that time, if sleep is broken up or if there are repeated ear problems, waiting can carry a cost. Whether to wait or to go ahead with a procedure is decided by the ear, nose and throat specialist.
- If the tonsils are removed, will my child's immunity be weaker?
- The tonsils are not the only part of the immune system; after they are removed, defence carries on through other lymphoid tissue. Even so, the operation is not recommended for every child, and the need for it is assessed case by case. It is best to put this question to the ear, nose and throat specialist who will be making the decision.
- Can a dentist see the adenoids?
- No. The adenoids sit behind the nose and cannot be assessed by looking into the mouth. A dentist can see the tonsils roughly, and can notice a narrow palate and the marks that dryness leaves inside the mouth. These findings raise suspicion; it is the ear, nose and throat specialist who determines their extent and what should be done.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.