Adenoids are small lumps of lymphoid tissue located behind the nasal cavity at the top of the airway. As part of the immune system, they help protect the body from bacteria and viruses that pass through the nose and mouth by trapping them. Adenoids are most active in early childhood and peak around the age of five, before normally starting to shrink and consistently disappearing by adolescence.

Rarely enlarged adenoids, called adenoid hypertrophy, is when the adenoid tissue is excessively swollen or enlarged. This condition is most common in children aged five and younger but can occur in adults, particularly if the adenoids fail to naturally shrink as well as for those who do not have the infections clear. While they pose no real danger to an individual, affected children may exhibit many different symptoms that can lead to issues, especially concerning breathing, ear functioning, sleep quality and more. Some children may need to have their enlarged or excessively enlarged adenoids surgically removed (adenoidectomy) in more severe or lengthy cases.

There are many reasons that adenoids can enlarge. Some of the reasons may be acute, such as infections, while others may be chronic, such as allergies or repetitive inflammation. Some of the more common triggering factors are: 

1. Infections:

The biggest found reasons for enlarging adenoids are recurrent ear infections and recurrent bacterial and viral infections of the upper respiratory tract. When the adenoids detect invading pathogens they produce immune cells that can cause intermittent swelling or chronic enlargement when infections continue for days or weeks.

2. Allergies:

Children or adults suffering from allergies, but especially allergic rhinitis, may have adenoid enlargement due to chronic inflammation in response to triggers such as pollen, dust mites, mold, pet dander, etc.

• Chronic sinusitis or rhinitis:

Repetitive or long-term inflammatory responses that impact the nasal passage or sinuses can irritate, and hence from swelling of the adenoids over a prolonged time.

• Gastroesophageal Reflux Disease (GERD):

Sometimes, acid reflux can travel all the way up to the throat and into the nasopharynx, irritating the adenoid tissues, leading to chronic inflammation and hypertrophy.

• Environmental Irritants:

Environmental pollutants in our environment including cigarette smoke, industrial vapors and indoor pollutants can irritate the mucous membranes, including the adenoids, leading to enlargement.

• Genetic Predisposition:

Some children may have a genetic predisposition to have larger adenoids or to display a hyperactive immune response to associated allergens and infections leading to greater susceptibility to adenoid hypertrophy.

• Other Medical Conditions:

Adenoid hypertrophy may also rarely be associated with other conditions like nasal tumors, lymphomas or immunodeficiency diseases such as HIV infection.

Enlarging adenoids usually occur as a result of some ongoing irritation or infection, which is especially common in children for a few good reasons.

To put it simply, you can “get” enlarged adenoids the same way you might “get” a sore throat or sinus infection—from “getting” germs, allergens or irritants into the upper airways; when we are chronically irritated, the adenoid tissue can gradually stay enlarged in the long-term.very possible cause of short stature.

Children have immature immune systems, which are less tolerant to viruses and bacteria than adults. Children also have larger adenoids compared to adults, as they have bigger adenoids in younger years since they respond to more germs. Young children often get viral and respiratory infections, which lead to ongoing inflammation of the adenoids. 

Mild enlargement of the adenoids is likely to remain asymptomatic, however, once the adenoid tissue becomes significantly enlarged, it may obstruct the nasal airway as well as interfere with nearby structures resulting in symptoms. The nature and severity of symptoms will vary depending on the degree of enlargement. 

1. Mouth Breathing:

One of the more common and noticeable signs–in particular in children–is chronic mouth breathing particularly at night. Blocked nasal passages due to enlarged adenoids makes breathing through the nose difficult or impossible necessitating the child to breathe through the mouth. 

• Snoring and Sleep Apnea: 

Enlarged adenoids often cause loud snoring while sleeping. In more severe cases, enlarged adenoids may cause obstructive sleep apnea (OSA) which is when breathing repeatedly stops and starts during sleep due to blockages in the airway. OSA in children can be the cause of restless sleep and daytime fatigue. 

• Chronic Nasal Congestion:

Children with enlarged adenoids may sound congested or “stuffed up” as if they have a cold but they don’t.

The children may frequently complain of not being able to breathe through their nose.

• Recurrent Ear Infections: 

With adenoids enlarged, the Eustachian tubes can become obstructed that sit in the back of the throat and drain the middle ear. This can lead to otitis media (inflammation of the middle ear) or fluid in the ears, which are frequently encountered by children with adenoid hypertrophy.

• Hearing Problems:

Fluid in the ears and recurrent ear infections can impair hearing. During the school years, children can become poor achievers if they have difficulty concentrating or paying attention.  

• Changes to speech and voice:

Some children with adenoid hypertrophy breathe through their mouths.  Because of the nasal obstruction from the enlarged adenoids, other children will have nasal-sounding speech patterns and/or poor articulation.  If children experience issues with speech development, they can lose confidence.   

• Difficulty swallowing:

When adenoids become severely enlarged, they can bulge through the back of the throat and cause partial obstruction of the throat. Due to this change in anatomy, swallowing food may become more uncomfortable or difficult, especially with solid food. 

• Recurrent Sore Throats or Bad Breath:

Chronic adenoid inflammation or recurrent adenoid infections may necessitate children to deal with chronic sore throats or chronic bad breath, which can occur regardless of the condition of their teeth and gums.

• Behavioral or Developmental Difficulties:

When enlarged adenoids result in poor quality sleep, children can exhibit daytime sleepiness, irritability, hyperactivity or inability to concentrate. These behaviors can sometimes be misdiagnosed as a behavioral disorder such as ADHD.

1. Chapped Lips and Dry Mouth:

Children in this situation will have symptoms of dry mouth, chapped lips, or dental complications like cavities or gingivitis because of the constant mouth breathing.

1. Adenoid Facies:

In chronic untreated cases, children may develop a characteristic facial appearance called adenoid facies. It is marked by a long, thin, and flat face with a slightly open mouth, a high, vaulted palate, and in some cases malocclusion. It is due to prolonged mouth-breathing and a lack of development from the mandible because of mouth breathing.

Diagnosing enlarged adenoids usually starts with a review of symptoms and a physical exam (the adenoids are hidden, so specific tools and tests are used to examine their size and effect).

1. Medical History and Symptoms:

The physician will inquire about breathing problems, sleep problems, recurrent infections, and or other issues that may be related.

• Physical Examination:

There is a general examination of the ears, nose, and throat which will reveal signs such as nasal congestion, fluid in the ear, and mouth breathing.

• Nasal Endoscopy (The Gold Standard):

A thin, lighted camera (endoscope) is inserted through the nose to directly see the adenoids.

• X-ray (Lateral Neck View):

Allows for a side view of the adenoids. This is a quick and non-invasive way to image the adenoids, although this method is not as accurate as endoscopy.

• Sleep Study (Polysomnography):

If sleep apnea is suspected there will be a full-size polysomnography to monitor breathing and oxygen levels while the child is sleeping.

• Hearing Tests:

The physician may do hearing tests or other tests of hearing/auditory function, but also may consider that fluid in the middle ear is due to blockage by the Eustachian tube as it relates to the adenoids.

• Throat Culture:

If there is a suspicion of infection an oral swab will reveal full spectrum bacterial presence or match a known bacterial infection which may be contributing to the enlarged adenoids.

The way enlarged adenoids are treated, generally, will depend on the extent of symptoms and the impact on quality of life. For mild cases, treatment may not be necessary. For more troublesome or severe cases, the physician may recommend medications or surgery.

1. Watchful Waiting:

When symptoms are mild with no major concerns like disrupted sleep or impact on development, physicians may recommend controlled observation. It is possible that conditions will self-resolve over time given that adenoids shrink as children grow older and many children outgrow the problem without any treatment.

• Medications:

Medications may treat symptoms or underlying causes, and may be most helpful in moderate cases:

• Antibiotics: These may be used to treat or prevent bacterial infection contributing to swelling of the adenoids.
  • Intranasal Corticosteroids: These medications reduce inflammation in the adenoids and nasal spaces, easing airflow.
  • Antihistamines or Decongestants: If allergies are contributing to the enlargement of the adenoids, these medications may be helpful in reducing symptoms.
  • Viral infections: These typically resolve on their own within 5-7 days and do not require antibiotics.

Currently, however, most medications relieve symptoms temporarily and are not useful for chronic or severe cases of adenoid hypertrophy.

• Adenoidectomy (Surgical Removal):

If symptoms are longstanding or a person’s health is seriously impeded, an adenoidectomy (surgical removal of the adenoids) may be necessary. The adenoidectomy is the most efficacious and durable treatment when:

• Chronic ear infections or hearing loss due to Eustachian tube blockage;
  • Obstructive sleep apnea or severe loud snoring; 
  • Constant nasal obstruction or nasal obstructive symptoms that cannot be managed with medication; and,
  • Recurrent sinus infections or sore throats. 

Adenoidectomy is usually a brief outpatient procedure performed in a hospital operating room under general anesthesia. The adenoidectomy could be done as the only procedure or as part of a tonsillectomy if the tonsils are enlarged or problematic as well.

• Management of Underlying Conditions:

If an adenoid was swollen from allergies or gastro esophageal reflux disease (GERD), it is necessary to manage those conditions. In treating the underlying condition, inflammation can be diminished, which could help diminish recurrence rates even after successful treatment.

Enlarged adenoids are very common, especially in young children. Chronic infection, allergies, and environmental irritants can lead to enlarged adenoids. Generally, some children may not have any issue; however, others may have long-standing problems such as mouth breathing, nasal obstruction, snoring, disturbed sleep, or recurrent ear infections.

In many cases with mild symptoms, natural improvement is likely due to the fact that as children grow, adenoids will shrink over time. In cases with more severe and persistent symptoms, childhood infections may lead to sleep apnea, hearing loss, or developmental delays; therefore, surgical treatment of the adenoid or medical treatment may be needed.

In all cases, prompt recognition of persistent symptoms and treatment is best. If your child is experiencing ongoing manifestations of breathing difficulty, recurrent infections, or disturbed sleep, it is best to consult your pediatrician or ENT physician. In most cases, if managed appropriately, enlarged adenoid cases lead to healthy and active children.

• Niedzielski, A., Chmielik, L.P., Mielnik‑Niedzielska, G., Kasprzyk, A., & Bogusławska, J. (2023). Adenoid hypertrophy in children: A narrative review of pathogenesis and clinical relevance. BMJ Paediatrics Open, 7, e001710. 
• Meier, J., & Lippert, B. (2023). Adenoid hypertrophy—Diagnosis and treatment: The new S2k guideline. HNO, 71, 123–134. 
• Merck Manual Professional Editorial Board. (2023). Adenoid disorders. In Merck Manual Professional Version.
• All content on this page has been reviewed by a medical professional.