From the Guidelines
Adenoidectomy is recommended for children with otitis media with effusion (OME) who are 4 years old or older, or for those with a distinct indication such as nasal obstruction, chronic adenoiditis, or chronic sinusitis, as it confers a 50% reduction in the need for future operations. Adenoids are lymphoid tissue located at the back of the nasal cavity that help fight infections by trapping germs that enter through the nose. They're part of the immune system and are largest in children, typically shrinking by adolescence. When adenoids become enlarged or infected (adenoiditis), they can cause symptoms like persistent nasal congestion, mouth breathing, snoring, sleep apnea, recurrent ear infections, and a nasal-sounding voice.
Treatment Options
- Mild cases may resolve with watchful waiting or antibiotics like amoxicillin (40-90 mg/kg/day divided twice daily for 10 days) for bacterial infections, as suggested by 1.
- For persistent or severe cases, surgical removal (adenoidectomy) may be recommended, especially when enlarged adenoids cause chronic breathing difficulties, recurrent infections, or affect hearing, as recommended by 1.
- Recovery from adenoidectomy typically takes 7-10 days, with most children experiencing significant symptom improvement afterward.
- Since adenoids naturally shrink with age, intervention is more common in children than adults, and the decision for surgery should balance the frequency and severity of symptoms against the risks of the procedure, as noted in 1.
Key Considerations
- The American Academy of Otolaryngology-Head and Neck Surgery recommends tympanostomy tubes, adenoidectomy, or both when surgery is performed for OME in a child 4 years old or older, as stated in 1.
- Adenoidectomy is not recommended for initial OME surgery unless a distinct indication exists, such as adenoiditis, postnasal obstruction, or chronic sinusitis, as suggested by 1.
- The benefit of adenoidectomy is apparent at age 2 years, greatest for children aged 3 years or older, and independent of adenoid size, as noted in 1.
From the Research
Adenoid Function and Location
- Adenoids are a secondary lymphoid organ located in the nasopharynx, playing a crucial role in the host defense of the upper respiratory tract 2.
- They are strategically located for mediating local and regional immune functions, exposed to antigens from both the outside air and the alimentary tract 3.
Adenoid Hypertrophy and Symptoms
- Adenoidal hypertrophy is a common condition in children, causing symptoms such as mouth breathing, nasal discharge, snoring, sleep apnea, and hyponasal speech 2.
- It also plays a role in the pathogenesis of rhinosinusitis, recurrent otitis media, and otitis media with effusion 2.
Treatment and Surgery
- Adenoidectomy is one of the most commonly performed pediatric surgical procedures worldwide, with indications including recurrent upper respiratory infections, otitis media with effusion, and obstructive sleep apnea syndrome 2.
- Non-surgical treatments, such as intranasal steroids, are also used in the treatment of adenoid hypertrophy 2.
- The effectiveness of adenoidectomy on respiratory symptoms in pediatric patients with allergic rhinitis is limited, with a significant percentage of children not presenting satisfactory benefits from surgery 4.
Immunological Consequences
- The possible immunological effects of adenoidectomy are still controversial, with some authors finding changes in immunoglobulin levels after surgery, while others failed to find significant changes 5.
- Tonsillectomy and adenoidectomy may lead to certain changes in the cellular and humoral immune system, but these alterations are clinically insignificant and no increased frequency of immunomodulated diseases should be expected 5.