Adenoid Hypertrophy in Children

Adenoid hypertrophy in children is the enlargement of the adenoids in the nasopharynx, which can obstruct nasal breathing, predispose to ear infections, and interfere with sleep and a child’s development.

Early evaluation and individualized management with an otolaryngologist (ENT) prevent complications and restore the child’s quality of life.

What is it?

The adenoids are lymphatic tissues located behind the nose that grow mainly during childhood and, when enlarged, can block the passage of air, promote snoring and sleep apnea, and also alter middle-ear ventilation. The volume is usually greatest between the preschool stage and the early school years and tends to regress in adolescence, although the intensity of symptoms varies according to the child and the relative size of the airway.

Symptoms and signs

• Chronic mouth breathing, habitual snoring, and breathing pauses during sleep, frequently with restless sleep or awakenings.
• Persistent nasal obstruction and a nasal (hyponasal) voice with “muffled” speech.
• Recurrent otitis media or fluid in the middle ear with possible conductive hearing loss and difficulty concentrating at school.
• Halitosis, recurrent rhinosinusitis and, in some cases, nasal bleeding.
• Dentofacial changes from chronic mouth breathing, such as open bite and a protruding dental arch, especially when the problem is prolonged.

Complications

Chronic obstruction can progress to sleep-disordered breathing, including obstructive apnea, with an impact on the child’s behavior, learning, and quality of life.

Persistence of the condition increases the chance of otitis media with effusion, recurrent ear infections, and sinusitis, as well as changes in speech and vocal resonance. In severe and prolonged situations, there is a risk of cardiopulmonary repercussions associated with upper airway obstruction.

Prevalence

Adenoid hypertrophy is common in childhood, a period in which the adenoids are naturally larger and clinically relevant. Population studies show a prevalence that varies depending on the diagnostic method and the age group, and observe that development peaks at preschool ages with a gradual decline in adolescence, which explains why some cases improve with growth.

Diagnosis

The diagnosis is clinical and endoscopic: flexible nasofibrolaryngoscopy in the office is the standard for directly visualizing the adenoid and grading the obstruction. A lateral neck radiograph may be considered when the child does not tolerate the endoscopic examination, although it has limitations compared with direct visualization.

When sleep apnea is suspected, a sleep study helps in stratifying severity and in the therapeutic decision, especially when the symptoms are disproportionate to the local finding.

Treatment

Clinical measures include nasal hygiene with saline solution, allergy control, and intranasal corticosteroids, which can improve symptoms and reduce adenoid volume in some cases.

In selected situations, antileukotrienes such as montelukast may reduce symptoms and adenoid size, especially in mild cases of sleep-disordered breathing, always under medical guidance.

Antibiotics have a role only when there is an associated bacterial infection and are not useful for isolated hypertrophy.

When there is significant nasal obstruction, sleep-disordered breathing, persistent otitis media with effusion, or refractory chronic rhinosinusitis, an adenoidectomy is indicated, either alone or combined with tonsillectomy according to the assessment of the adenotonsillar complex. The adenoidectomy is performed on a day-hospital basis, with a short recovery, and complications such as bleeding and velopharyngeal insufficiency are rare and, when they occur, generally transient.

When to seek care?

If the child habitually snores, breathes through the mouth, has breathing pauses, restless sleep, declining school performance, recurrent otitis, or hearing difficulty, evaluation with an otolaryngologist (ENT) is recommended. The endoscopic examination in the office makes it possible to confirm the diagnosis and discuss, with the family, the best therapeutic path for each case.

Specialized care

Care with an otolaryngologist (ENT) experienced in adenoid hypertrophy and sleep disorders in children ensures an accurate diagnosis, careful clinical management, and a surgical indication only when truly necessary. At the office of Dr. José Eduardo Marcondes, the evaluation ranges from clinical measures to surgeries such as adenotonsillectomy when indicated, with a focus on the child’s safety, comfort, and functional recovery.

For families in São Paulo and the surrounding region, there are units in Alphaville, on Faria Lima, and in Morumbi, facilitating access to a complete and humanized evaluation.