The adenoids are small patches of lymphoid tissue situated in the upper throat (nasopharynx), just behind the nasal cavity. As part of the immune system, their function is to trap airborne pathogens—bacteria and viruses—that enter the body through the nose. While they are most active in childhood and typically shrink or disappear by adolescence, the tissue can persist or re-enlarge in adults. This is a less common but significant medical concern.
Recognizing the Signs of Enlargement
Enlarged adenoids in adults often manifest as symptoms related to chronic upper airway obstruction. A persistent, stuffy nose, or chronic nasal obstruction, is one of the most frequent complaints, leading to difficulty breathing through the nose. This blockage often forces individuals to breathe through their mouth, especially while sleeping, which can result in a dry mouth, chapped lips, and a sore throat upon waking.
The obstruction can also affect sleep quality, contributing to loud snoring and symptoms of sleep-disordered breathing, such as obstructive sleep apnea. Because of their location near the opening of the Eustachian tubes, enlarged adenoids may impair middle ear function, sometimes causing a feeling of blocked ears, recurrent ear infections, or fluid buildup. The blockage of the nasal passage can also alter the resonance of the voice, sometimes leading to a characteristic “hyponasal” or “blocked nose” sound.
Clinical Methods for Diagnosis
Diagnosis typically begins with an Ear, Nose, and Throat (ENT) specialist reviewing the patient’s symptoms and conducting a head and neck examination. Unlike the tonsils, adenoids are not directly visible by looking into the mouth because they are located high in the nasopharynx. Therefore, a specialized method is required to accurately assess the tissue.
The gold standard for diagnosing adult adenoid hypertrophy is Nasal Endoscopy. This involves gently inserting a thin, flexible fiberoptic scope through the nose. This procedure allows the physician to directly visualize the size of the adenoid tissue and determine the degree to which it is blocking the nasal airway and the Eustachian tube openings. The endoscopic view provides a clear, real-time assessment of the adenoid’s size and surface characteristics, which is essential for guiding treatment decisions.
Imaging techniques often complement endoscopic findings, assessing surrounding structures and ruling out other causes of obstruction. A lateral neck X-ray provides a quick, simple assessment of the soft tissue shadow in the nasopharynx, indicating adenoid size. More detailed imaging, such as a Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI), may be ordered, especially in adult patients, to evaluate the extent of the enlargement and screen for underlying masses or pathology. The diagnostic process also excludes other conditions that mimic adenoid hypertrophy, such as chronic rhinosinusitis or tumors.
Why Adenoids Enlarge in Adults
Adult adenoid enlargement is often a reactive process, differing from the physiological growth seen in children. Common underlying causes include chronic or recurrent infections and persistent inflammatory states. Exposure to environmental irritants, such as air pollution and tobacco smoke, can contribute to chronic inflammation that triggers the lymphoid tissue to re-enlarge.
Chronic allergic rhinitis is a frequent factor, as the long-term inflammatory response to allergens causes the adenoidal tissue to remain swollen. In adults, adenoid enlargement must be taken seriously to exclude neoplastic processes. Although rare, conditions like sinonasal carcinoma, lymphoma, or HIV infection can cause lymphoid hyperplasia in the nasopharynx, requiring a thorough diagnostic workup to rule out these serious diagnoses.
Options for Treatment
Management of enlarged adenoids follows two main pathways: medical and surgical, depending on symptom severity and the underlying cause. For mild to moderate cases, medical management is typically the first step, aiming to reduce inflammation and treat any underlying infection or allergy. A trial of intranasal corticosteroids, often lasting four to six weeks, is a common first-line treatment to decrease the size of the inflamed tissue.
If an infection is suspected, appropriate antibiotics may be prescribed, and antihistamines or leukotriene receptor antagonists can be used if the enlargement is linked to chronic allergies. When symptoms are severe, medical therapy has failed, or if the enlargement is causing complications like obstructive sleep apnea or chronic ear issues, surgical removal, known as adenoidectomy, is often recommended. Endoscopic adenoidectomy is the preferred surgical technique in adults, providing better visualization for complete and precise removal of the persistent tissue.