What is adenoid hypertrophy? 

Adenoid hypertrophy is the growth of the adenoid tonsil and this condition can occur with or without an acute or chronic infection of the adenoids They can obstruct enough airflow so breathing through the nose requires an uncomfortable effort and inhalation occurs through an open mouth. It also affects the voice as well as hearing. 

Who is at risk? 

Adenoid hypertrophy is a childhood disease. Adenoids are present at birth and grow to their largest size between the ages of 3 and 5 and begin to shrink around the age of 7 or 8 and are usually almost gone by adulthood. 

What are the causes of adenoid hypertrophy? 

Following are some of the causes responsible for the hypertrophy of adenoids- 

• Viral infections – The adenoids are lymphoid tissues located in the upper airway, and their primary function is to help the immune system by trapping the foreign substances. When a viral infection occurs, the immune system responds, which can lead to inflammation and swelling of the adenoids. 
• Recurrent allergies – Recurrent infections contribute significantly to adenoid hypertrophy by causing ongoing inflammation by causing ongoing inflammation, increasing lymphoid tissue proliferation, and leading to chronic swelling. 

• Allergens/Irritants – Allergens trigger an immune response that causes inflammation in the nasal passages and throat. This ongoing inflammation can extend to the adenoids, causing them to become swollen and enlarged over time. 

• Gastroesophageal Reflux – Acid reflux reaching the throat and nasal passages can cause chronic irritation and inflammation. The adenoids located at the back of the nasal cavity, can become inflamed due to exposure to the acid reflux. 

• Children under 5 years – In young children, the immune system is still developing. As a result, the adenoids may become enlarged in response to infections or allergens. Overtime, they typically shrink as the child grows older, especially after the age of 5. 

• Frequent nosebleeds – Nosebleeds do not directly cause adenoids hypertrophy, they may be a symptom of underlying issues like nasal congestion, infections, or inflammation, which could contribute adenoids enlargement. 

What are the functions of adenoids? 

Adenoids are a patch of tissue that is high up in the throat, just behind the nose. They, along with the tonsils, are part of the lymphatic system.  

Adenoids are made of lymphoid tissue which consists of connective tissue and white blood cells, especially lymphocytes. Adenoids help to fight infections in the body as they produce antibodies or white blood cells. 

They generally shrink during adolescence and disappear by adulthood. 

What are the signs and symptoms of adenoid hypertrophy? 

Although lymphoid tissue acts to fight infections, but sometimes bacteria and viruses can lodge within it and survive. Very large adenoids will block air passage in both the nose and the ears. This obstruction of normal air ventilation can lead to both sinusitis and otitis media. 

Other symptoms seen in adenoid hypertrophy are- 

• Bad breath – It can occur due to mouth breathing. Mouth breathing tends to dry out the mouth, reducing saliva production, which is important for cleaning the mouth and neutralizing odors. 

• Dry mouth – Enlarged adenoids can block the nasal airways, leading to chronic mouth breathing. 

• Frequent ear infections – When the adenoids become enlarged, they can obstruct the eustachian tubes, leading to a variety of issues including frequent ear infections. 

• Cracked lips – It can occur due to several factors like mouth breathing, dry mouth, and post-nasal drip. 

• Sleep apnea – When the adenoids become enlarged, they can obstruct the airway, particularly the upper airway, which includes the throat and nasal passages. This obstruction makes it difficult for air to flow freely during sleep. 

• Mouth breathing, difficult breathing – The adenoids are located in the back of the nasal cavity, and when they become enlarged, they can block the airflow through the nose, leading to mouth breathing to get enough air. 

• Runny nose or nasal congestion – Enlarged adenoids can obstruct the nasal passages, making it difficult for air to flow freely through the nose. This can result in production of excess mucous as the body tries to clear the blockage, leading to a runny nose. 

• Snoring – Snoring is a common symptom of enlarged adenoids, especially in children, and it occurs due to the blockage or narrowing of the airway caused by the enlarged adenoids. 

• Restlessness while sleeping – The discomfort caused by the enlarged adenoids, which obstruct the airway and cause difficulty breathing, often leads to disrupt or poor-quality sleep. 

How can we diagnose this condition? 

• X-ray (side view of the throat) – For adenoids hypertrophy, a lateral X-ray is typically done. In this X-ray, the adenoids appear as a soft tissue mass at the back of the nasal cavity. 

• Sleep apnea studies (severe cases only) – Enlarged adenoids can lead to obstructive sleep apnea (OSA), as they can block the airway, particularly during sleep when the muscles of the throat relax. Sleep apnea studies for adenoid hypertrophy includes – 

• Polysomnography – it includes an overnight sleep study where various parameters such as brain activity, heart rate, respiratory effort, and oxygen levels are monitored.  

• Home Sleep Apnea Testing – It’s less comprehensive than a full PSG, but it can still provide valuable information about breathing patterns during sleep, hear rate, and oxygen saturation.  

• Clinical evaluation – Physical examination by an ENT specialist can reveal signs of adenoid hypertrophy. 

• Imaging studies – while not primarily used for diagnosing sleep apnea, imaging studies can assess the size of the adenoids. 

• Medical history – Physicians may take a complete medical history to focus on the symptoms related to the upper respiratory system, sleep disturbances, recurrent infections, and any related complications.  

• Physical examination – The examination should focus on identifying symptoms related to nasal obstruction, sleep disturbances, and any other signs of related conditions.  

• General inspection – Look for signs of respiratory distress, such as nasal flaring, chest retractions, or mouth breathing.  

• Head and neck examination – Inspect for nasal obstruction, mouth breathing (signs of dry mouth or bad breathing), examine the back of the throat for redness, inflammation, or tonsil enlargement. 

• ENT – Check for signs of otitis media, such as fluid in the ear or redness of the eardrum. Look for tonsil hypertrophy and assess whether both adenoids and tonsils are contributing to airway obstruction. 

• Throat culture – It can be helpful in specific situations where there is suspicion of a bacterial infection in the throat that could be associated with or aggravated by adenoid hypertrophy. 

• Blood test – Blood tests may be ordered if there are concerns about chronic infections, underlying systemic conditions, or complication related to adenoids hypertrophy. 

• Streptococcal test – it is not used to directly diagnose adenoid hypertrophy, but it may be relevant if there are concerns about bacterial throat infections. 

• Nasal endoscopy – It involves the use of a flexible or rigid endoscope to directly visualize the structures inside the nasal passages and nasopharynx. 

Is the removal of adenoids safe? 

Yes, adenoid removal is a safe process. Removal of adenoids is only done if enlarged adenoids are causing breathing issues, swallowing difficulty or recurrent ear infections. 

However, rarely certain complications like bleeding, infection, and voice change might be seen. 

Do adenoids affect speech? 

Yes, enlarged adenoids can cause both resonance and speech issues. 

Adenoids play an important role in the speech development of children, up to puberty. 

Can adenoids affect hearing? 

Yes, adenoids affect the hearing especially if repeated infections occur which can lead to sinus and ear infections. Badly swollen adenoids can sometimes lead to infections or middle ear fluid causing a temporary hearing loss. 

What are the complications of adenoid hypertrophy? 

Certain common complications seen in cases of adenoid hypertrophy are- 

• Chronic ear infections – When the adenoids become enlarged, they can obstruct the eustachian tubes, leading to a variety of issues including frequent ear infections. 

• Sleep apnea – Enlarged adenoids can lead to obstructive sleep apnea (OSA), as they can block the airway, particularly during sleep when the muscles of the throat relax. 

• Pulmonary hypertension – If adenoid hypertrophy leads to severe, prolonged upper airway obstruction, it can result in secondary complications like respiratory distress or altered blood flow, potentially influencing pulmonary pressure. 

• Right-sided heart failure – It is not a typical or direct complication of adenoid hypertrophy. However, in severe cases, chronic upper airway obstruction due to adenoid hypertrophy could potentially lead to secondary issues that might affect heart function e.g.: 

• Chronic hypoxia – Prolonged difficulty in breathing and reduced oxygen levels can place a strain on the heart, particularly the right side, which pumps blood to the lungs. This strain may eventually contribute to right-sided heart failure if untreated. 

• Pulmonary hypertension – As a result of chronic hypoxia, pulmonary hypertension can develop. Over time, the increased workload on the right side of the heart can lead to right-sided heart failure. 

• Voice changes – Voice changes can be a complication of adenoid hypertrophy, particularly if the enlarged adenoids cause significant obstruction or impact the airway. In some cases, if the obstruction is severe enough, it can lead to changes in vocal quality, making the voice sound strained, hoarse, or weak. 

What is the relationship between adrenal hypertrophy and aldosterone production? 

In some cases, adrenal hypertrophy may be associated with hyperaldosteronism, where the adrenal glands produce too much aldosterone, a hormone that regulates sodium and potassium balance. Primary hyperaldosteronism (e.g. Conn’s syndrome) can sometimes cause adrenal enlargement.  

How does adenoid hypertrophy relate to Cushing’s syndrome? 

Adrenal hypertrophy can be a direct consequence of Cushing’s syndrome, a condition characterized by prolonged exposure to high levels of cortisol. In Cushing’s syndrome, there is often overproduction of cortisol either due to an ACTH-secreting tumor or an adrenal tumor. This results in adrenal gland enlargement, or hypertrophy, as the glands work to produce more cortisol. 

Can adenoid hypertrophy be mistaken for other conditions? 

Yes, adrenal hypertrophy can sometimes be mistaken for other conditions due to overlapping symptoms, such as: 

Pituitary tumors – These can also cause hormone imbalances like  

those seen in Cushing’s disease and may lead to adrenal hypertrophy. 

PCOS – Women with PCOS may have hormonal imbalances that could overlap with symptoms seen in adrenal disorders. 

Thyroid disorders – Symptoms like weight changes, fatigue, and hypertension can also occur in thyroid dysfunction, leading to confusion in diagnosis. 

What is the role of adrenal hypertrophy in congenital adrenal hyperplasia? 

Congenital adrenal hyperplasia is a group of genetic disorders affecting the adrenal glands, often leading to increase in gland size. In CAH, there is deficiency of enzymes that are necessary for cortisol production. This causes the adrenal glands to become enlarged as they attempt to compensate by producing more of the precursor hormones, which may lead to an overproduction of androgens, resulting in symptoms like abnormal hair growth and menstrual irregularities. 

Can adrenal hypertrophy occur without any noticeable symptoms? 

Yes, in some cases adrenal hypertrophy may occur without obvious symptoms, particularly if the condition is mild or develops slowly. In such cases, if the hormonal balance is not significantly disturbed, the condition may not require immediate treatment, but regular monitoring would be recommended. 

Can stress contribute to adrenal hypertrophy? 

Yes, chronic stress can contribute to adrenal hypertrophy over time. Your body produces higher levels of cortisol in stress that can lead to glandular enlargement, especially if the stress is chronic or overwhelming. 

What is the homoeopathic treatment for adenoid hypertrophy? 

• Sanguinaria- Hypertrophy of adenoids with Offensive breath and purulent expectoration. The patient complains of Dry and constricted feeling in the throat. Difficult breathing through the nose, leading to mouth breathing. Snoring due to airways obstructions. Sleep disruptions due to breathing difficulty. 

• Tuberculinum- It is commonly indicated for people who are prone to frequent respiratory infections like colds, sinusitis, or ear infections, which can be exacerbated by enlarged adenoids. It is a suitable medicine for adenoids with increased sensitivity to cold. The patient complains of a hard, dry cough with thick, easy and profuse expectoration during sleep.  

• Baryta carb- One of the key indications for Baryta carb is enlarged tonsils and adenoids, especially in children. It helps with chronic enlargement and inflammation in these areas, which can lead to dysphagia, snoring, and nasal congestion. It is helpful in cases of adenoids with tonsillitis where shooting pain as of excoriation, in the throat is felt worse during deglutition.  

• Cistus Canadensis- Suited to cases of adenoid enlargement with Swelling and suppuration of glands of the throat along with tonsillitis. It may be indicated for individuals who have a persistent cough or nasal congestion, often accompanied by thick mucus or a feeling of tightness in the chest. It is used for sinus congestion, sinusitis, and conditions where there is thick, yellowish discharge from the nose. 

• Calcarea carb- Medicine for children with hypertrophies adenoids and excessive sweating on the head. These cases often show a tendency for fat deposition. Calc carb is often used for individuals who are prone to frequent colds, sinus infections, and respiratory issues such as asthma or bronchitis. Individuals who feel chilly or have a strong sensitivity to cold may benefit from this remedy.