Often, tonsils and adenoids are surgically removed at the same time. Although you can see your tonsils by taking a mirror and looking in your throat, adenoids aren't directly visible. Doctors use a special scope to get a peek at the adenoids, and sometimes will order a head X-ray for a better idea of their size.

So, what are adenoids exactly? They're a mass of tissue, located in the passage that connects the back of the nasal cavity to the throat. Adenoids — which are different from the tonsils — filter out bacteria and viruses entering through the nose and produce antibodies to help the body fight infections.

Adenoids begin to shrink after about 5 years of age. They often practically disappear by the time you're a teen.

What Are the Symptoms of Enlarged Adenoids?

Because adenoids trap germs that enter the body, adenoid tissue sometimes temporarily swells as it tries to fight off an infection.

Symptoms associated with enlarged adenoids include:

• difficulty breathing through the nose
• breathing through the mouth
• talking as if the nostrils are pinched
• breathing noisily
• snoring
• stopping breathing for a few seconds while sleeping (called sleep apnea)
• ear infections or middle ear fluid that might make ear tube surgery necessary

If your doctor thinks you have enlarged adenoids, he or she might:

• ask you how things feel in your ears, nose, and throat, and then examine these areas
• feel your neck near your jaw

To get a really close look at things, your doctor might want to take one or more X-rays. If an infection is suspected, your doctor may prescribe oral antibiotics.

When Is Surgery Necessary?

A doctor may recommend surgical removal of enlarged or infected adenoids if they're bothersome and medicine is not controlling the problem (this procedure is called an adenoidectomy).

Surgery may be recommended if a person experiences one or more of the following:

• difficulty breathing
• sleep apnea
• recurrent infections
• the need for ear tubes

Having adenoids removed is especially important when repeated infections lead to sinus and ear infections. Badly swollen adenoids can interfere with the ability of the body to ventilate the middle ears. This can sometimes lead to infections or temporary hearing loss. Therefore, people whose infected adenoids cause frequent earaches and fluid buildup may need to get an adenoidectomy at the same time as ear tube surgery.

And although adenoids can be taken out without the tonsils, if someone has tonsil problems, the tonsils may need to be removed at the same time.

What Happens During the Surgery?

During an adenoidectomy:

• The patient receives general anesthesia. This means the surgery will be performed in an operating room and monitored by a CRNA (certified registered nurse anesthetist) or an anesthesiologist (a doctor who specialize in administering drugs to patients) during surgery.
• The patient will be asleep for about 20 minutes.
• The surgeon can get to the adenoids (and tonsils if needed) through the patient 's open mouth — there's no need to cut any skin.
• The surgeon removes the tonsils and/or the adenoids and then cauterizes (or seals) the blood vessels.

After an adenoidectomy, the patient will wake up in the recovery area. In most cases, the total time in the hospital is less than 5 hours. However, patients who have trouble breathing or show signs of bleeding will return immediately to the operating room. Young children, overweight children, and those with chronic disease such as seizure disorders or cerebral palsy, may need to stay overnight for observation.

After Surgery

The typical recuperation after a tonsillectomy and/or an adenoidectomy often involves several days of pain and discomfort.

In less than a week after surgery, everything should return to normal. The cut area will be left to heal naturally, which means there are no stitches to worry about. There's a small chance any tissue that's left behind can swell, but it rarely causes new problems.

After surgery, symptoms typically disappear immediately unless there's a lot of swelling that could temporarily cause some symptoms to recur.

Understanding Enlarged Adenoids

It's important to remember that enlarged adenoids are normal in some people. If the adenoids aren't infected, a doctor may choose to wait to operate because the adenoids may eventually shrink on their own.

Reviewed by: Steven P. Cook, MD
Date reviewed: November 2010
Originally reviewed by: Aaron S. Chidekel, MD