Adenoid Hypertrophy: Snoring, Sleep Apnea & Treatment for Kids

• Adenoid hypertrophy is often identified by symptoms such as nasal congestion and snoring, and is most commonly seen in children aged 3–6 years. 
• Severe adenoid hypertrophy may obstruct the upper airway, causing sleep apnea, oxygen deprivation, and, in extreme cases, life-threatening complications.
• Adenoidectomy can improve sleep apnea symptoms by up to 85%.

The adenoid gland is a lymphatic tissue located at the back of the nasal cavity above the tonsils and is not visible through the mouth. As part of the immune system, it traps bacteria and viruses entering the upper respiratory tract. During infections, the adenoids become swollen and inflamed, indicating an underlying health issue. Adenoid hypertrophy—or enlarged adenoids—is most commonly seen in children aged 3–6 years, and is associated with snoring in 7% of cases and sleep apnea in 2%.
The adenoid gland plays a protective role in childhood, primarily between the ages of 2 and 12. As children grow older, the gland gradually regresses and has no significant role in preventing infections during adulthood.

Enlargement of the adenoids is caused by bacterial or viral infections entering through the nose, and is a natural immune response to prevent infection. Once the infection subsides, the adenoids typically shrink back to their normal size. However, in some children the adenoids remain swollen even after the infection has cleared. Conditions such as allergies, chronic sinusitis or recurrent colds may also contribute to persistent adenoid hypertrophy.

• Misaligned jawline due to continuous mouth breathing.
• Middle ear infections caused by enlarged adenoids obstructing airflow to and from the middle ear, leading to fluid buildup, hearing difficulties and speech problems.
• Sleep apnea, due to enlarged adenoids blocking the upper airway, causing breathing interruptions during sleep.
• Negative impacts on physical development, cognitive abilities, and emotional well-being resulting from disrupted sleep.
• Adenoid tissue can become a reservoir for harboring pathogens, resulting in chronic colds and recurrent respiratory infections.

Adenoid hypertrophy affects the upper respiratory system, with noticeable symptoms primarily presenting at night. The two key symptoms are nasal congestion and snoring, but other symptoms may include:

• Restless sleep
• Sleep apnea
• Sore throat
• Difficulty swallowing
• Swollen lymph nodes in the neck
• Middle ear infections, causing muffled hearing or hearing loss
• Mouth breathing, leading to dry, cracked lips and bad breath
• Chronic nasal congestion and persistent runny nose

Adenoid hypertrophy is a common cause of snoring in children, which can disrupt sleep quality, leading to developmental issues including attention deficit disorders. Enlarged adenoids, especially in children with small upper airways, can obstruct the airway, causing sleep apnea, oxygen deprivation, and in severe cases, life-threatening complications.
If left untreated, snoring caused by adenoid hypertrophy can slow development due to oxygen deprivation during sleep, affecting brain and nervous system function. This can result in poor academic performance, hyperactivity, and even facial structure abnormalities from habitual mouth breathing. Adenoid hypertrophy also disrupts normal sleep, leaving children with insufficient rest, which can lead to complications such as hyperactivity, delayed growth, bedwetting in older children, and, in severe cases, heart failure due to repeated oxygen deprivation during sleep.

For these reasons, if your child snores, do not dismiss it as normal. Consult a doctor promptly for diagnosis and appropriate treatment to prevent potential long-term complications.

The doctor will begin by reviewing the patient’s medical history and symptoms. If abnormalities are suspected, additional tests may be conducted, such as neck X-rays to assess the size of the adenoids and blood tests to check for infections. In severe cases, a sleep test may be recommended, which involves an overnight stay in a hospital to monitor various body functions, such as breathing, brain waves, heart rhythms, chest movement, oxygen levels and carbon dioxide levels.

Treatment varies depending on the underlying cause, as follows:

• Allergies: Avoid allergens and use nasal sprays to reduce swelling.
• Infections: Antibiotics are prescribed to treat bacterial infections.
• Surgery: If medication is ineffective and symptoms persist, such as snoring and frequent illnesses, adenoidectomy may be recommended. Studies confirm that adenoid removal does not weaken the immune system and improves sleep apnea symptoms in 85% of cases. Adenoidectomy is performed through the mouth, leaving no external scars.

• The doctor will ensure the child is healthy enough for surgery and evaluate any surgical risks.
• The child must fast (no food or drink) for 8 hours before surgery, which is typically scheduled in the morning to minimize hunger discomfort.

• Avoid excessively spicy or hot foods for one week.
• Maintain oral hygiene by brushing teeth regularly.
• Avoid swimming for at least three weeks.
• Keep the child out of school for about one week.
• While complications are rare, there is a slight risk of infection or post-operative bleeding. Caregivers should ensure the child takes prescribed medications and follows medical advice.

Patients typically recover and experience significant improvement within 2–3 weeks after surgery.

Adenoid hypertrophy is common in children and often cannot be entirely prevented, but the condition typically improves or resolves as the child grows older. If parents are concerned, they should consult a doctor early when symptoms first appear. Medical advice can help effectively manage and control the condition.

Adenoid hypertrophy is frequently seen in children, often presenting with symptoms such as nasal congestion and runny nose, resembling allergies, along with snoring, the latter of which is an important warning sign. Parents should monitor their child closely and, if snoring is frequent or accompanied by sleep apnea, seek prompt medical attention to identify the cause and initiate timely treatment.