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The adenoids are a mass of lymphoid tissue which sit at the back of the nose and above the palate. They form part of Waldeyers Ring which is a ring of lymphoid tissue including the adenoids and tonsils which fight the viruses and bacteria and other foreign bodies such as dust mite and pollens coming in through the nose or mouth to the lungs. The adenoids may enlarge in response to infection and may become chronically infected (Adenoiditis) which may lead to chronic infected discharge from the nose or recurrent ear infections or even sinusitis.

The enlarged adenoids that are due to an allergic response may cause significant upper airway obstruction and features of Obstructive Sleep Disorder ( see Obstructive Sleep Disorders). The adenoids may be enlarged in children as young as 3-6 months sometimes in association with enlarged tonsils. Adenoid enlargement leads to snoring, mouth breathing, struggling to breathe and occasional obstructive apnoea. Enlarged adenoids may be not particularly symptomatic but may lead to chronic mouth breathing and abnormal growth of the face and jaws and significant orthodontic problems often known as the “adenoid face”.

The adenoids can be assessed first by the history then by examination either with a mirror in the older child or in the younger child using a fibreoptic scope through the nose or occasionally viewing an x-ray of the adenoids. We examine the soft palate carefully to ensure the child does not have a hidden cleft palate which may show by a bifid or two part uvula, which is the part of the soft palate that dangles in the middle at the back of the throat. Removal of the adenoid should only be done by experienced ENT surgeons who can perform partial adenoidectomy which usually prevents voice problems in children with palate abnormalities and airway obstruction.

There is no evidence to show that removal of the adenoids by themselves or even the tonsils and adenoids have any significant effect on the immune system of children.

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