Adenoid Hypertrophy Treatment in Sydney

Adenoid hypertrophy, commonly referred to as enlarged adenoids, is one of the most frequent paediatric ENT conditions. The adenoids are a mass of lymphoid tissue located at the back of the nasal cavity, where the nose meets the throat. When they become excessively enlarged, they can block nasal breathing, cause snoring and sleep apnoea, and contribute to recurrent ear infections and glue ear. Adenoidectomy (surgical removal) is a safe and effective treatment that provides lasting relief.

Symptoms of Enlarged Adenoids

Because the adenoids sit at the crossroads of the nasal airway and the Eustachian tube openings, their enlargement can cause a wide range of symptoms:

• Persistent mouth breathing, particularly noticeable during sleep
• Snoring, noisy breathing, and restless sleep
• Obstructive sleep apnoea: pauses in breathing during sleep, often followed by gasping or choking
• A constantly blocked or runny nose despite no active cold
• Nasal voice quality (hyponasality: sounding like speaking with a blocked nose)
• Recurrent middle ear infections (acute otitis media)
• Glue ear (otitis media with effusion) causing hearing difficulties
• Recurrent sinusitis
• Bad breath (halitosis) from chronic mouth breathing and post-nasal drip
• Dry lips and dental changes from prolonged mouth breathing (adenoid facies)

In severe cases, chronic nasal obstruction from enlarged adenoids can affect facial development, school performance (due to poor sleep quality and hearing loss), and overall quality of life.

Causes and Risk Factors

Adenoid enlargement is a normal part of childhood immune development but becomes problematic when the tissue grows large enough to cause obstruction:

• Age: adenoids are largest between ages 2 and 7, coinciding with peak exposure to new infections in childcare and early school settings
• Recurrent upper respiratory infections: repeated viral and bacterial infections stimulate adenoid growth
• Allergic rhinitis: chronic allergic inflammation can contribute to adenoid enlargement
• Gastro-oesophageal reflux: acid reaching the nasopharynx may stimulate adenoid tissue
• Environmental factors: exposure to cigarette smoke, air pollution, and crowded childcare environments
• Genetics: some children are predisposed to larger lymphoid tissue

Adenoids normally begin to shrink from around age 7 to 8, and are usually vestigial by adolescence. However, in some children the obstruction is significant enough to warrant intervention before natural regression occurs.

Diagnosis

At Central Sydney ENT, our paediatric ENT specialists assess enlarged adenoids using:

Clinical history: A detailed history of your child's breathing, sleep quality, snoring pattern, ear infections, and nasal symptoms. Parents are often asked to provide a video recording of their child sleeping to document snoring and breathing pauses.

Flexible nasendoscopy: A thin, flexible camera is gently passed through one nostril to directly visualise the adenoids and assess the degree of obstruction. This is a brief, well-tolerated examination that provides the most accurate assessment of adenoid size.

Lateral neck X-ray: An X-ray of the nasopharynx can show the size of the adenoid pad relative to the airway. While less precise than nasendoscopy, it is sometimes used as an initial screening tool, particularly in young children who may not tolerate endoscopy.

Hearing assessment: A hearing test (audiometry) and tympanometry are performed to assess whether the enlarged adenoids have caused glue ear or conductive hearing loss.

Sleep study: In children with suspected obstructive sleep apnoea, a sleep study (polysomnography) may be recommended to document the severity of airway obstruction during sleep.

Treatment Options

Watchful Waiting

In mild cases, particularly in older children approaching the age when adenoids naturally shrink, a period of observation may be appropriate. Regular review ensures that symptoms are monitored and intervention is offered if they worsen.

Medical Management

Intranasal corticosteroid sprays (such as mometasone) can reduce adenoid inflammation and may provide temporary relief of nasal obstruction. They are most useful for mild to moderate enlargement and as a bridge while awaiting surgery. Antihistamines may be added if allergic rhinitis is a contributing factor.

Adenoidectomy

Adenoidectomy is the definitive treatment for significant adenoid hypertrophy. It is one of the most commonly performed paediatric ENT procedures in Australia and has an excellent safety profile.

The operation is performed under general anaesthesia through the mouth: there are no external incisions or visible scars. The adenoid tissue is removed using a curette, suction diathermy, or powered microdebrider. The procedure takes approximately 15 to 30 minutes.

Recovery is typically rapid, with most children returning to normal activities within 2 to 3 days. Post-operative pain is usually mild and managed with paracetamol. Children generally go home the same day.

Combined Adenotonsillectomy

When enlarged adenoids coexist with enlarged tonsils, as is common in children with obstructive sleep apnoea or recurrent tonsillitis, both are often removed in a single operation (adenotonsillectomy). This addresses both sources of upper airway obstruction simultaneously.

Adenoidectomy with Grommets

For children with enlarged adenoids and concurrent glue ear, adenoidectomy is frequently performed alongside insertion of ventilation tubes (grommets) into the eardrums. The grommets allow fluid to drain from the middle ear and restore hearing, while removing the adenoids prevents recurrence by opening the Eustachian tube pathways.

Our paediatric ENT surgeons, including Dr Alexander Zhang, Dr Arjuna Ananda, Dr Jareen Ebenezer, have extensive experience in adenoidectomy and paediatric airway management across seven Sydney locations.

When to See an ENT Specialist

You should seek a referral to a paediatric ENT specialist if your child:

• Snores regularly or has noisy breathing during sleep
• Breathes through their mouth most of the time, day and night
• Has pauses in breathing during sleep (observed apnoeas)
• Experiences recurrent ear infections or has been diagnosed with glue ear
• Has persistent nasal congestion that does not respond to treatment
• Shows signs of daytime tiredness, behavioural changes, or poor concentration at school

Related Conditions

Adenoid hypertrophy is closely linked to several other conditions treated at Central Sydney ENT:

• Tonsillitis: enlarged tonsils often coexist with enlarged adenoids and may be removed together
• Glue Ear (Otitis Media with Effusion): a common consequence of adenoid hypertrophy that can cause hearing loss in children
• Snoring and Sleep Apnoea: enlarged adenoids are the most common cause of obstructive sleep apnoea in young children