Persistent snoring in a child is the main symptom of enlarged adenoids.In day-time there is mouth breathing. Purulent rhinorrhoea (if there is secondary sinusitis) and epistaxis also occur, with or without nasal symptoms. There is hearing loss due to otitis media with effusion, or earache from recurrent acute otitis media.Adenoids normally regress before puberty and adults with large adenoids are rare. If an adult has nasal obstruction due to postnasal lymphoid tissue, the histology is essential to exclude a lymphoma. Nasal obstruction may occur from birth due to large adenoids, and the baby has difficulty with bottle and breast feeding. It is occasionally necessary to remove these “congenital adenoids” in toddlers. A conservative attitude should be taken, however, with removal of adenoids awaiting regression of the lymphoid tissue. Adenoidectomy alone is not common surgery. Tonsillar enlargement is usually also present, and is an additional cause of the upper respiratory tract obstruction and snoring.
Lateral radiograph of adenoids. The postnasal space is often difficult or
impossible to see in a child, and a lateral radiograph clearly shows the size of the
adenoids and degree of obstruction. In this radiograph, a small airway is present
(lower arrows) despite a large adenoid shadow (upper arrow).