What are adenoids?
Adenoids (also called pharyngeal tonsils) are a collection of tissue sitting in the back of the nose. They function as part of our immune system to sample things we breath in and things we eat. As babies, our immune system is sampling our environment and then teaching the body whether something is safe (apple) or not (virus) so the immune system can learn when it needs to react.
Diagram of upper airway
Because of this constant activity as we learn and grow, the tissue can often be very large. In fact, it is the largest from ages 3-6yo. This makes sense when you think of all the viral illnesses your toddler gets, especially if in a high exposure environment like preschool. Unfortunately, if the swelling is so severe that it blocks the pathway to breathe, it can lead to mouth breathing instead.
Risk factors for adenoid hypertrophy include:
recurrent infections-viral, bacterial, fungal
immune system deficiency
allergic rhinitis (environmental-outdoor like pollens and indoor like animal dander)
genetics
GERD/LPR (diet related-especially high sugary and processed foods, dairy and gluten in some)
passive smoke exposure (even if you smoke outside!)
Mouth breathing changes the natural physiology of our body in profound ways.
First of all, the air we breathe in through the mouth is unhumidified (a function your nose performs) so the dryness can cause sore throats, dental caries, and increase risk of viral illness.
Second, breathing through the mouth causes the jaw to drop down and back, the tongue to rest away from the roof of the mouth (hard palate) and the lower face to elongate. The roof of the mouth, without the tongue resting against it, begins to arch and narrow, causing narrowing of the nasal passages and changing the shape of the jaw. These changes can increase risk of nasal congestion, dental problems, snoring and sleep apnea.
Finally, swallowing is affected because as you chew and swallow you must breath through your nose. But if the nose is blocked, there’s a struggle to breath and chew/swallow leading to uncoordinated patterns and increasing chances of choking. Speech can also be impacted since the distance the tongue must move to make certain sounds has increased.
Here is an example of a child without enlarged adenoids (circled). You can see there is plenty of room under the red circle and it doesn’t cover up the Eustachian tube (the pink bump on the right side of the picture).
In this example, the adenoids (circled in red) completely fill the space and contact the soft palate at the bottom of the picture. This child has no room to breathe.
You can learn more about your child’s adenoids by reaching out to your local ENT and undergoing a nasopharyngoscopy-a simple, quick in office camera exam that takes about 30 seconds. It’s important to note that the adenoids start to shrink away around 10 years of age in most people.
Ensuring an open nose to breathe through is the first step to better airway health!
