Adenoids are glands located in the upper airway behind the nose and above the soft palate. They're made of lymphoid tissue that's similar to the tonsils and act as a filter for draining inflammatory and waste debris from the nose, sinuses and upper airway. The openings of the Eustachian tubes, which drain the middle part of the ears, are located right next to the adenoids. For this reason, the function of the adenoids is intimately connected to ear function. When the adenoids are infected or inflamed, they get swollen and block the openings to the Eustachian tubes. That causes fluid to build up in the ears, which leads to ear infections. It's also the reason someone with a cold or a runny nose from allergies often gets a sensation of ear fullness or blockage. That chain of events is especially common in kids, because their Eustachian tubes are smaller and have a shape that makes it harder for them to drain.
History
Someone with ear infections that are related to enlarged adenoids often has a history suggestive of adenoid enlargement. He may have had frequent sore throats or throat infections. Children with enlarged adenoids also often snore. Enlarged adenoids also commonly go along with enlarged tonsils, and a history of big tonsils may suggest that they have big adenoids as well. According to the American Academy of Pediatrics, a child with a history suggestive of adenoid enlargement is at an increased risk for ear infections.
Features
Ear infections that are related to enlarged tonsils share similar features. Those infections generally happen due to a blockage of the Eustachian tubes, preventing pressure equilibration in the middle part of the ear and causing a subsequent buildup of fluid. That fluid buildup can cause pain and pressure even without an infection. The fluid also has a high likelihood of getting infected, which can cause even more pain--as well as fever and decreased hearing.
Identification
It's important to identify enlarged adenoids in a child with frequent ear infections. Often, the function of the ear is otherwise normal. Adenoids do regress with age, but children with large adenoids can continue to suffer from ear infections for several years. If this goes on without treatment, it can have lasting consequences on hearing function. Enlarged adenoids can be suspected from a history of frequent sore throats, large tonsils or snoring. They can also sometimes be visible on Xrays. The only way to make a definitive diagnosis, however, is for an otolaryngologist to look directly at the adenoids with a flexible scope camera.
Prevention
Although the options to prevent ear infections caused by enlarged adenoids are limited, a few possible approaches exist. It's important to be proactive. People with seasonal or environmental allergies should keep up on their allergy medications, as adenoid tissue and other lining around the Eustachian tube openings can swell during allergic reactions. That swelling can block drainage from the ears. In addition, topical decongestants such as Afrin, or oral decongestants such as Sudafed can be used to decrease tissue swelling during upper airway infections. Those infections have the potential to cause adenoid swelling and ear blockage.
Treatment
The definitive treatment for ear infections caused by adenoid enlargement is twofold. Ear tubes are a safe way to create an opening that allows the middle part of the ear to release the pressure that goes along with Eustachian tube blockage. The tubes relieve most ear pressure symptoms and decrease the number of infections, even if done without any other treatments. In addition to the tubes, however, surgically removing the adenoids can decrease the likelihood of Eustachian tube blockage that caused the ear infections in the first place. For these reasons, the two operations are often done together.
References
- Children's Health Topics: Ear Infections
- "Clinical Otolaryngology and Allied Sciences";Are the tonsils and adenoids a reservoir of infection in otitis media with effusion? A. Richard Maw; November 1985
- "New England Journal of Medicine";Effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion; George Gates; December 1987
