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The adenoids are composed of lymphoid tissue on the posterior wall of the nasopharynx and form part of Waldeyer’s ring, which consists primarily of the adenoids, palatine tonsils and lingual tonsils.

Natural history of adenoids

Although present at birth, they are usually invisible until 3-6 months. They can grow until about age 6, then involute through adulthood. Enlargement is pathological when they encroach on the nasopharyngeal airway, and this usually does not occur until 1-2 years of age.

Clinical findings

  • nasal congestion: adenoid facies
  • chronic or recurrent otitis media due to their proximity to the eustachian tubes
  • swallowing difficulties
  • speech anomalies (hyponasal speech)
  • rhinorrhea
  • sleep-disordered breathing

Pathological organisms

  • Haemophilus influenzae
  • group A beta-hemolytic Streptococcus
  • Staphylococcus aureus
  • Moraxella catarrhalis
  • Streptococcus pneumoniae

Radiographic features

The lateral neck x-ray is the main imaging study. The size of the adenoids is less of a consideration than the degree to which they encroach on the nasopharyngeal airway (Adenoids Grades):

  • if no adenoidal tissue after 6 months, suspect immune deficiency
  • if enlarged adenoids well after childhood, suspect lymphatic malignancy


Managment options include

  • wait until they involute
  • surgical removal

Indications for an adenoidectomy includes:

  • enlargement causing nasal airway obstruction
  • recurrent or persistent otitis media in children aged 3-4 years and older
  • recurrent and/or chronic sinusitis

Related articles

Head and neck anatomy

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