Adenoiditis: Symptoms, Types, Causes and Treatment

Adenoiditis is a common yet often misunderstood condition, especially in children. It involves inflammation of the adenoids—small masses of lymphatic tissue located at the back of the nasal cavity. While the adenoids play a crucial role in defending the body against pathogens, they can themselves become infected and problematic. Understanding the symptoms, types, causes, and treatment options for adenoiditis is key for effective management and improved quality of life.

Symptoms of Adenoiditis

Adenoiditis presents with a variety of symptoms that can significantly impact daily life, particularly in children. Recognizing these symptoms early can help guide timely intervention and prevent complications.

Symptom	Description	Commonality	Source(s)
Nasal Obstruction	Difficulty breathing through the nose, mouth breathing	High	1 2
Chronic Cough	Persistent, often dry or productive	Moderate	1
Ear Problems	Recurrent otitis, hearing loss	Moderate	2
Sore Throat	Throat irritation, discomfort	Moderate	1
Snoring	Noisy breathing during sleep	High	7
Lymphadenitis	Swelling of neck lymph nodes	Moderate	2
Purulent Discharge	Thick mucus from nose or throat	High	2

Table 1: Key Symptoms

Upper Airway Obstruction and Mouth Breathing

One of the hallmark symptoms of adenoiditis is nasal obstruction, which leads to persistent mouth breathing. This symptom is particularly pronounced in children, and can result in characteristic facial changes if left unaddressed over time 1 2 7.

Persistent Cough and Sore Throat

Chronic cough is another frequent complaint. It is often due to the “upper airway cough syndrome,” where post-nasal drip triggers an ongoing cough reflex. Sore throat can accompany this, especially during acute exacerbations or when the infection spreads to adjacent tissues 1.

Ear Complications

Adenoiditis is closely linked to recurrent ear infections, particularly exudative otitis media. Symptoms may include a feeling of fullness in the ear, hearing difficulties, and sometimes pain. Tympanometry often confirms these cases, especially in children with chronic or recurrent infections 2.

Snoring and Sleep Disturbances

Due to airway blockage, snoring and restless sleep are common in those with adenoiditis. In severe cases, this can contribute to sleep apnea and its associated daytime fatigue 7.

Lymphadenitis and Purulent Discharge

Swollen cervical lymph nodes (lymphadenitis) and purulent (pus-like) nasal or throat discharge are strong indicators of active infection and inflammation in the adenoids 2.

Types of Adenoiditis

Adenoiditis is not a one-size-fits-all condition. It exists in several forms, each with its own features and clinical implications. Understanding these types is vital for accurate diagnosis and management.

Type	Features	Chronicity	Source(s)
Acute	Rapid onset, severe symptoms	Short-term	1
Chronic	Persistent, milder symptoms	Long-term	1 2 3 6
Hypertrophic	Enlargement of adenoids, airway obstruction	Variable	1 2 4 7

Table 2: Types of Adenoiditis

Acute Adenoiditis

Acute adenoiditis develops suddenly and presents with severe symptoms such as high fever, intense sore throat, nasal obstruction, and purulent discharge. It often follows an upper respiratory tract infection and may resolve with appropriate therapy 1.

Chronic Adenoiditis

Chronic adenoiditis is characterized by persistent, often milder symptoms that can last for months. These include ongoing nasal congestion, chronic cough, recurrent ear infections, and sometimes subtle systemic effects such as increased risk for “infectious-immune” diseases (e.g., rheumatic fever, autoimmune nephropathy) 1 2 3.

Chronic adenoiditis is frequently overlooked or confused with simple adenoid hypertrophy. It is increasingly common due to rising rates of chronic upper airway infections 1. Chronic forms are often associated with biofilm-producing bacteria, making them resistant to conventional therapies 3.

Adenoid Hypertrophy

Adenoid hypertrophy refers to the abnormal enlargement of the adenoids. While not always inflamed, hypertrophic adenoids can cause airway obstruction and recurrent infections. When hypertrophy coexists with infection, the clinical picture is more complicated, often leading to more severe symptoms and a need for combined management strategies 1 2 4 7.

Causes of Adenoiditis

The development of adenoiditis is multifactorial, involving infectious agents, environmental factors, and individual host susceptibility. Understanding these causes is essential for targeted prevention and therapy.

Cause	Mechanism/Trigger	Population	Source(s)
Bacterial Infection	Pathogenic bacteria invade adenoids	Children	1 3 2
Viral Infection	Viruses initiate inflammation	Children	2 3
Biofilm Formation	Bacteria form resistant biofilms	All ages	3
Environmental Factors	Pollution, poor air quality	Children	7
Family Infections	Close contacts carry pathogens	Children	2

Table 3: Main Causes

Infectious Agents

• Bacterial Pathogens: The primary culprits in adenoiditis are bacteria such as Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae. These organisms are commonly found in the nasopharynx and can invade the adenoidal tissue, especially when immune defenses are compromised 3.
• Viral Infections: Viruses are often the initial trigger, weakening local defenses and paving the way for secondary bacterial infections. Herpes viruses and other atypical pathogens have been implicated, particularly in children with recurrent infections 2 3.

Biofilm Formation

A significant factor in chronic adenoiditis is the ability of bacteria to form biofilms—complex communities that adhere to the adenoid surface and are resistant to both immune responses and antibiotics. This persistence underlies the difficulty in eradicating chronic infections and often necessitates more aggressive or prolonged treatment 3.

Environmental and Familial Factors

Children are especially vulnerable to environmental triggers such as air pollution or exposure to irritants, which can impair the protective functions of the adenoids. Family members with acute or chronic infections significantly increase the risk for children, highlighting the role of close contact in transmission 2 7.

Treatment of Adenoiditis

Treating adenoiditis requires an individualized approach, balancing the need for effective symptom relief with the goal of preserving immune function, particularly in children. Both conservative (medical) and surgical options are available, with the choice depending on severity, chronicity, and response to initial therapies.

Treatment	Approach/Method	Indication	Source(s)
Conservative	Antibiotics, anti-inflammatories, herbal remedies, laser therapy	Mild-moderate cases	1 3 5 6 7
Surgical	Adenoidectomy, endoscopic techniques	Severe or refractory cases	1 4 7
Adjunctive	Radiowave coagulation, phototherapy	Chronic or relapsing cases	4 6

Table 4: Treatment Options

Conservative (Non-surgical) Treatment

• Antibiotic Therapy: Systemic and topical antibiotics remain the cornerstone for bacterial adenoiditis, especially when specific pathogens are identified by culture 1 3.
• Anti-inflammatory & Immune-Modulating Agents: Medications such as Tonsilotren and Cinnabsin have shown efficacy in reducing inflammation and adenoid size, even allowing some children to avoid surgery 5.
• Tailored Nasal Mixtures: Selecting medications based on the specific microflora present in the nasal cavity optimizes treatment and preserves the protective function of the adenoids 7.
• Phototherapy and Laser Therapy: Novel approaches, such as endonasal monochromatic coherent radiation (635 nm), have demonstrated benefits in normalizing immune function and reducing exacerbations in chronic cases 6.

Conservative management is especially favored in children with mild to moderate symptoms or in early stages, and it can significantly decrease the need for surgical intervention 5 7.

Surgical Treatment

• Adenoidectomy: Surgical removal of the adenoids is considered when conservative management fails, or in cases of severe hypertrophy causing airway obstruction, recurrent otitis media, or persistent symptoms 1 4.
• Endoscopic and Radiowave Techniques: Minimally invasive endoscopic shave adenotomy and radiowave coagulation (using devices like SURGITRON) reduce recurrence rates and promote faster recovery. These are particularly beneficial for adults and children with more advanced disease (grade 3 hypertrophy) 4.

Surgical intervention, while effective, carries potential risks and should be reserved for cases where other treatments have proven insufficient 4 7.

Prevention and Early Intervention

• Early Conservative Therapy: Prompt recognition and conservative management of adenoid hypertrophy can prevent progression to more severe disease and avoid surgery in many cases 7.
• Family Education: Reducing exposure to infectious contacts and environmental irritants can help lower the incidence of adenoiditis, especially in susceptible children 2 7.

Conclusion

Adenoiditis is a multifaceted condition with significant implications for respiratory and overall health, especially in children. Early recognition and targeted therapy are crucial for optimal outcomes.

Key takeaways:

• Symptoms include nasal obstruction, chronic cough, recurrent ear infections, snoring, lymphadenitis, and purulent discharge 1 2 7.
• Types span acute, chronic, and hypertrophic forms, each requiring tailored management 1 2 3 4 7.
• Causes are mainly infectious (bacterial, viral), with environmental and familial factors playing important roles; biofilm-producing bacteria are central to chronic cases 2 3 7.
• Treatment options range from conservative medical therapy to surgical intervention; early, individualized, and evidence-based approaches reduce complications and improve quality of life 1 3 4 5 6 7.

By understanding the full spectrum of adenoiditis, healthcare providers and families can work together to ensure effective prevention, timely diagnosis, and successful management of this common yet complex condition.