Enlarged Adenoids in Children: Complete Guide to Symptoms, Diagnosis & Treatment
Enlarged adenoids are one of the most common reasons children develop persistent nose block, snoring, mouth breathing, and sleep problems. Many parents aren’t aware that the adenoid, a small patch of tissue hidden at the back of the nose, can quietly grow large enough to affect a child’s breathing, facial development, and even behaviour. In this guide, you’ll learn exactly what enlarged adenoids are, how they cause symptoms like “adenoid face,” how ENT specialists diagnose the problem, and when adenoid surgery or adenoidectomy may be needed to help your child breathe and sleep normally again.
What Are Adenoids?
Adenoids are a small patch of lymphoid tissue located at the back of the nose, high up in the nasopharynx. Many parents ask, “Where are your adenoids?” or “Where are adenoids found?” They sit behind the nasal cavity, right at the area your ENT camera enters during an endoscopic exam. Adenoids play a role in a child’s immune system, especially during early years.
What Do Adenoids Do?
Adenoids help filter bacteria and viruses entering through the nose. However, when they become infected or swollen repeatedly, they can turn from helpful to problematic.
What Is Adenoid Hypertrophy (Enlarged Adenoids)?
Adenoid hypertrophy or hypertrophic adenoids simply means the adenoid tissue has grown larger than normal. This is very common in infants and young children.
Adenoid Face : How Enlarged Adenoids Change a Child’s Appearance
Long-standing adenoid enlargement can affect facial growth.
A child may develop what is commonly known as “adenoid face”, which includes:
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Long, narrow face
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Open-mouth posture
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Shorter lower jaw
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Protruding upper teeth
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Flattened nose bridge
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Dark eye circles
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Dull or tired facial expression
Early diagnosis helps prevent permanent facial changes.
Symptoms & Signs of Enlarged Adenoids
Nasal & Breathing Symptoms
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Constant blocked nose
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Open-mouth breathing
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Snoring
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Noisy breathing during sleep
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Sleep apnea or pauses in breathing
Ear & Throat Symptoms
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Recurrent ear infections
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Middle ear fluid (glue ear)
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Hearing loss
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Chronic throat clearing
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Post-nasal drip
Behavior & Sleep Symptoms
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Irritability
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Poor sleep quality
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Daytime tiredness
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Reduced concentration in school
These are classic enlarged adenoid symptoms and signs that prompt an ENT assessment.
Adenoid Infection (Adenoiditis)
When adenoids get infected, symptoms include:
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Fever
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Yellow or green nasal mucus
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Bad breath
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Sore throat
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Ear discomfort
Recurring infections often trigger further enlargement of the adenoid tissue.
Adenoid vs Tonsil – What’s the Difference?
Adenoids and tonsils are both lymphoid tissues, but they sit in different areas and cause different problems when enlarged. Adenoids are located at the back of the nose and cannot be seen through the mouth; when swollen, they usually cause blocked nose, snoring, and mouth breathing.
Tonsils sit at the back of the throat and are easily visible; enlarged tonsils tend to cause sore throats, swallowing difficulty, and sometimes sleep apnea. Many children have enlargement of both, and when this causes significant breathing or sleep issues, an adenotonsillectomy may be recommended.
How Do ENTs Diagnose Adenoid Enlargement?
At your ENT visit, evaluation may include:
1. Nasal Endoscopy
A thin camera is inserted into the nose. This provides a clear visual of the adenoid in the nose and how much it blocks the airway.
2. Lateral Neck X-ray
Useful for children who cannot tolerate endoscopy.
3. Sleep Assessment
In children with snoring or suspected sleep apnea.
Endoscopic View of Adenoid Hypertrophy in Children
This video shows a real endoscopic view of severe (Grade 4) adenoid hypertrophy in a child. The enlarged adenoid tissue almost completely blocks the back of the nasal airway, forcing the child to breathe through the mouth instead of the nose. Over time, chronic mouth breathing can affect facial growth and lead to features commonly known as “Adenoid Face” — including a shorter lower jaw, protruding teeth, open-mouth posture, tired-looking eyes, and poor sleep quality.
By visualising the actual obstruction inside the nose, parents can better understand why their child may snore, mouth breathe, or struggle with blocked nose symptoms. Early diagnosis and timely treatment can help restore proper nasal breathing, improve sleep, and prevent long-term facial changes.
Watch the video to see how enlarged adenoids look on endoscopy and how they can impact facial development in children.
When Is Adenoid Surgery Needed?
Adenoid removal is recommended when:
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Persistent nasal block
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Significant snoring or sleep apnea
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Chronic mouth breathing / adenoid face
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Multiple ear infections (middle ear)
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Speech or feeding issues due to nasal obstruction
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Recurrent adenoid infection despite treatment
Adenoidectomy (Adenoid Removal) Explained
Adenoidectomy is a short surgical procedure to remove enlarged adenoids from the back of the nose.
How Is Adenoid Removed?
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Performed under general anaesthesia
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ENT surgeon uses a special curette, microdebrider, or coblator
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No external incision; surgery is done entirely through the nose via endoscope
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Bleeding is minimal
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Child usually goes home the next day
Will Adenoids Grow Back?
In most children, adenoids do NOT grow back.
However, in a small number (especially very young kids), some regrowth can occur, usually mild and not problematic.
Recovery After Adenoid Removal
Most children recover quickly. Expected recovery includes:
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Mild throat discomfort 2–3 days
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Occasional blocked nose due to swelling
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Better breathing within 1–2 weeks
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Snoring reduces gradually as swelling settles
School can usually be resumed in 4–5 days.
Frequently Asked Questions
What age do adenoids enlarge the most?
Peak size is between ages 3–7.
Can medicine shrink adenoids?
Medication helps with infection or allergy-related swelling, but permanent enlargement usually requires surgery.
How long is the surgery?
Around 20–30 minutes.
Is adenotonsillectomy safe?
Yes. It is one of the most common paediatric ENT surgeries.