Adenoids: Hidden culprit behind recurrent coughs, loud snoring

When four-year-old Hidaya Akoth began struggling to breathe and started snoring loudly, her parents thought it was due to a bout of flu that had also blocked her nose.

Frequent trips to the hospital and a series of school absenteeism due to persistent coughs and flu made her parents increasingly worried.

“She would have coughs and flu every two weeks. Doctors prescribed strong antibiotics, but she would only get better for a week or two before we had to return to hospital again. She missed school often,” recounts her mother, Vivian Adhiambo.

Ms Adhiambo says she even changed hospitals at one point. “I was frustrated. I kept consulting friends, and they would recommend different doctors, but the outcome was always the same. Eventually, I decided to seek the services of an ear, nose and throat (ENT) specialist,” she says.

At the ENT clinic in 2018, Adhiambo discovered that her daughter was suffering from adenoids.

“The doctor asked about my daughter’s symptoms, which included frequent flu, coughing, difficulty in breathing with minimal improvement even when on medication, and loud snoring,” she recalls.

Her daughter was sent for an X-ray on the same day, and after reviewing the results, the doctor diagnosed her with adenoids.

“The specialist said the adenoids were still mild and recommended nasal sprays to shrink them and help her breathe better,” she adds.

Years later, when Hidaya turned 11, the condition worsened. The adenoids enlarged and became more problematic.  “At this point, I had to pile pillows to raise her head just so she could breathe properly. She developed poor eating habits, and foam would form in her mouth while she slept. She would wake up exhausted,” says Adhiambo.

When she returned to an ENT specialist, an adenoidectomy was recommended because Hidaya’s airway had become very narrow.

“The thought of surgery was frightening. We had mixed feelings. But if I were to go through the experience again, I wouldn’t wait so long before agreeing to the operation,” she reflects.

ENT surgeon Erick Nyabuti of Aga Khan Hospital in Kisii describes adenoids as masses of lymphoid tissue located high in the throat behind the nose.

He explains that adenoids are part of the immune system, acting as a first line of defence by trapping and destroying bacteria and viruses entering through the nose and mouth.

“They can start developing in utero, from the fourth month of pregnancy, and scans can show their presence. After birth, they rapidly increase in size between one and five years. By the time a child is eight to ten years old, they start to shrink. In adults, they are usually absent because they have regressed,” he says.

Speech problems

Mr Nyabuti adds that adenoids can cause speech problems due to their location.

“Because they are at the back of the nose, they can block airflow, preventing proper articulation. Affected children may have hyponasal speech,” he explains.

He says adenoids are diagnosed clinically through symptoms such as nasal blockage, mouth breathing, recurrent ear infections, snoring and persistent nasal discharge.

“The doctor takes a detailed history — symptoms often begin around six to eight months of age and worsen gradually. Most patients we see are between two and five years old, which coincides with the rapid growth of adenoids and tonsils,” he says.

Examination may involve a lateral soft tissue neck X-ray to visualise the tissue, or for cooperative and courageous children, a mirror or small camera (endoscope) may be used to view the back of the nose.

Non-surgical treatment includes  nasal steroids to reduce the size of the adenoids and antibiotics to treat recurrent infections.

“These are normal tissues that sometimes enlarge or get infected. Medical management targets recurrent infections such as sinusitis or ear infections, often caused by common bacteria,” he explains.

He adds that many children also have allergies, requiring anti-allergy medication. “Studies show nasal steroids can reduce the size of adenoids, but when treatment stops, symptoms often recur.”

Surgery is advised depending on symptoms. He notes that early surgery usually resolves symptoms, though adenoids can regrow.

“This happens because remnants may remain after surgery. If done very early — say between eight months and two years — the rapid growth of the child compared to the adenoids can cause symptoms to return,” he explains.

Professor Walter Otieno, from the Department of Paediatrics and Child Health at Maseno University School of Medicine, and a leading researcher on childhood illnesses, explains that adenoids are larger in children because those under five are more prone to bacterial, viral and fungal infections.

“Adenoids help the body fight microorganisms, but because infections are frequent, they enlarge,” he says.

On whether adenoid removal is becoming more common, Prof Otieno says: “It’s one of the most frequent surgical procedures in children, and rates are likely increasing due to greater awareness and early intervention.”