Adenoids - enlarged

Alternative names
Enlarged adenoids

The adenoids are lymphatic tissue in the back of the nose, similar to the tonsils. If the adenoids become enlarged, it can cause cause mouth breathing, snoring, bad breath, and chronic runny nose. It can also cause health-threatening conditions such as sleep apnea, pulmonary hypertension, and right-sided heart failure.

Causes, incidence, and risk factors
Enlargement of the adenoids may occur naturally (beginning during fetal development), or it may be caused by long-term inflammation.


  • Mouth breathing (mostly at night)  
  • Dry mouth  
  • Cracked lips  
  • Mouth open during day (more severe obstruction)  
  • Bad breath  
  • Persistent runny nose or nasal congestion  
  • Frequent ear infections  
  • Snoring  
  • Restlessness while sleeping  
  • Intermittent sleep apnea

Signs and tests

A physical examination of the throat confirms that the tonsils are enlarged. The adenoids cannot be seen by looking in the mouth directly, but can be seen with a special mirror or using a flexible endoscope through the nose.

Tests may include:

  • X-ray (side view of the throat)  
  • Sleep apnea studies (severe cases only)

Surgical removal of the adenoids (adenoidectomy) will prevent complications, and will cure complications if they already exist from enlarged adenoids. Antibiotics may be used to treat tonsil, adenoid, and sinus infections when they occur.

Expectations (prognosis)
Full recovery is expected. Right-sided heart failure is reversible when the sleep apnea and airway obstruction are treated.


  • Right-sided heart failure (cor pulmonale)  
  • Sleep apnea  
  • Chronic otitis media

Calling your health care provider
Call your health care provider if your child has difficulty breathing through the nose. Call if the child has other symptoms discussed above.

Treating throat infections early may prevent the adenoids from becoming enlarged from long-term infection and inflammation. Adenoidectomy prevents the complications of long-term airway obstruction.

Johns Hopkins patient information

Last revised: December 3, 2012
by Gevorg A. Poghosian, Ph.D.

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