Adenoid hypertrophy
Adenoid hypertrophy | |
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Adenoid hilighted in green. | |
Specialty | Otorhinolaryngology |
Adenoid hypertrophy (enlarged adenoids) is the unusual growth (hypertrophy) of the adenoid (pharyngeal tonsil) first described in 1868 by the Danish physician Wilhelm Meyer (1824–1895) in Copenhagen. He described a long term adenoid hypertrophy that will cause an obstruction of the nasal airways. These will lead to a dentofacial growth anomaly that was defined as "adenoid facies" (see long face syndrome).
There is very little lymphoid tissue in the nasopharynx of young babies; humans are born without substantial adenoids. The mat of lymphoid tissue called adenoids starts to get sizable during the first year of life. Just how big the adenoids become is quite variable between individual children.
Signs and symptoms
Enlarged adenoids can become nearly the size of a
Nasal blockage is determined by at least two factors: 1) the size of the adenoids, and 2) the size of the nasal pharynx passageway. The adenoid usually reaches its greatest size by about age 5 years or so, and then fades away ("atrophies") by late childhood - generally by the age of 7 years. The lymphoid tissue remains under the mucosa of the
The symptoms caused by enlarged adenoids are mostly due to where this lymphoid tissue is located. The adenoids are in the midline of the nasopharynx, and the
The nasopharynx lies directly above the throat. Splashes of excessive "drip" from infected adenoids may fall directly onto the
Causes
The adenoids, like all lymphoid tissue, enlarge when infected. Although lymphoid tissue does act to fight infection, sometimes
Diagnosis
- Posterior rhinoscopy: was used in earlier times; the postnasal space is visualized using a posterior rhinoscopy mirror.
- Diagnostic nasal nasopharyngoscopecan help to see details in a cooperative child.
- Computed tomographyscan of nasopharynx
- X-ray lateral view of nasopharynx
Detailed nasal examination should always be done to exclude other causes of nasal obstruction.
Treatment
There is some low-quality evidence suggesting that mometasone may lead to symptomatic improvement in children with adenoid hypertrophy.[2]
Surgical removal of the adenoids is a procedure called adenoidectomy. Carried out through the mouth under a general anaesthetic, adenoidectomy involves the adenoids being curetted, cauterised, lasered, or otherwise ablated. Adenoidectomy is most often performed because of nasal obstruction, but is also performed to reduce middle ear infections and fluid (otitis media). The procedure is often carried out at the same time as a tonsillectomy, since the adenoids can be clearly seen and assessed by the surgeon at that time.
Additional reading
- Gates G (1996). "Sizing up the adenoid". Arch Otolaryngol Head Neck Surg. 122 (3): 239–40. PMID 8607949.
- Kenna, Margaret A.; Bluestone, Charles D.; Stool, Sylvan E. (1996). "Chapters 58–59". Pediatric otolaryngology. Vol. 2. Philadelphia: Saunders. ISBN 978-0-7216-5248-1.
- BUPA Health Fact Sheet. "Adenoidectomy"
References
- ISBN 9789350258910.
- PMID 26235732.
External links