ADENOIDS

ADENOIDS

DEFINITION:

Hypertrophy of the adenoids.

EPIDEMIOLOGY:

Age of onset: usually >2 years of age

Risk factors: recurrent upper respiratory tract infections

PATHOGENESIS:

1. Background

The adenoids are nasopharyngeal lymphoid tissue consisting primarily of B cells and epithelial cells

are part of the Waldeyer Ring - lymphoid tissue that encircles the pharynx and includes the lingual tonsil, faucial tonsils, adenoids, and lymphoid tissue on the posterior pharyngeal wall - the adenoids are present at birth, undergo hypertrophy and hyperplasia to reach a maximal size between 2-5 years and then slowly shrinks

Become colonized within the first few days after birth

1. Infection

Acute or chronic - exudates

Complications - abscesses and post nasal drip

2. Hypertrophy

due to recurrent infections

complications - otitis media and upper airway obstruction

Pathogenesis

Infection of adenoids -> hypertrophy -> adenoidal tissue fills the nasopharynx -> obstruction of the nasopharynx +/- Eustachian tubes -> drainage and clearance of the nasal mucosa blocked

CLINICAL FEATURES:

Respiratory Manifestations

1. mouth breathing +/-  àdry mucous membranes of the mouth and lips
2. foul smell from mouth
3. snoring
4. obstructive sleep apnea +/-
5. impaired small, taste, and/or hearing
6. nasal voice
7. Rarely -pulmonary arterial hypertension, cor-pulmonale

Complications:

1. chronic nasopharyngitis - chronic cough
2. chronic rhinitis/rhinorrhea
3. chronic otitis media

INVESTIGATIONS:

Imaging Studies X-ray nasopharynx lateral view

Fiber optic Bronchoscope - diagnostic

MANAGEMENT:

Surgery

Indications for adenoidectomy:

1. Upper airway obstruction +/- sleep apnea especially in those patients with craniofacial anomalies
2. Placement of a second set of myringotomy tubes
3. Chronic sinusitis
4. Chronic hypo nasality
5. Chronic mouth breathing (as the jaws will become misaligned with time)