ADENOIDS
 
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ADENOIDS

 

DEFINITION:

Hypertrophy of the adenoids.

EPIDEMIOLOGY:

  • incidence: ?
  • 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 (ciliated for mucosal clearing and squamous for antigen identification and presentation to the B 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 regress
  • become colonized within the first few days after birth
  • principle disturbances affecting the adenoids:

1. Infection

  • acute or chronic with edema, erythema, and/or purulent exudates
  • complications include abscesses and post nasal drip

2. Hypertrophy

  • usually in response to recurrent infections
  • complications include otitis media and upper airway obstruction

2. Pathogenesis

  • chronic or recurrent infection of the adenoids -> hypertrophy of the adenoids -> adenoidal tissue fills the vault of the nasopharynx -> obstruction of the nasopharynx +/- eustachian tubes -> drainage and clearance of the nasal mucosa blocked

CLINICAL FEATURES:

  • 1. Respiratory Manifestations

    • mouth breathing +/-
      • dry mucous membranes of the mouth and lips
      • halitosis
      • snoring
      • obstructive sleep apnea +/-
        • pulmonary arterial hypertension
        • cor pulmonale
    • impaired small, taste, and/or hearing
    • nasal voice
    • complications:
      • chronic nasopharyngitis - chronic cough
      • chronic rhinitis/rhinorrhea - chronic otitis media

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    INVESTIGATIONS:

  • 1. Imaging Studies

  • 1. Fiberoptic Bronchoscope

    • diagnostic

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    MANAGEMENT:

  • 1. Surgery

    • indications for adenoidectomy:
      • upper airway obstruction +/- sleep apnea especially in those patients with craniofacial anomalies
      • placement of a second set of myringotomy tubes
      • chronic sinusitis
      • chronic hyponasality
      • chronic mouth breathing (as the jaws will become misaligned with time)

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