DISEASES OF NASOPHARYNX

1. DISEASES OF
NASOPHARYNX
DR.AARYA SERIN

2. ADENOIDS
 Adenoids are also called as nasopharyngeal
tonsil
 Situated at junction of the roof and posterior wall
of the nasopharynx
 Composed of vertical ridges of lymphoid tissue
separated by deep clefts and covered by ciliated
columnar epithelium
 Adenoids have no crypts and no capsule unlike
palatine tonsil
 consists of B and T-lymphocytes

3. DEVELOPMENT
 Development starts at 16th week of intra- uterine
life
 Clinically not present at 1st month after birth
 Adenoids are identifiable by 4th month-2 yrs
 Hypertrophy/hyperplasia starts at 3-5 years of
age
 Involutes at puberty and almost completely
disappears by the age of 20.

4. CLINICAL IMPORTANCE
 1ST month after birth any mass in nasopharynx –
Encephalocoele should be suspected
 Absence or decrease in size of adenoids at
4months-2years hypogammaglobenemia /
wiskot-aldrich syndrome should be suspected
 Ectopic hypophysis-remnant rathke’s
pouchchronophil adenoma in females after 50
years

5. BLOOD SUPPLY
 Ascending palatine branch of facial.
 Ascending pharyngeal branch of external
carotid.
 Pharyngeal branch of the third part of maxillary
artery.
 Ascending cervical branch of inferior thyroid
artery of thyrocervical trunk.
 Lymphatics from the adenoid drain into upper
jugular nodes directly or indirectly via
retropharyngeal and parapharyngeal nodes

6. ADENOID HYPERPLASIA /
ADENOIDITIS - ETIOLOGY
 Physiological enlargement 3-5 years of age (some
children develop generalized lymphoid hyperplasia)
 Recurrent attacks of rhinitis, sinusitis, tonsillitis
 Allergy of upper respiratory tract

7. CLINICAL FEATURES
 NASAL SYMPTOMS
 Nasal obstruction
 Nasal discharge
 Sinusitis (commonly chronic maxillary sinusitis)
 Epistaxis
 Voice change

8. CLINICAL FEATURES
 EAR COMPLAINTS
 Tubal obstruction
 Recurrent attacks of acute otitis media
 Chronic suppurative otitis media and serous otitis
media

9. CLINICAL FEATURES
 Adenoid facies: elongated face with dull
expression, open mouth, prominent and crowded
teeth, hitched up upper lip, pinched in
appearance of nose, high arched palate
 Pulmonary hypertension / cor-pulmonale
 Aprosexia, i.e. lack of concentration

10. DIAGNOSIS
 Posterior rhinoscopic examination difficult to
perform in children
 Rigid or flexible nasopharyngoscopy
 X-ray lateral view of the nasopharynx
 Detailed nasal examination to be conducted to
rule out other causes of nasal obstruction

11. TREATMENT
 When symptoms are not marked breathing
exercises, decongestant nasal drops,
antihistaminics, antibiotics can be used
 When symptoms are marked
adenoidectomy is done

12. ACUTE NASOPHARYNGITIS
 Etiology: may be due to isolated infection or
secondary to generalized upper respiratory tract
infection
 Viruses: influenza, para-influenza, rhino virus,
adeno virus
 Bacteria: streptococci, pneumococcus,
haemophilus influenzae

13. CLINICAL FEATURES
 Dryness and burning sensation of the throat
above soft palate
 Pain and discomfort localized to the back of nose
with some difficulty in swallowing
 In severe infections there is fever and enlarged
cervical lymph nodes
 Examination reveals congested and swollen
mucosa often covered with whitish exudate

14. TREATMENT
 Mild cases: spontaneous recovery seen.
Analgesics may be used to relieve pain
 Severe cases require systemic antibiotics
 If associated with adenoids topical
decongestant drops can be used

15. CHRONIC NASOPHARYNGITIS
Etiology : associated with chronic
infections of nose, paranasal sinuses and
pharynx
 Commonly seen in heavy smokers, drinkers
and those exposed to dust and fumes

16. CLINICAL FEATURES
 postnasal discharge with irritation at the back of
the nose is most common complaint
 Patient will have consistent desire to clear throat
by hawking or inspiratory snorting
 Examination of nasopharynx reveals congested
mucosa and mucopus or dry crusts
 In children adenoids are often enlarged and
infected

17. TREATMENT
 chronic infections of the nose, paranasal
sinuses and oropharynx should be treated
 Smoking and drinking should be stopped
 Avoid dust and fumes
 Alkaline nasal douche to remove crusts and
mucopus
 Steam inhalation

18. THORNWALDT’S DISEASE
(PHARYNGEAL BURSITIS)
 It is infection of pharyngeal bursa which is a
median recess representing attachment of
notochord to endoderm of primitive pharynx
 It is located in the posterior wall of nasopharynx
in the adenoid mass

19. CLINICAL FEATURES
 Persistent post nasal discharge with
crusting in nasopharynx
 Nasal obstruction
 Tubal obstruction and resulting serous otitis
media
 Dull type of occipital headache
 Recurrent sore throat
 Low grade fever
Examination reveals a cystic and fluctuant
swelling in posterior wall of nasopharynx

20. TREATMENT
 Antibiotics
 Marsupialisation of cystic swelling and adequate
removal of its lining membrane