Adenoids Hypertrophy

8,400 views

Published on

Adenoids Hypertrophy

  1. 1. What are adenoids? <ul><li>Single pyramidal lymphoid tissue on posterior-superior nasopharynx > A part of the normal growth process > Not visible through the mouth </li></ul>
  2. 2. What is cause of adenoids hypertrophy? cause by chronic inflammation
  3. 3. Sign&Symptoms Nasal obstruction - mouth breathing (mostly at night) - dry mouth, cracked lips - persistent runny nose or nasal congestion - snoring - Obstructive sleep apnea ( snore and stop breathing ) Ear and sinus problem <ul><li>- frequent ear infections (otitis media) </li></ul><ul><li>frequent sinus infection (sinusitis) </li></ul>Voice - flat and toneless. Cardiopulmonary complications - Pulmonary hypertension - Cor pulmonale ( Right side heart failure ) - Right ventricular hypertrophy Weight loss or lack of weight gain - BMI < 19
  4. 4. Differential Diagnosis Other : - Obesity (BMI>25) Cause Organ Infection Airway obstruction Neoplasm Nose <ul><li>Rhinitis </li></ul><ul><li>- Rhinopolypus </li></ul>- FB in nose - Deviated septum - Nasal polyps Sinus <ul><li>Sinusitis </li></ul>- Chronic sinusitis - Mass or CA Tonsils & adenoids <ul><li>Tonsillitis </li></ul><ul><li>- Adenoiditis </li></ul>-Tonsil hypertrophy - Adenoids hypertrophy <ul><li>Mass or CA </li></ul>Trachea - Tracheitis <ul><li>Trachea stenosis </li></ul>- Mass or CA
  5. 5. Indication for admit <ul><li>Moderate to severe </li></ul><ul><li>Sign of infection ( fever, leucocytosis, dyspnea, dehydrate ) </li></ul><ul><li>Severe </li></ul><ul><li>Multiple nose, ear or sinus infections </li></ul><ul><li>- 7 episodes per year for 1 year </li></ul><ul><li>- 5 episodes per year for 2 years </li></ul><ul><li>- 4 episodes per year for 3 years </li></ul><ul><li>Obstructive Sleep Apnea </li></ul><ul><li>Cardiopulmonary complications </li></ul><ul><li>- Pulmonary hypertension </li></ul><ul><li>- Cor pulmonale ( right side heart failure ) </li></ul><ul><li>- Right ventricle hypertrophy </li></ul><ul><li>Cancer ( rarely a cause ) </li></ul>
  6. 6. Investigate <ul><li>CBC </li></ul><ul><li>UA </li></ul><ul><li>X-ray neck, PNS </li></ul><ul><li>Imaging study ( CT scan ) </li></ul><ul><li>In case normal physical examination </li></ul><ul><li>Sleep lab ( Ploy sommogram ) </li></ul><ul><li>Add for surgery </li></ul><ul><li>PT,PTT </li></ul><ul><li>CxR </li></ul>
  7. 7. What is the treatment of adenoids hypertrophy? <ul><li>Medical management </li></ul><ul><li>Penicillin is first line treatment </li></ul><ul><li>Beta-lactamase in recurrent or unresponsive (response in 1 month) </li></ul><ul><li>Surgery management </li></ul><ul><li>Adenoidectomy </li></ul><ul><li>Tonsiloadenoidectomy </li></ul>
  8. 8. Length of stay <ul><li>ICD-10 : J35.2 = 2.5 days </li></ul><ul><li>ICD-9 : 474.12 = 2.5 days </li></ul>
  9. 9. Further slides for hyperlink
  10. 10. Antibiotics <ul><li>Pennicillin </li></ul><ul><li>Amoxycilin, Ampicillin , Cloxacillin, Penicillin,Amoksiklave,Augmentin, Unasyn </li></ul><ul><li>Beta-lactames </li></ul><ul><li>Meropenam,Ertapenam(Invanz), </li></ul><ul><li>Impenam(Tienam) </li></ul>
  11. 11. Adenoidectomy <ul><li>Ear infection </li></ul><ul><li>Recurrent nasal congestion </li></ul><ul><li>Sinus infection </li></ul>
  12. 12. Tonsiloadenoidectomy <ul><li>Multiple nose, ear or sinus infections </li></ul><ul><li>( no sign of infection at least 2 wks.) </li></ul><ul><li>Obstructive Sleep Apnea </li></ul><ul><li>( persisting for at least 3 month ) </li></ul><ul><li>Cardiopulmonary complication </li></ul><ul><li>Cancer ( rarely a cause ) </li></ul>

×