Position, Signs and symptoms, examination, Differential Diagnosis, Treatment is discussed here

1. “ADENOIDS”
Dr. Shraddha Joshi
Ph.D. 1st year
Shalakya Tantra
Dept.
ITRA
Jamnagar

2. ADENOID
S
 Also known as Lushka’s tonsils, Nasopharyngeal tonsils.
 Hypertrophy of lymphoid tissue sufficient to produce symptoms.
 Commonly between age of 3-7 years.

3. Etiology
 Physiological:
 Occurs due to marked immunological activity.
 Gradually regresses in size with the increase in size of the
nasopharynx to become atrophic at puberty.
 Persistence of adenoid into adult life is uncommon.
 Pathological:
 Due to: Recurrent URTI.
 Recurrent Rhino-sinustis.

4. Symptoms
 May produce symptoms due to relative disportion in size
between the adenoid and the nasopharynx.
 Obstruction of naso-pharynx may be responsible for the
following:
 Nasal diseases: Attacks of cold, persistent nasal
discharge, obstruction, hypo-nasality, snoring.
 Mouth breathing.
 Noisy respiration- while awake and snoring during sleep.
 Difficulty in feeding.
 Olfactory sensitivity is reduced ( in relation to adenoids
size).

5.  Aural diseases:
 ET dysfunction resulting in chronic tubal disease.
 Recurrent attacks of earache, otitis media with effusion,
recurrent ASOM.
 Formation of adhesions.
 COM leading to deafness and ear discharge.
 Nocturnal cough and headache.
 Recurrent infection:
 Recurrent rhino-sinusitis.
 Recurrent ASOM
 Post nasal drip
 Recurrent pharyngitis.
 Chronic irritative cough.
 Recurrent bronchitis

6.  Disorders of masticatory units:
 Mal-development of upper jaw as high arched or gothic
palate ( due to absence of pressure of the tongue on the
upper jaw, and absence of lateral pressure on the upper
jaw and alveolus by the tension of buccinator muscles
and the masticatory muscles because of the open mouth
breathing.)
 Anomalies of position of the teeth or incorrect contact
may result.

7.  Disorders of lower respiratory tract:
 Results in chronic laryngitis and bronchitis.
 Loss of development and poor general development
may result.
 Effects on intelligence and mental development:
 Chronic respiratory obstruction & hypoxia & increased
levels of CO2 resulting in restlessness, disturbed/ broken
sleep & daytime sleeping.
 Lack of concentration- due to hearing loss.
 Recurrent infections- results in sick leave from school.
 Nocturnal emesis.
 Child- Shy & not friendly.

8.  GIT Disturbances:
 Morning vomiting: due to swallowed PND.
 Indigestion: As child swallows bolus of food.
 Loss of appetite: Due to loss of olfaction.
 Dry mouth: Due to mouth breathing.

9. Signs
 General Examination:
Adenoid facies (Long face syndrome).
 Dull look
 Pinched nostrils
 Loss of naso labial fold
 Retracted upper lip
 Open mouth breathing
 Protruding teeth, crowding teeth and hyperplasia of
gums.
 Narrow maxillary arch.
 High arch palate.
 Vacant expression

10.  Guye’s aprosexia- Children will have subnormal mental
condition with inability to concentrate and lack of
attention.
 Associated findings:
 Flat chest or Pectus excavatum.
 Rounded shoulders.

11.  Specific Examination:
 Nasal Cavity:
 When the airflow through the nasal cavity ceases due to
adenoid hypertrophy, a characteristic secondary change
occurs in the mucosa of the anterior nasal cavity.
 This change consists of a state of vasoconstriction.
 Purple discoloration of the mucosa of anterior portion of
the IT. (D/D Allergic Rhinitis)
 Nasal Discharge: Thick mucoid & mucopurulent nasal
discharge.

12.  Oral Cavity & Oropharynx:
 Protruding teeth with misalignment.
 Inflamed spongy gum.
 High arch palate
 Posterior rhinoscopy reveals adenoid hypertrophy
(above 6 years of age).
 Classical triad of Calanan:
 Bifid uvula.
 Soft palate muscles diathesis giving a translucent zone.
 Bony notch in the hard palate on palpation, which
indicates the presence of submucous cleft palate.

13.  Ear:
 Eustachian tube dysfunction or otitis media with
effusion.
 Flexible nasalpharyngoscopy:
 Examine the percentage of obstruction and an occult
submucous cleft palate.
 In case of occult submucous cleft palate: a concavity
 In vediofluoroscopy: Soft palate appears thin and
foreshortened.

14.  Investigations:
Specific:
 X-ray of nasopharynx lateral view.
 Rigid/flexible nasal endoscopy: Gold Standard
Grading of adenoid on endoscopy:
Grade I: Obstruction of upto 1/3rd of choana.
Grade II: Obstruction of 1/3rd to 2/3rd of choana.
Grade III: Obstruction of upto 2/3rd to near complete
obstruction of choana.
Grade IV: Complete obstruction of choana.

16.  Investigations:
Related:
 Pure Tone Audiometry.
 Tympanogram.
 Differential Diagnosis:
 Antrochoanal Polyp
 Juvenile Angiofibroma
 Meningioma
 Encephalocele

17.  Complications of Adenoid Hypertrophy:
 Recurrent attacks of otitis media.
 Otitis media with effusion.
 Sinusitis
 Rhinolalia Clausa
 Treatment:
 Adenoidectomy (Usually combined with tonsillectomy.)