Adenoids are lymphoid tissue located in the nasopharynx that are typically not visible through the mouth. Adenoid hypertrophy can be caused by chronic inflammation and causes nasal obstruction, mouth breathing, ear infections, and sinus infections. Indications for surgery include recurrent ear or sinus infections, obstructive sleep apnea, or cardiopulmonary complications. Treatment involves antibiotics initially and adenoidectomy or tonsilloadenoidectomy for persistent or severe cases.

1. What are adenoids? Single pyramidal lymphoid tissue on posterior-superior nasopharynx > A part of the normal growth process > Not visible through the mouth

2. What is cause of adenoids hypertrophy? cause by chronic inflammation

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 - frequent ear infections (otitis media) frequent sinus infection (sinusitis) 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. Differential Diagnosis Other : - Obesity (BMI>25) Cause Organ Infection Airway obstruction Neoplasm Nose Rhinitis - Rhinopolypus - FB in nose - Deviated septum - Nasal polyps Sinus Sinusitis - Chronic sinusitis - Mass or CA Tonsils & adenoids Tonsillitis - Adenoiditis -Tonsil hypertrophy - Adenoids hypertrophy Mass or CA Trachea - Tracheitis Trachea stenosis - Mass or CA

5. Indication for admit Moderate to severe Sign of infection ( fever, leucocytosis, dyspnea, dehydrate ) Severe Multiple nose, ear or sinus infections - 7 episodes per year for 1 year - 5 episodes per year for 2 years - 4 episodes per year for 3 years Obstructive Sleep Apnea Cardiopulmonary complications - Pulmonary hypertension - Cor pulmonale ( right side heart failure ) - Right ventricle hypertrophy Cancer ( rarely a cause )

6. Investigate CBC UA X-ray neck, PNS Imaging study ( CT scan ) In case normal physical examination Sleep lab ( Ploy sommogram ) Add for surgery PT,PTT CxR

7. What is the treatment of adenoids hypertrophy? Medical management Penicillin is first line treatment Beta-lactamase in recurrent or unresponsive (response in 1 month) Surgery management Adenoidectomy Tonsiloadenoidectomy

8. Length of stay ICD-10 : J35.2 = 2.5 days ICD-9 : 474.12 = 2.5 days

9. Further slides for hyperlink

10. Antibiotics Pennicillin Amoxycilin, Ampicillin , Cloxacillin, Penicillin,Amoksiklave,Augmentin, Unasyn Beta-lactames Meropenam,Ertapenam(Invanz), Impenam(Tienam)

11. Adenoidectomy Ear infection Recurrent nasal congestion Sinus infection

12. Tonsiloadenoidectomy Multiple nose, ear or sinus infections ( no sign of infection at least 2 wks.) Obstructive Sleep Apnea ( persisting for at least 3 month ) Cardiopulmonary complication Cancer ( rarely a cause )