ADENOIDS AND TMANAGMENT OF ENDOCRINE DISODERS ASSOCIATED

1. Adenoiditis
Dr. Hassan Ali

2. Adenoids
 Enlargement of the nasopharyngeal tonsil
(adenoids) sufficient to produce symptoms.
Physiological enlargement occurs at the age of 3
to 7 years.
Pathological enlargement is due to simple
inflammation during recurrent attacks of upper
respiratory tract infections
The size of the mass relative to that of the
nasopharyngeal space is the important factor in
producing the symptoms.

3. Clinical picture
Nasal obstruction, this leads to mouth
breathing, snoring, difficulty in feeding
specially in infants, hyponasal voice and
obstructive sleep apnea syndrome (OSAS).

4. Cont..

5. Nasal discharge
• Mucoid or mucopurulent (egg-white plug of
mucus seen behind the uvula on gagging), the
post-nasal discharge leads to recurrent
nocturnal cough and excoriation of the nasal
vestibule.

6. cont.
Eustachian tube obstruction: predisposes to
secretory otitis media, recurrent acute
suppurative otitis media and later on chronic
otitis media may occur.
 Adenoid facies, May develop with pinched
nostrils, prominent incisors, open mouth
leading to spongy gums and dental caries, high
arched palate and flat or pigeon chest.

7. Adenoids facies

8. Cont.
Mental dullness and apathetic looking due to
hearing loss, chronic hypoxia and look of
adenoid face.
Nocturnal enuresis.

9. Diagnosis
 Posterior rhinoscopy: can show the adenoids
but difficult.
 Digital palpation: to feel the adenoids but
should be avoided.
 Endoscopic examination is the best method if
possible.
 Lateral X-ray nasopharynx for soft tissue is
good.

10. Complications
Descending infection: secretory otitis media,
suppurative otitis media, sinusitis, rhinitis,
laryngitis and bronchitis.
Obstructive sleep apnea syndrome (OSAS).
 Impaired concentration and excessive day
time sleepiness.

11. Treatment
 Treatment of choice is Adenoidectomy.

12. Adenoidectomy Operation
Indications
Enlargement of the adenoids sufficient to
produce symptoms.
Contraindications:
Systemic: Bleeding tendency as haemophilia
and purpura.
Local: Cleft palate.

13. Technique
The operation is done by under General
Anesthesia.
Position is supine with extended neck by
pillow under shoulders, The adenoid curette is
passed behind the soft palate into the
nasopharynx to shave the adenoids mass
A pack is put for few minutes to stop bleeding
then removed.

14. Complications
Similar to tonsillectomy.
Other complications: include trauma to the
uvula, soft palate, and Eustachian cushions.

15. Thanks for your attention