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Adenoid Hypertrophy

Adenoids Hypertrophy

Adenoid hypertrophy is a common childhood condition with unclear etiology and potentially severe consequences. The disease consists of increased adenoid tonsils and represents one of the most frequent surgical indications in this age period.


Presentation

The disease affects males and females to the same extent and is rarely encountered after the age of 15 years because adenoid tissue undergoes a normal process of involution beyond this age [1] [2]. Patients usually present between the ages of 3 and 5 because adenoid growth causes nasopharyngeal airway narrowing [3]. Children from high socioeconomic classes are infrequently affected.

In incipient stages, adenoid hypertrophy is asymptomatic. As the disease progresses, patients manifest with chronic mouth breathing, sleep disturbances, nasal obstruction, rhinorrhea, swallowing difficulties, snoring, cough, epistaxis, and halitosis. Hearing loss develops gradually as a consequence of persistent or recurring middle ear infections. If left untreated for a long period of time, the patient presents with hyponasal voice and a typical facies, characterized by elongated middle facial area and narrow palate [4].

When obstructive sleep apnea develops as a consequence of adenoid hypertrophy, it can cause more severe, long-term morbidity such as failure to thrive, learning difficulties, delayed speech [5], decreased intelligence quotient, and hyperactivity. Possible cardiovascular impairment consists of elevated diastolic blood pressure, left ventricular hypertrophy, and decreased right ventricular ejection fraction [1] [6].

Clinical examination may reveal signs consistent with atopy such as a cough, expiratory wheezing and rhonchi, and prolonged expiratory time.

Recurrent Otitis Media
  • Chronic adenoid infection could lead to the obstruction of the nasopharyngeal Eustachian tube orifice and consequent recurrent otitis media. Therefore, a complete examination of an ear, nose, and throat is useful in all patients.[symptoma.com]
  • Numerous studies have shown that adenoidectomy is more effective than conservative treatment in patients with recurrent otitis media, especially exudative otitis media.[czytelniamedyczna.pl]
  • Recurrent otitis media with effusion Craniofacial and occlusive developmental abnormality due to adenoid enlargement Growth retardation BIBLIGRAPHY : Adherent biofilms in adenotonsillar diseases in children.[drdkjha.com]
  • otitis media due to their proximity to the Eustachian tubes Painful swallowing Sleep apnea Most commonly cultured bacteria Haemophilus influenzae Group A beta-hemolytic Streptococcus Staphylococcus aureus Moraxella catarrhalis Streptococcus pneumoniae[learningradiology.com]
  • Chronic sinusitis, recurrent otitis media with effusion, and chronic serous otitis media associated with pediatric adenoidal hypertrophy are common indications for surgical removal of the adenoid [ 6 ].[panafrican-med-journal.com]
Intravenous Administration
  • After intravenous administration of contrast medium most lesions showed a slight enhancement (58.6%). Moderate enhancement was seen in 32.4% and a marked enhancement was identified in 9.0%.[ncbi.nlm.nih.gov]
Snoring
  • The primary outcomes were improvement in symptoms of nasal obstruction, mouth breathing, rhinorrhea, snoring, cough, and total nasal symptoms.[ncbi.nlm.nih.gov]
  • From Wikidata Jump to navigation Jump to search upper respiratory tract disease characterized by the unusual growth of the adenoid tonsil; has symptom snoring, has symptom hyponasality, has symptom otitis media with effusion, has symptom mouth breathing[wikidata.org]
  • Out of 13, 5 patients complained of nasal obstruction and snoring, 3 complained of snoring and mouth breathing, rest of the 5 patients complained of fullness in ears, diminished hearing and nasal obstruction.[webmedcentral.com]
Rhinitis
  • The second group consisted of sixteen children with adenoid hypertrophy and perennial allergic rhinitis.[ncbi.nlm.nih.gov]
  • Severity of Sneezing at Baseline and Week 12 [ Time Frame: Baseline and Week 12 ] Sneezing is a symptom of allergic rhinitis.[clinicaltrials.gov]
Nasal Congestion
  • AH should be considered and investigated particularly in non-asthmatic children with pronounced nasal congestion and A. alternata sensitivity.[ncbi.nlm.nih.gov]
  • The scores for nasal congestion and snoring in the MF group exhibited a 0.05; Fig. 2 ).[nature.com]
  • Severity of Nasal Congestion at Baseline and Week 12 [ Time Frame: Baseline and Week 12 ] Nasal congestion is a symptom of allergic rhinitis.[clinicaltrials.gov]
Tonsillar Hypertrophy
  • There was also a significant difference between rates of tonsillar hypertrophy and nasopharynx obstruction in the EN group (p 0.009).[pagepressjournals.org]
  • Due to the multifactorial etiology of the tonsillar hypertrophy, the patient’s comorbidities must also be taken into account.[czytelniamedyczna.pl]
  • For most of them there is a vicious cycle established, where the adenoid-tonsillar hypertrophy constitutes the main item for the rest of the visceral-cranial alterations and the teeth occlusion.[medigraphic.com]
  • There might also be a genetic link, as tonsillar hypertrophy often runs in families.[healthline.com]
  • Mean AHI was 8.4 11.6 events/hour for children with tonsillar hypertrophy, and 3.1 6.7 events/hour for those without tonsillar hypertrophy.[journals.plos.org]
Rhinorrhea
  • There was tendency of improvement in rhinorrhea, and cough with mometasone.[ncbi.nlm.nih.gov]
  • Number of Participants Referred to Surgery (Adenoidectomy) Within 12 Weeks of Start of Therapy [ Time Frame: Baseline to 12 weeks ] Secondary Outcome Measures : Severity of Rhinorrhea at Baseline and Week 12 [ Time Frame: Baseline and Week 12 ] Rhinorrhea[clinicaltrials.gov]
  • As the disease progresses, patients manifest with chronic mouth breathing, sleep disturbances, nasal obstruction, rhinorrhea, swallowing difficulties, snoring, cough, epistaxis, and halitosis.[symptoma.com]
  • They appear to play an important role in the development of “immunological memory”. 1 Adenoid hypertrophy (AH) is a very common condition in children. 2 Symptoms associated with AH include nasal congestion, rhinorrhea, hyponasal speech, open-mouthed breathing[rborl.org]
Vascular Disease
  • Mean platelet volume is an indicator of larger and more reactive platelets and has been shown to be increased in patients with vascular disease, including peripheral, pulmonary, and coronary artery disease.[ncbi.nlm.nih.gov]
Mouth Breathing
  • From Wikidata Jump to navigation Jump to search upper respiratory tract disease characterized by the unusual growth of the adenoid tonsil; has symptom snoring, has symptom hyponasality, has symptom otitis media with effusion, has symptom mouth breathing[wikidata.org]
  • MATERIALS AND METHODS: Eighty-six mouth-breathing children (male 54.65%, mean age 7.0 2.2 years) were randomly selected from a hospital population.[ncbi.nlm.nih.gov]
  • All patients with adenoid hypertrophy suffer of nasal obstruction, mouth breathing in addition to other symptoms.[alliedacademies.org]
Halitosis
  • As the disease progresses, patients manifest with chronic mouth breathing, sleep disturbances, nasal obstruction, rhinorrhea, swallowing difficulties, snoring, cough, epistaxis, and halitosis.[symptoma.com]
  • The adenoids are located at the back of nose and when enlarged, may cause nasal obstruction, recurrent sinusitis, post nasal drip, sleep apnea, chronic runny nose, halitosis and even chronic cough.[childrensnational.org]
  • Halitosis (bad breath) can occur because of infections of the tonsils. Snoring because of obstruction to the airway from the enlarged tonsils.[entcenterutah.com]
  • […] adenoid hypertrophy and gastroesophageal reflux disease: A meta-analysis. ( 30313042 ) Niu X...Chen X 2018 10 Adenoid hypertrophy affects screening for primary ciliary dyskinesia using nasal nitric oxide. ( 30368395 ) Rybnikar T...Skoloudik L 2018 11 Halitosis[malacards.org]
Normal Hearing
  • The average threshold level in the 0.25 kHz frequency of children was found to have poorer hearing thresholds than those in the 0.5, 1, 2, and 4 kHz (P 0.001) frequencies; 29.7% (92/310) of ears with MEE were regarded as normal hearing level.[ncbi.nlm.nih.gov]
Meningism
  • Although not previously reported, radiofrequency diathermy for adenoid hypertrophy can be considered a risk factor for bacteremia and meningitis.[ncbi.nlm.nih.gov]
Learning Difficulties
  • When obstructive sleep apnea develops as a consequence of adenoid hypertrophy, it can cause more severe, long-term morbidity such as failure to thrive, learning difficulties, delayed speech, decreased intelligence quotient, and hyperactivity.[symptoma.com]

Workup

Adenoid hypertrophy is best diagnosed by means of flexible nasopharyngoscopy. This investigation is indicated when the manifestations presented above are present or when the patient presents with recurrent sinusitis, otitis media, or persistent ear effusions. When obstructive sleep apnea is suspected, a sleep study is called for in order to gather information about its severity. Radiological evaluation, such as the lateral neck X-ray should be avoided unless more severe pathology, such as neoplasia or angiofibroma, is suspected. However, if a radiography is performed, due to the fact that it is still considered a valid and reliable test [7] [8], the physician should assess not the absolute dimensions of the adenoids, but the degree of obstruction they cause. If adenoids are very small or absent, an immune deficiency should be investigated, while severely enlarged masses may suggest lymphatic malignancy.

Adenoid flora occasionally needs to be assessed. It is usually composed of group A beta-hemolytic streptococci, but Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae may also be encountered. Anaerobic bacteria may be found in the core of the adenoids [9]. Other possibly present bacteria include Enterococcus species, Staphylococcus epidermidis, Streptococcus viridans, Escherichia coli, Pseudomonas, Moraxella, Klebsiella, Neisseria, Prevotella, Fusobacterium, Peptostreptococcus, and Bacteroides species [10] [11]. Chronic adenoid infection could lead to the obstruction of the nasopharyngeal Eustachian tube orifice and consequent recurrent otitis media. Therefore, a complete examination of an ear, nose, and throat is useful in all patients.

Biopsy specimens reveal reactive hyperplasia of B-cells and inflammatory infiltrates consisting of polymorphonuclears, plasmocytes, or eosinophils [2] [12].

Alternaria
  • On the other hand, sensitivity to Alternaria alternata was significantly more frequent in AR patients with AH (p 0.032). The presence of AH increased the severity of the disease and prolongs disease duration.[ncbi.nlm.nih.gov]

Treatment

  • BACKGROUND: The effect of topical mometasone for adenoid hypertrophy treatment is well established. Nevertheless, the influence of atopy on this treatment remains ill defined.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis Hypertrophied adenoids are a normal part of growing up and should be respected for their important role in the development of immunity.[healthofchildren.com]
  • Outcome and Prognosis Chronic persistent otitis media Gates et al have the most quoted article concerning the effectiveness of adenoidectomy for preventing the recurrence of chronic (ie, 2 mo) serous otitis media in children aged 4-9 years. [9] In a study[emedicine.medscape.com]

Etiology

  • OBJECTIVE: Adenoid hypertrophy (AH) is a common etiology of chronic upper airway obstruction. Upper respiratory tract obstruction may cause chronic alveolar hypoventilation and pulmonary vasoconstriction.[ncbi.nlm.nih.gov]
  • Adenoid hypertrophy is a common childhood condition with unclear etiology and potentially severe consequences. The disease consists of increased adenoid tonsils and represents one of the most frequent surgical indications in this age period.[symptoma.com]
  • […] last modified on: Fri, 04/07/2017 - 13:55 Also known as reactive lymphoid hypertrophy or more simply reactive lymph nodes Benign etiology - lymphoid proliferation in response to antigen exposure Often noted with other lymphadenopthy in the neck Retropharyngeal[medicine.uiowa.edu]
  • The exact etiology of AH in adults are known but some studies have tried to propose outcomes. Most common cause is persistence of childhood adenoids due to chronic inflammation [3].[medcraveonline.com]
  • ( 25590321 ) Rezende R.M....Valera F.C. 2015 49 Relative etiological importance of adenoid hypertrophy versus sinusitis in children with persistent rhinorrhoea. ( 25621229 ) Maheswaran S....Irodi A. 2015 50 The effect of adenoidectomy operation made on[malacards.org]

Epidemiology

  • Martin-Luther-University Halle-Wittenberg, Germany alex.surow@medizin.uni-halle.de. 2 Department of Radiology, Martin-Luther-University Halle-Wittenberg, Germany. 3 Department of Otorhinolaryngology, Martin-Luther-University Halle-Wittenberg, Germany. 4 Department of Epidemiology[ncbi.nlm.nih.gov]
  • Department of Biostatistics & Clinical Epidemiology Christian Medical College and Hospital Vellore India 2. Dept. of ENT Speech & Hearing Christian Medical College & Hospital Vellore India[link.springer.com]
  • The Annals of otology, rhinology, and laryngology. 2017 Jul [PubMed] Bhattacharyya N,Lin HW, Changes and consistencies in the epidemiology of pediatric adenotonsillar surgery, 1996-2006.[knowledge.statpearls.com]
  • Epidemiology United States statistics Population and autopsy studies suggest that about 30% of middle-aged or elderly individuals have colonic polyps.[emedicine.medscape.com]
  • An epidemiologic study of lower limit of prevalence. Chest 107: 963-966. doi: . PubMed: 7705162. View Article Google Scholar 4.[journals.plos.org]
Sex distribution
Age distribution

Pathophysiology

  • In one previous study in patients with obstructive sleep apnea (OSA), it has been claimed that mean platelet volume (MPV), an indicator of platelet activation is increased and that MPV has an important role in the pathophysiology of cardiovascular diseases[ncbi.nlm.nih.gov]
  • Various genetic factors may affect certain disease phenotypes and change the severity of chronic inflammatory diseases by altering gene expression levels. 6 Secretoglobins (SCGBs) are a newly discovered and rapidly growing physiologically and pathophysiologically[rborl.org]
  • Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 126.[medlineplus.gov]
  • Chronic upper airway obstruction and cardiac dysfunction: anatomy, pathophysiology and anesthetic implications. Paediatric Anaesth. 2004;14:75-83. 2. Sie KC, Perkins JA, Clarke WR. Acute right heart failure due to adenotonsillar hypertrophy.[arquivosdeorl.org.br]
  • Pathophysiology Colonic polyps, or adenomas, are benign epithelial neoplasms that arise from the epithelial cells lining the colon.[emedicine.medscape.com]

Prevention

  • Further studies are necessary to evaluate their possible therapeutic role in preventing recurrent tonsillitis and treating postoperative patients to help normalize their blood levels of antioxidants.[ncbi.nlm.nih.gov]
  • Adenoidectomy may be recommended when tympanostomy tube surgery () failed to prevent ear infection.[medical-dictionary.thefreedictionary.com]

References

Article

  1. Kang K, Chou C, Weng W, et al. Associations between Adenotonsillar Hypertrophy, age and obesity in children with obstructive sleep apnea. PLoS ONE. 2013;8(10):78666.
  2. Eziyi J, Amusa Y, Nwawolo C. The prevalence of nasal diseases in Nigerian school children. J Med Med Sci. 2014;5(4):71-77.
  3. Acharya K, Bhusal C, Guragain R. Endoscopic grading of adenoid in otitis media with effusion. J Nep Med Assoc. 2010;49(1):47-51.
  4. Urshitz M, Guenther A, Eggebrecht E, et al. Snoring, intermittent hypoxia and academic performance in primary school children. Am J Respir Crit Care Med. 2003;168(4):464-468.
  5. Roberts J, Burchinal M, Jackson S, et al. Otitis media in early childhood in relation to preschool language and school readiness skills among African American children. Pediatrics. 2000;106(4):723-735.
  6. Scadding G. Non-surgical treatment of adenoidal hypertrophy: the role of treating IgE-mediated inflammation. Pediatr Allergy Immunol. 2010;21(8):1095-1106.
  7. Kurien M, Lepcha A, Mathew J, et al. X-Rays in the evaluation of adenoid hypertrophy: It's role in the endoscopic era. Indian J Otolaryngol Head Neck Surg. 2005;57(1):45–47.
  8. Feres M, de Sousa H, Francisco S, et al. Reliability of radiographic parameters in adenoid evaluation. Braz J Otorhinolaryngol. 2012;78(4):80-90.
  9. Okur E, Aral M, Yildirim I, et al. Bacteremia during adenoidectomy. Int J Pediatr Otorhinolaryngol. 2002;66:149–153.
  10. Taylan I, Ozcan I, Mumcuoglu I, et al. Comparison of the surface and core bacteria in tonsillar and adenoid tissue with beta lactamase production. Indian J Otolaryngol Head Neck Surg. 2011;63:223–228.
  11. Al-Mazrou K, Al-Khattaf A. Adherant Biofilms in adenotonsillar diseases in children. Arch Otolaryngol Head Neck Surg. 2008;134:20–23.
  12. Anita S, Zoltán P, Péter C, et al. Microbiological Profile of Adenoid Hypertrophy Correlates to Clinical Diagnosis in Children. BioMed Research International. 2013;2013:1-10.

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Last updated: 2019-07-11 21:16