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]

  An adenotonsillectomy is indicated in patients with chronic/recurrent sinusitis, chronic/recurrent otitis media, and/or symptomatic nasal obstruction. Epidemiology Adenoid hypertrophy is the most common cause of nasal obstruction in children. [amboss.com]

  For adenoidal enlargement in adults, which is much rarer and usually pathological, please see the separate article, adenoidal hypertrophy (adults). nasal congestion: adenoid facies chronic or recurrent otitis media due to their proximity to the Eustachian [radiopaedia.org]

  Numerous studies have shown that adenoidectomy is more effective than conservative treatment in patients with recurrent otitis media, especially exudative otitis media. [czytelniamedyczna.pl]

• 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

  Comparison of the groups for AR duration demonstrated significantly higher frequency of persistent rhinitis in patients with AH (p 0.05). [ncbi.nlm.nih.gov]

  Adenoid hypertrophy and adenoiditis are accompanied by chronic rhinitis with or without otitis media. It is very common phenomena at ages 2-6 years and those children are symptomatic with snoring, rhinitis, nasal obstruction. [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 non-responders were those patients whose nasal congestion score decreased 50% and had subjective symptoms, especially nasal congestion, that were not obviously relived. [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]

• 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]

  […] pathological, please see the separate article, adenoidal hypertrophy (adults). nasal congestion: adenoid facies chronic or recurrent otitis media due to their proximity to the Eustachian tubes swallowing difficulties speech anomalies (hyponasal speech) rhinorrhea [radiopaedia.org]

• 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]

• 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 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].

• Neisseria Gonorrhoeae

  gonorrhoeae, Corynebacterium diphtheriae, Chlamydophila pneumoniae, and Mycoplasma pneumoniae.[4][5][2] Fusobacterium, Peptostreptococcus, and Prevotella species have also been identified as anaerobic organisms involved in causing infectious adenoid [ncbi.nlm.nih.gov]

• 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]

  HDM and Alternaria were the predominant allergens in the allergic group with recurrence. [jacionline.org]

• Beta-Hemolytic Streptococcus Group A

  For instance, beta-hemolytic Streptococcus group A belongs to the flora of tonsils. [czytelniamedyczna.pl]

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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.
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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.