Adenoid Hypertrophy

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.

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].

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.