Summary
Adenoid hypertrophy is hyperplasia of the pharyngeal tonsils. It only becomes symptomatic if it leads to congestion of the choanae and eustachian tubes. The condition is common in children with recurrent inflammation of the upper airways. Clinical features include mouth breathing, snoring, hyponasal speech, and adenoid facies. Adenoid hypertrophy is diagnosed using flexible nasopharyngoscopy, which should show enlarged adenoid tissue. An adenotonsillectomy is indicated in patients with chronic/recurrent sinusitis, chronic/recurrent otitis media, and/or symptomatic nasal obstruction.
Epidemiology
- Common in children
- Very rare in adults [1]
Adenoid hypertrophy is the most common cause of nasal obstruction in children.
Epidemiological data refers to the US, unless otherwise specified.
Etiology
- Physiological
- Adenoidal inflammation due to
- Viral or bacterial infections
- Allergens
Clinical features
Mechanical congestion of the choanae
- Mouth breathing
- Hyponasal speech
-
Adenoid facies
- Elongated, open-mouthed face, short upper lip, thin nostrils
- Malpositioned and prominent upper teeth, hypoplastic upper jaw, high-arched palate
- Chronic or recurrent rhinosinusitis, nasopharyngitis, and/or epistaxis
- Halitosis [2]
- Obstructive sleep apnea (OSA)
Mechanical congestion of the eustachian tubes
- Recurrent chronic otitis media
- Tympanic effusion
- Conductive hearing loss → developmental disorders (e.g., language development disorder)
Hyperplasia of the pharyngeal tonsil does not itself cause symptoms. The patient only becomes symptomatic after congestion of the choanae and auditory tubes.
Diagnosis
- Flexible nasopharyngoscopy showing hyperplasia of the adenoids
Treatment
- Asymptomatic adenoid vegetations do not require treatment.
-
Adenotonsillectomy, or surgical excision of adenoids, is indicated for:
- Chronic/recurrent otitis media in children
- Chronic/recurrent sinusitis
- Severe symptomatic nasal obstruction (e.g., obstructive sleep apnea)
- Treat the underlying cause of inflammation (e.g., intranasal corticosteroids for allergies or antibiotics for infection)