Adenoids

Position, Signs and symptoms, examination, Differential Diagnosis, Treatment is discussed here

1. “ADENOIDS” Dr. Shraddha Joshi Ph.D. 1 st year Shalakya Tantra Dept. ITRA Jamnagar

2. ADENOIDS Also known as Lushka’s tonsils, Nasopharyngeal tonsils. Hypertrophy of lymphoid tissue sufficient to produce symptoms. Commonly between age of 3-7 years.

3. Etiology Physiological : Occurs due to marked immunological activity. Gradually regresses in size with the increase in size of the nasopharynx to become atrophic at puberty. Persistence of adenoid into adult life is uncommon. Pathological : Due to: Recurrent URTI. Recurrent Rhino- sinustis .

4. Symptoms May produce symptoms due to relative disportion in size between the adenoid and the nasopharynx . Obstruction of naso -pharynx may be responsible for the following: Nasal diseases: Attacks of cold, persistent nasal discharge, obstruction, hypo-nasality, snoring. Mouth breathing. Noisy respiration- while awake and snoring during sleep. Difficulty in feeding. Olfactory sensitivity is reduced ( in relation to adenoids size).

5. Aural diseases: ET dysfunction resulting in chronic tubal disease. Recurrent attacks of earache, otitis media with effusion, recurrent ASOM. Formation of adhesions. COM leading to deafness and ear discharge. Nocturnal cough and headache. Recurrent infection: Recurrent rhino-sinusitis. Recurrent ASOM Post nasal drip Recurrent pharyngitis. Chronic irritative cough. Recurrent bronchitis

6. Disorders of masticatory units: Mal-development of upper jaw as high arched or gothic palate ( due to absence of pressure of the tongue on the upper jaw, and absence of lateral pressure on the upper jaw and alveolus by the tension of buccinator muscles and the masticatory muscles because of the open mouth breathing.) Anomalies of position of the teeth or incorrect contact may result.

7. Disorders of lower respiratory tract: Results in chronic laryngitis and bronchitis. Loss of development and poor general development may result. Effects on intelligence and mental development: Chronic respiratory obstruction & hypoxia & increased levels of CO 2 resulting in restlessness, disturbed/ broken sleep & daytime sleeping. Lack of concentration- due to hearing loss. Recurrent infections- results in sick leave from school. Nocturnal emesis. Child- Shy & not friendly.

8. GIT Disturbances: Morning vomiting: due to swallowed PND. Indigestion: As child swallows bolus of food. Loss of appetite: Due to loss of olfaction. Dry mouth: Due to mouth breathing.

9. Signs General Examination: Adenoid facies (Long face syndrome). Dull look Pinched nostrils Loss of naso labial fold Retracted upper lip Open mouth breathing Protruding teeth, crowding teeth and hyperplasia of gums. Narrow maxillary arch. High arch palate. Vacant expression

10. Guye’s aprosexia - Children will have subnormal mental condition with inability to concentrate and lack of attention. Associated findings: Flat chest or Pectus excavatum . Rounded shoulders.

11. Specific Examination: Nasal Cavity: When the airflow through the nasal cavity ceases due to adenoid hypertrophy, a characteristic secondary change occurs in the mucosa of the anterior nasal cavity. This change consists of a state of vasoconstriction. Purple discoloration of the mucosa of anterior portion of the IT. (D/D Allergic Rhinitis) Nasal Discharge: Thick mucoid & mucopurulent nasal discharge.

12. Oral Cavity & Oropharynx : Protruding teeth with misalignment. Inflamed spongy gum. High arch palate Posterior rhinoscopy reveals adenoid hypertrophy (above 6 years of age). Classical triad of Calanan : Bifid uvula. Soft palate muscles diathesis giving a translucent zone. Bony notch in the hard palate on palpation, which indicates the presence of submucous cleft palate.

13. Ear : Eustachian tube dysfunction or otitis media with effusion. Flexible nasalpharyngoscopy : Examine the percentage of obstruction and an occult submucous cleft palate. In case of occult submucous cleft palate: a concavity In vediofluoroscopy : Soft palate appears thin and foreshortened.

14. Investigations: Specific: X-ray of nasopharynx lateral view. Rigid/flexible nasal endoscopy: Gold Standard Grading of adenoid on endoscopy: Grade I: Obstruction of upto 1/3 rd of choana . Grade II: Obstruction of 1/3 rd to 2/3 rd of choana . Grade III: Obstruction of upto 2/3 rd to near complete obstruction of choana . Grade IV: Complete obstruction of choana .

15. Investigations: Related: Pure Tone Audiometry. Tympanogram . Differential Diagnosis: Antrochoanal Polyp Juvenile Angiofibroma Meningioma Encephalocele

16. Complications of Adenoid Hypertrophy: Recurrent attacks of otitis media. Otitis media with effusion. Sinusitis Rhinolalia Clausa Treatment : Adenoidectomy (Usually combined with tonsillectomy.)