Adenoiditis

• Inflammation/Enlargement of the adenoids which can cause obstruction to the nasopharyngeal airway
• Consequent recurrent sinonasal infections, otitis media, or maldevelopment of the face (adenoids facies) can result

• Common in children (immunologically active age)
• Physiological hypertrophy (peak 2-4 years)
• Recurrent upper respiratory tract infections
• Allergy
• Low socioeconomic status
• Environmental factors

Adenoids hypertrophy in adults though not common should raise suspicion of lymphoma.

Causative Organisms

• Bacterial: Most common cultured bacteria are
• Hemophilus influenzae
• GABHS
• Staphylococcus aureus
• Moraxella catarrhalis
• Streptococcus pneumoniae
• Mycobacterium tuberculosis… rare

• Increased aerobic bacterial load and the number of B and T cells.
• Increased dendritic cells in the crypts and extrafollicular areas but less in the surface epithelium.
• Physiological hypertrophy.

Nasal Symptoms

• Nasal obstruction with mouth breathing and snoring
• Anterior nasal discharge - mucoid or mucopurulent
• Postnasal drip
• Obstructive sleep apnea
• Hyponasal speech
• Epistaxis - rare

Ear Symptoms

• Recurrent otalgia
• Aural fullness
• Impaired hearing
• Ear discharge

Throat Symptoms

• Recurrent sore throat
• Dysphagia
• Change in voice

General Symptoms

• Mental dullness
• Nocturnal enuresis
• Night terrors
• Growth retardation
• Frequent diarrhea
• Malnutrition

• Dull appearance
• Pinched nose
• Mouth breathing
• Dribbling of saliva
• Flat nasal arch
• Malar hypoplasia
• Elongated face
• Loss of nasolabial fold
• Short protruding upper lip
• Crowding of teeth
• High-arched palate

Nasal:

• Reduced or absence of nasal patency
• Discharge (usually in the floor or middle meatus)
• Engorged turbinates
• Mucosal congestion and edema
• Posterior rhinoscopy: enlarged adenoids

Aural:

• Retracted or bulging tympanic membrane
• Ear discharge may be seen
• Conductive deafness with tuning fork

Throat:

• Mucosal congestion of the pharynx
• Granular posterior pharyngeal wall
• Postnasal drip may be seen

Neck:

• Cervical lymphadenopathy (upper deep cervical and posterior triangle lymph nodes)

• Diagnostic nasal endoscopy
• X-ray postnasal space
• Sleep studies - polysomnography
• Computed tomographic scan

Medical Treatment

• Control of recurrent respiratory/aural infection
• Antihistamines and decongestants
• Steroid nasal spray
• Improve nutritional status
• Adequate bed rest
• Breathing exercises

Surgical Treatment

• Adenoidectomy
• Myringotomy and grommet insertion (required if associated with otitis media with effusion)

Indications for Adenoidectomy

• Recurrent acute otitis media
• Otitis media with effusion in the presence of reduced nasal airway, affecting both ears and may present for at least 3 months
• Triad of snoring, mouth breathing, and hyponasal speech in a patient with adenoid enlargement
• For biopsy of suspected malignancy