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Adenoidal Hypertrophy

Alternative Names: Adenoidal enlargement.

Definition: Increased size of the adenoid.

What Is Going on in My Body? The adenoid, along with the tonsils at the back of the mouth and tonsillar tissue at the base of the tongue form a ring of tissue (Waldeyer’s ring) that assists in preventing bacteria, viruses, and toxins from entering the body. The adenoid and the tonsillar tissues are largely composed of a group of blood cells termed B lymphocytes, which make antibody. This antibody binds bacteria, viruses, and other toxins and inactivates them, thus keeping them from entering into the body and causing disease. Unlike the tonsils which can be seen by looking directly through the mouth, the adenoid is positioned at the backmost part of the nasal cavity and up behind the soft palate. The adenoid, like tonsillar tissue, can be involved with both acute and chronic infections. With ongoing infection or inflammation, the adenoid can progressively enlarge. Since it sits at the backmost part of the nasal cavity, its main symptoms affect nasal function.

What Are the Signs and Symptoms? With an enlarged adenoid, airflow is prevented from moving through the backmost part of the nasal cavity down into the airway. Therefore, individuals who have a hypertrophic adenoid often have difficulty breathing through their nose and tend to mouth-breathe. As a result, these children take a long time to eat since they have to stop chewing to mouth-breathe. The normal healthy nose also manufactures mucus. This mucus is normally swept through the back part of the nasal cavity and then swallowed. However, if the adenoid is enlarged, it can prevent mucus from exiting the back part of the nasal cavity. Therefore, individuals with a hyperplastic, enlarged adenoid tend to have runny noses. An infected adenoid can also impair drainage from the ear through the eustachian tube and thus lead to difficulties with fluid accumulating behind the eardrum (otitis media) or eustachian tube dysfunction. An enlarged, diseased adenoid has also been implicated in nighttime upper airway obstruction in children. Typically these children snore quite loudly and may even have obstruction of their upper airway (sleep apnea). In children a diseased adenoid can also cause symptoms of chronic sinusitis.

What Are the Causes and Risks? Most of the time the cause of an enlarged adenoid is not clear. In studies where they have been compared to more normal-sized adenoids, a chronic infection with Hemophilus influenza, a normal bacteria of the upper respiratory tract, has been identified. The adenoid can also hypertrophy from chronic irritation from infected or inflamed nasal secretions being swept back over it. There may be some adenoidal enlargement occurring with chronic allergic states. Adenoidal hyperplasia in adults is quite rare. If it is identified, malignancies of the type B white blood cell (lymphoma plasmacytoma) or HIV must be considered.

How to Prevent the Disease: There is no way to prevent adenoidal hypertrophy.

HOW IS IT DIAGNOSED: In young children one of the easiest ways to identify it is with an x-ray. In older children it can often be diagnosed in the office by using a mirror to examine the area behind the palate. An additional way to diagnose it is to use fiberoptic nasal examination. This employs either flexible or rigid fiberoptic instruments. In this fashion the adenoid can be examined at the back part of the nasal cavity directly.

What Are the Long-Term Effects? Long-term adenoidal enlargement can lead to ear disease and chronic mouth-breathing. There is some concern that chronic mouth-breathing in children may result in elongation of the middle part of the face and a narrow, high-arched palate that can result in orthodontic abnormalities. Undiagnosed obstructive sleep apnea may cause pulmonary hypertension, poor mental alertness, and hypertrophy of the right side of the heart.

Am I Putting Others at Risk? No.

What Are the Treatments? If the adenoidal enlargement is fairly acute, it will often respond to antibiotics and oral steroids. In some individuals a big adenoid can be reduced by long?term nasal steroid sprays. In those who do not respond to these forms of medication management, surgery is often employed.

What Are the Side Effects to the Treatments? As with any antibiotic, there is always the possibility of allergic reactions. Brief courses of oral steroids usually have few side effects and do not have any of the typical long-term side effects often associated with chronic steroid usage. Short-term oral steroids may be complicated by stomach irritation, appetite stimulation, irritability, sleep disturbance, or fluid retention. The main side effect to surgical treatment involves the brief hangover that can occur with general anesthetics. Fortunately, there are very few risks associated with removal of the adenoid (adenoidectomy). The main immediate post-operative complication is excessive bleeding, but this is seen in less than 1% of patients.

What Happens After Treatment? If the adenoid is acutely enlarged and responds well to antibiotic and steroid therapy, then it will return to a smaller size, with lessening of the amount of nasal obstruction. However, if the adenoid re-enlarges and re-creates the symptoms, surgery would then be necessary. Typically those individuals who have required adenoidectomy have an improvement in eustachian tube function and lessening of their nasal obstruction and excessive nasal discharge; and in those children who have had their adenoid removed for chronic sinus disease, 25% of them will have their sinus disease resolve.

How Do I Monitor the Disease? The main way to monitor the disease is by symptoms of nasal obstruction, chronic nasal discharge, and ear disease.

What Are the Resources and Support Available? This is not really applicable to this particular topic.