Adenoid hypertrophy/Enlarged adenoids
The adenoids (lymphatic tissue
in the back of the throat), along
with the tonsils, comprise the
An enlargement of the adenoids (lymphatic tissue in the back of the throat). The
adenoids, along with the tonsils, comprise the Waldeyer ring.
Causes, incidence, and risk factors:
Hypertrophy (enlargement) of the adenoids may occur naturally (beginning
during fetal development) or be caused by chronic inflammation . This
enlargement can cause breathing difficulties ranging from mouth breathing,
snoring, bad breath, and chronic runny nose, to health threatening conditions
such as intermittent sleep apnea, pulmonary hypertension, and right-sided heart
failure (cor pulmonale).
Hypertrophy (enlargement) of the
adenoids may occur naturally (beginning during fetal development), or it
may be caused by chronic
inflammation. This enlargement can cause breathing
difficulties ranging from mouth breathing, snoring,
breath, and chronic runny
nose, to health threatening conditions such as intermittent sleep
hypertension, and right-sided
heart failure (cor
- mouth breathing (mostly at night)
- dry mouth
- cracked lips
- mouth open during day (more severe obstruction)
- bad breath
- persistent runny nose or nasal congestion
- frequent ear infections (otitis media)
- restlessness while sleeping
- intermittent sleep apnea
Signs and tests:
Physical examination of the throat confirms that the tonsillar tissue is enlarged.
The adenoids cannot be visualized by looking in the mouth directly but can be
seen with a special mirror looking into the nasopharynx.
X-ray, side view of the throat demonstrates hypertrophy of the adenoids.
sleep apnea studies (severe cases only)
Treatment - การรักษา :
Adenoidectomy (surgical removal of the adenoids) will prevent complications,
and will cure complications if they already exist from adenoid hypertrophy.
Antibiotics may be used to treat tonsil, adenoid, and sinus infections when they
|| The adenoids are lymph tissue
at the back of the throat.
Adenoidectomy (removal of the
adenoids) is frequently done in
conjunction with surgical removal
Conservative treatment by change
of climate and drugs is not satisfactory in the majority of the cases.
Surgical treatment is by
adenoidectomy. There are some different opinions about it among
Otorrhynolaryngologist, Pediatrics and Allergists. Nowadays the adenoid is
seen as a lymphatic tissue and the indication of surgery is very
judicious.There is absolute indication of surgery in cases of severe
obstructive of the airways causing Obstructive sleeping apnea syndrom (OSAS
) and cor pulmonale. Relative surgery indications are recurrent otitis
media, recurrent sinusitis, oral and facial deformities.
The surgery is realized under
general anesthesia and adenoid is removed with Beckmans ring adenotome
which separates the adenoid at its base. As the adenoid grows principally
between 3-5 years, when possible we should postpone the surgery until this
time .If it is done before this time there is possibility of growth of
this lymphoid organ and necessity of another surgery.
Full recovery is expected. Right-sided heart failure (cor pulmonale) is reversible
on correction of the sleep apnea and airway obstruction.
right-sided heart failure (cor pulmonale)
chronic otitis media
Calling your health care provider:
Call your health care provider if your child has symptoms of airway obstruction
that interferes with normal nasal breathing, or if the child has other symptoms
Early treatment of throat infections may reduce hypertrophy associated with
chronic infection and inflammation. Adenoidectomy prevents the complications
associated with chronic airway obstruction related to hypertrophy.
1) ARMSTRONG P., WASTIE M.L. Diagnostic Imaging 3.ed. p 418,1992.
2) BECKER W., NAUMANN H.H, PFLALTZ C.R, Ear nose and Throat disease 2.ed.
p 307,312,320-322, 1994.
3) HUNGRIA H, Otorrinolaringologia 6.ed. p 141-142,1991.
4) Manual de Otorrinolaringologia da Sociedade Brasileira de Pediatria ,p