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 ต่อมอดีนอยด์โต
 Adenoid hypertrophy/
 Enlarged adenoids




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  ต่อมอดีนอยด์โต Adenoid hypertrophy/Enlarged adenoids      
  The adenoids (lymphatic tissue
  in the back of the throat), along  
  with the tonsils, comprise the 
  Waldeyer ring. 


Definition:
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, bad breath, and chronic runny nose, to health threatening conditions such as intermittent sleep apnea, pulmonary hypertension, and right-sided heart failure (cor pulmonale).


Symptoms:
- 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)
- snoring
- 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 
occur. 

 The adenoids are lymph tissue 
  at the back of the throat.  
  Adenoidectomy (removal of the 
  adenoids) is frequently done in 
  conjunction with surgical removal 
  of tonsils. 

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 Beckman’s 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.


Expectations (prognosis):
Full recovery is expected. Right-sided heart failure (cor pulmonale) is reversible 
on correction of the sleep apnea and airway obstruction. 


Complications:

right-sided heart failure (cor pulmonale)
sleep apnea
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 
discussed above. 


Prevention:
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. 

Bibliography
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 60-62, 82.


   


 






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