Adenoid hypertrophy

Adenoid hypertrophy, also known as enlarged adenoids refers to an enlargement of the adenoid (pharyngeal tonsil) that is linked to nasopharyngeal mechanical blockage and/or chronic inflammation. Adenoid hypertrophy is a characterized by hearing loss, recurrent otitis media, mucopurulent rhinorrhea, chronic mouth breathing, nasal airway obstruction, increased infection susceptibility, dental malposition, and dentofacial abnormalities ("adenoid facies" or "mouth breather face").

The exact cause of adenoid hypertrophy in children remains unclear, but it is likely linked to immunological responses, hormonal factors, or genetic components. Adenoid hypertrophy is an immunological abnormality characterized by altered cytokine production, with children experiencing higher levels of proinflammatory cytokines. Adenoid hypertrophy can also be caused by gastric juice exposure during gastroesophageal reflux disease, passive smoking, and recurrent bacterial and viral infections. Pathogen colonization can disrupt the immune system's equilibrium with the adenoid's natural flora. Genetic factors, such as variations in TLR2 and TLR4 genes, also contribute to the condition. Adenoids naturally undergo hypertrophy between the ages of 6-10 and atrophy around 16 years old.

A clinical examination and nasoendoscopy are the gold standard for diagnosing adenoid hypertrophy. Visual examinations should be conducted to identify adenoid facies, eczema, and similar signs in diseases like partial choanal atresia, significant palatine tonsil hyperplasia, nasal airway blockage, endonasal foreign bodies, nasal concha hyperplasia, and allergic or viral rhinitis. Neoplasms, benign or malignant ones, should be ruled out. Screening for juvenile nasopharyngeal angiofibroma is crucial in male adolescents, while adult patients should be evaluated for carcinoma and lymphoma. Thornwaldt cysts should also be considered in the differential diagnosis.

Patients with adenoid hyperplasia alone should follow conservative therapy and off-label intranasal corticosteroids. Patients with significant symptoms and unsatisfactory responses to conservative measures may be candidates for adenoidectomy. An adenoidectomy can shrink and reduce nasal obstruction in patients. Patients usually experience improved eustachian tube function, reduced obstruction, and decreased nasal discharge. The prevalence of adenoid hypertrophy in the pediatric population is estimated to be 34%.

Enlarged adenoids can become nearly the size of a ping pong ball and completely block airflow through the nasal passages. Even if enlarged adenoids are not substantial enough to physically block the back of the nose, they can obstruct airflow enough so that nasal breathing requires an uncomfortable amount of work, and inhalation occurs instead through mouth breathing. Adenoids can also obstruct the nasal airway enough to affect the voice without stopping nasal airflow.

Adenoid hypertrophy is characterized by several typical signs and symptoms, including conductive hearing loss, recurrent otitis media (including cholesteatoma), mucopurulent rhinorrhea, chronic mouth breathing, nasal airway obstruction, increased susceptibility to infection, and occasionally dental malposition.

If left untreated, adenoid hypertrophy can cause pulmonary hypertension, ear issues, obstructive sleep apnea, failure to thrive, and craniofacial abnormalities.

The exact cause of adenoid hypertrophy in children is unclear. Most likely, immunological responses, hormonal factors, or genetic components have some relationship. Contributing environmental factors include air pollution and smoking.