Adenoid Hyperplasia

Adenoid hyperplasia (adenoid hypertrophy) is enlargement of the lymphoid tissue of the nasopharynx. It's a fairly common childhood condition. Normally, adenoidal tissue is small at birth (¾"% to 1¼ " [2 to 3.2 cm]), grows until the child reaches adolescence, and then slowly begins to atrophy. In adenoid hyperplasia, this tissue continues to grow.

Causes

Most tonsil and adenoid hypertrophy is simply caused by the normal growth pattern for that type of tissue. Less often, the hypertrophy is due to repeated throat infections by cold viruses, strep throat, mononucleosis, and in the past, diphtheria. The acute infections are usually referred to as tonsillitis, the adenoids getting little recognition because they cannot be seen without special instruments. Symptoms include painful, bright red, often ulcerated tonsils, enlargement of lymph nodes (glands) beneath the jaw, fever, and general discomfort.

Signs and Symptoms

Typically, adenoid hyperplasia produces symptoms of respiratory obstruction. Parents may report that the child breathes through the mouth; snores at night; experiences frequent, prolonged nasal congestion; and has a history of chronic otitis media with some hearing loss. Sleep apnea, rhinorrhea, daytime sleepiness, fatigue, fever, and nasal discharge are also common.

The child may mention a decrease in appetite due to alteration in taste and smell.

Inspection confirms mouth breathing. The child's voice may sound nasal and muffled. You may also detect foul breath and dry oral mucous membranes. If the child experienced persistent mouth breathing during the formative years, inspection may show distinctive facial features changes, including a slightly elongated face, open mouth, highly arched palate, shortened upper lip, and vacant expression. Signs of nocturnal respiratory insufficiency may be apparent, including intercostal retractions and nasal flaring.

Cervical posterior lymph nodes may feel enlarged on palpation.

Diagnostic tests

Nasopharyngoscopic or rhinoscopic visualization of abnormal tissue mass confirms adenoid hyperplasia. X-rays (lateral pharyngeal films) show obliteration of the nasopharyngeal air column and lymphoid hypertrophy.

Treatment

Antibiotics initially may be used for recurring infection of the adenoids and adenoid hypertrophy. If medical management isn't effective, surgery is indicated. Adenoidectomy, the treatment of choice for adenoid hyperplasia, commonly is recommended for the patient with recurrent or prolonged mouth breathing, nasal speech, adenoid facies, recurrent otitis media, constant nasopharyngitis, and nocturnal respiratory distress. This procedure usually eliminates recurrent nasal infections and ear complications and reverses secondary hearing loss.

Adenoidectomy should be performed in conjunction with tympanotomy tube placement when the adenoidal hypertrophy contributes to ear disorders. Antibiotics may be used to treat infection. Decongestants may be used to decrease edema.

Prevention

Prevention can be directed toward prompt evaluation and appropriate treatment of sore throats to prevent overgrowth of adenoid tissue. Avoiding other children with acute respiratory illness also reduces the spread of these common illnesses.