ADENOIDS

Anatomy and Physiology
The nasopharyngeal tonsils, commonly called "adenoids",
is situated at the junction of the roof and posterior wall of
the nasopharynx. It is composed of vertical ridges of lymphoid
tissue separated by deep clefts and covered by ciliated
columnar epithelium. Unlike palatine tonsils,
adenoids have no crypts and no capsule. Adenoid tissue is
present at birth, shows physiological enlargement up to the
age of six years, and then tends to atrophy at puberty and
almost completely disappears by the age of 20.
Adenoids receive their blood supply from :
(i) Ascending palatine branch of facial.
(ii) Ascending pharyngeal branch of external carotid.
(iii) Pharyngeal branch of the third part of maxillary
artery.
(i v) Ascending cervical branch of inferior thyroid
artery of thyrocervical trunk.
Lymphatics from the adenoid drain into upper jugular
nodes directly or indirectly via retropharyngeal and parapharyngeal
nodes.
Aetiology
Adenoids are subject to physiological enlargement in
childhood. Certain children have a tendency to generalised
lymphoid hyperplasia in which adenoids also take
part.
Recurrent attacks of rhinitis, sinusitis or chronic tonsillitis
may cause chronic adenoid infection and hyperplasia.
Allergy of the upper respiratory tract may also contribute
to the enlargement of adenoids.
Clinical Features
Symptoms and signs depend not merely on the absolute
size of the adenoid mass but are rel ative to the available
space in the nasopharynx.
Enlarged and infected adenoids may cause nasal, aural
or general symptoms.
A. Nasal Symptoms
1. . Nasal obstruction is the commonest symptom. This
leads to mouth breathing. Nasal obstruction also
interferes with feeding or suckling a child. As respiration
and feeding cannot take place simultaneously,
a child with adenoid enlargement fails to
thrive. .
2. Nasal discharge. It is partly due to choanal obstruction,
as the normal nasal secretions cannot drain into
nasopharynx and partly due to associated chronic
rhinitis. The child often has a wet bubbly nose.
3. Sinusitis. Chronic maxillary sinusitis is commonly
associated with adeno ids. It is due to persistence of
nasal discharge and infection. Reverse is also true that
a primary maxillary sinusitis may lead to infected and
enlarged adenoids.
4. Epistaxis. When adeno ids are acutely inflamed, epistaxis
can occur with nose blowing.
5. Voice change. Vo ice is tone less and loses nasal quality
due to nasal obstruction.
B. Aural Symptoms
1. Tubal obstruction . Adenoid mass blocks the
eustachian tube leading to retracted tympaniC membrane
and conductive hearing loss.
2. Recurrent attacks of acute otitis media may occur due
to spread of infection via the eustachian tube.
3. Chronic suppurative otitis media may fail to resolve in
the presence of infected adenoids.
4. Serous otitis media. Adenoids form an important cause
of serous otit is media in children. The waxing and
waning size of adeno ids causes intermittent eustachian
tube obstruction with fluctuating hearing loss.
c. General Symptoms
1. Adenoid facies: Chronic nasal obstruction and
mouth breathing lead to characteristic facia l appearance
called adenoid facies. The child has an elongated
face with dull expression, open mouth
prominent and crowded upper teeth, and hitched up
upper lip. Nose gives a pinched-in appearance due
to disuse atrophy of alae nasi. Hard palate in the;e
cases is highly arched as the moulding action of the
tongue on palate is lost.
2. Pulmonary hypertension. Long-stand ing nasal
obstruction due to adenoid hypertrophy can cause
pulmonary hypertension and cor pu lmonale.
Diagnosis
Examination of postnasal space is possible in some young
children and an adenoid mass can be seen with a mirror.
A rigid or a flexible nasopharyngoscope is also useful [
see details of the nasopharynx. Soft tissue lateral radiograph
of nasopharynx will reveal the size of adenoid
and also the extent to which nasopharyngeal air Sp8 C~
has been compromised. Detailed nasal exam·
ination shou ld always be conducted to exc lude otht'"
causes of nasal obstruction.
Treatment
When symptoms are not marked, breathing exercises,
decongestant nasal drops and antihistaminics for any coexistent
nasal allergy can cure the condition without
resort to surgery.
When symptoms are marked, adenoidectomy is done.