Adenoid hypertrophy

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Adenoid hypertrophy is hyperplasia of the pharyngeal tonsils and only becomes symptomatic when it leads to congestion of the choanae and eustachian tubes. The condition is common in children and causes recurrent inflammation of the upper respiratory tract.

Causes

  • Physiological
  • Adenoidal inflammation due to:
    • Viral or bacterial infections 
    • Allergens

Signs and symptoms

  • Nasal obstruction leading to mouth−breathing
  • Difficulty in breathing and eating, drooling, snoring and toneless voice.
  • “Adenoid facies” may later develop
  • Eustachian tube obstruction often leads to deafness.
  • Other features:
    • Nasal discharge
    • Postnasal drip
    • Cough
    • Cervical adenitis
  • Mental dullness and apathy may be marked due to poor breathing, bad posture or deafness.
  • Nocturnal enuresis
  • Habit tics and night terrors may be aggravated

Investigations

  • History
  • X−ray lateral view of the nasopharynx

Differential diagnosis

  • Allergic rhinitis
  • Sinusitis
  • Otitis media

Complications

  • Sinusitis
  • Recurrent otitis media
  • Pneumonitis

Treatment objectives

  • To significantly improve nasopharyngeal airway and consequently improve nasal breathing
  • Treat concurrent infection

Non-pharmacological treatment

  • Bed rest and warmth
  • Analgesics e.g. paracetamol
  • Steam inhalation
  • Asymptomatic patients do not require treatment

Pharmacological treatment

  • Asymptomatic adenoid vegetations do not require treatment
  • Treat the underlying cause of inflammation 

Allergies:

Beclomethasone nasal spray

<6 years: Not recommended as safety and efficacy are not established

6-11 years: 1 spray/nostril twice daily (168 mcg/day)

Note:

  • May increase to 2 sprays/nostril (336 mcg/day) in patients not adequately responding or those with more severe symptoms
  • Decrease dose to 1 spray/nostril twice daily once adequate control is achieved

>12 years and adults: 1-2 sprays/nostril twice daily (total dose: 168-336 mcg/day)

Antibiotics for infection

Amoxicillin oral

Adult:

500 mg every 8 hours for 10-14 days

Child:

15mg/kg (maximum 500mg) every 8 hours for 10-14 days

Patient Education

  • Clear the nose regularly
  • Keep the child warm
  • Breastfeed frequently
  • Return quickly if:
    • Child's condition worsens
    • Breathing is difficult
    • Feeding becomes a problem.

Referral

  • Refer to ENT surgeon for adenotonsillectomy (surgical excision of adenoids) for:
    • Chronic/recurrent otitis media in children
    • Chronic/recurrent sinusitis
    • Severe symptomatic nasal obstruction (e.g., obstructive sleep apnoea)