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 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 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%.