Adenoid hypertrophy (enlarged adenoids) is the unusual growth (
hypertrophy
Hypertrophy is the increase in the volume of an organ or tissue due to the enlargement of its component cells. It is distinguished from hyperplasia, in which the cells remain approximately the same size but increase in number.Updated by Linda J ...
) of the
adenoid
In anatomy, the adenoid, also known as the pharyngeal tonsil or nasopharyngeal tonsil, is the superior-most of the tonsils. It is a mass of lymphatic tissue located behind the nasal cavity, in the roof of the nasopharynx, where the nose blends ...
(pharyngeal tonsil) first described in 1868 by the Danish physician
Wilhelm Meyer (1824–1895) in
Copenhagen
Copenhagen ( or .; da, København ) is the capital and most populous city of Denmark, with a proper population of around 815.000 in the last quarter of 2022; and some 1.370,000 in the urban area; and the wider Copenhagen metropolitan ar ...
. He described a long term adenoid hypertrophy that will cause an obstruction of the nasal airways. These will lead to a dentofacial growth anomaly that was defined as "adenoid facies" (see
long face syndrome Long face syndrome, also referred to as skeletal open bite, is a relatively common condition characterised by excessive vertical facial development. Its causes may be either genetic or environmental. Long face syndrome is "a common dentofacial abno ...
).
There is very little lymphoid tissue in the nasopharynx of young babies; humans are born without substantial adenoids. The mat of lymphoid tissue called adenoids starts to get sizable during the first year of life. Just how big the adenoids become is quite variable between individual children.
Signs and symptoms
![Adenoid hypertrophy](https://upload.wikimedia.org/wikipedia/commons/f/f6/Adenoid_hypertrophy.jpg)
Enlarged adenoids can become nearly the size of a
ping pong ball
Table tennis, also known as ping-pong and whiff-whaff, is a sport in which two or four players hit a lightweight ball, also known as the ping-pong ball, back and forth across a table using small solid rackets. It takes place on a hard table div ...
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
Mouth breathing, medically known as chronic oral ventilation, is long-term breathing through the mouth. It often is caused by an obstruction to breathing through the nose, the innate breathing organ in the human body. Chronic mouth breathing ma ...
. Adenoids can also obstruct the nasal airway enough to affect the voice without actually stopping nasal airflow altogether.
Nasal blockage is determined by at least two factors: 1) the size of the adenoids, and 2) the size of the nasal pharynx passageway.
The adenoid usually reaches its greatest size by about age 5 years or so, and then fades away ("atrophies") by late childhood - generally by the age of 7 years. The lymphoid tissue remains under the mucosa of the
nasopharynx
The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and trachea (the tubes going down to the stomach and the lungs). It is found in vertebrates and invertebrates, though its struct ...
, and could be seen under a microscope if the area was biopsied, but the mass is so reduced in size that the roof of the nasopharynx becomes flat rather than mounded. Just as the size of the adenoids is variable between individuals, so is the age at which adenoids atrophy.
The symptoms caused by enlarged adenoids are mostly due to ''where'' this lymphoid tissue is located. The adenoids are in the midline of the nasopharynx, and the
Eustachian tubes open from either ear to the right and left of them. In children with excessive middle ear infections and chronic middle ear fluid, there is a high bacterial count in the adenoids as compared to children without problematic otitis media, even if the size of the adenoids is small. The adenoids in these cases provide a reservoir of pathogenic bacteria that cause ear infections and subsequent middle ear effusions (fluid).
The nasopharynx lies directly above the throat. Splashes of excessive "drip" from infected adenoids may fall directly onto the
vocal cords
In humans, vocal cords, also known as vocal folds or voice reeds, are folds of throat tissues that are key in creating sounds through vocalization. The size of vocal cords affects the pitch of voice. Open when breathing and vibrating for speech ...
. Although the
larynx
The larynx (), commonly called the voice box, is an organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal inlet is about ...
and vocal cords do not ordinarily become infected from adenoiditis, their
mucosa
A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It is ...
does become irritated. The vocal cords are extremely sensitive to touch, and any fluid drops falling on them cause an irresistible urge to cough. Adenoiditis therefore is one of the causes of cough.
Causes
The adenoids, like all lymphoid tissue, enlarge when infected. Although lymphoid tissue does act to fight infection, sometimes
bacteria
Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were among ...
and
viruses
A virus is a submicroscopic infectious agent that replicates only inside the living cells of an organism. Viruses infect all life forms, from animals and plants to microorganisms, including bacteria and archaea.
Since Dmitri Ivanovsky's 1 ...
can lodge within it and survive. Chronic infection, either viral or bacterial, can keep the pad of adenoids enlarged for years, even into adulthood. Some viruses, such as the
Epstein–Barr virus
The Epstein–Barr virus (EBV), formally called ''Human gammaherpesvirus 4'', is one of the nine known human herpesvirus types in the herpes family, and is one of the most common viruses in humans. EBV is a double-stranded DNA virus.
It is b ...
, can cause dramatic enlargement of lymphoid tissue. Primary or reactivation infections with Epstein–Barr virus, and certain other bacteria and viruses, can even cause enlargement of the adenoidal pad in an adult whose adenoids had previously become atrophied.
Diagnosis
# Posterior
rhinoscopy
A Rhinoscope (or Nasoscope) is a thin, tube-like instrument used to examine the inside of the nose. A rhinoscope has a light and a lens for viewing and may have a tool to remove tissue.
Types
Rhinoscopy is performed by two procedures.
* Anterio ...
: was used in earlier times; the postnasal space is visualized using a posterior rhinoscopy mirror.
# Diagnostic nasal
endoscopy
An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...
: A rigid or a flexible
nasopharyngoscope can help to see details in a cooperative child.
#
Computed tomography scan of nasopharynx
#
X-ray
An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...
lateral view of nasopharynx
Detailed nasal examination should always be done to exclude other causes of nasal obstruction.
Treatment
There is some low-quality evidence suggesting that
mometasone
Mometasone, also known as mometasone y 3 s, is a steroid medication used to treat certain skin conditions, hay fever, and asthma. Specifically it is used to prevent rather than treat asthma attacks. It can be applied to the skin, inhaled, or use ...
may lead to symptomatic improvement in children with adenoid hypertrophy.
Surgical removal of the adenoids is a procedure called
adenoidectomy
Adenoidectomy is the surgical removal of the adenoid for reasons which include impaired breathing through the nose, chronic infections, or recurrent earaches. The effectiveness of removing the adenoids in children to improve recurrent nasal sympto ...
. Carried out through the mouth under a
general anaesthetic
General anaesthetics (or anesthetics, see spelling differences) are often defined as compounds that induce a loss of consciousness in humans or loss of righting reflex in animals. Clinical definitions are also extended to include an induced coma ...
, adenoidectomy involves the adenoids being
curette
A curette is a surgical instrument designed for scraping or debriding biological tissue or debris in a biopsy, excision, or cleaning procedure. In form, the curette is a small hand tool, often similar in shape to a stylus; at the tip of the cu ...
d,
cauterised, lasered, or otherwise ablated. Adenoidectomy is most often performed because of nasal obstruction, but is also performed to reduce middle ear infections and fluid (
otitis media
Otitis media is a group of inflammatory diseases of the middle ear. One of the two main types is acute otitis media (AOM), an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling at the ear, ...
). The procedure is often carried out at the same time as a
tonsillectomy
Tonsillectomy is a list of surgical procedures, surgical procedure in which both palatine tonsils are fully removed from the back of the throat. The procedure is mainly performed for recurrent tonsillitis, throat infections and obstructive sleep ...
, since the adenoids can be clearly seen and assessed by the surgeon at that time.
Additional reading
*
*
BUPA Health Fact Sheet. "Adenoidectomy"
References
External links
{{Circulatory and respiratory system symptoms and signs
Mouth
Tonsil disorders
Gross pathology
Otorhinolaryngology