What is adenoid hypertrophy?
Adenoids are pathologically enlarged due to repeated inflammatory stimulation and cause symptoms called adenoid hypertrophy.
Anatomy of adenoids
Adenoids, also known as pharyngeal tonsils and proliferators, are hidden in the posterior end of the nasal cavity, located at the junction of the nasopharyngeal apex and posterior wall, between the two sides of the pharyngeal fossa, and are the lymphatic tissue at the top of the nasopharynx. It is shaped like a peeled orange, with 5 to 6 longitudinal grooves, which are prone to bacterial retention. The adenoids are present after birth and are largest around 6 years of age, and generally shrink gradually after 10 years of age.
Causes of adenoid hypertrophy
The adenoids can rapidly grow and hypertrophy, causing increased nasal obstruction and obstructing nasal drainage, and the secretions from rhinitis and sinusitis stimulate the adenoids to continue to grow, forming a vicious circle of mutual causation. Mostly seen in children, often in combination with chronic tonsillitis.
Clinical manifestations of adenoid hypertrophy.
The hypertrophic adenoids obstruct the posterior nostril and compress the eustachian tube to varying degrees, as well as stimulate the pharynx, larynx and lower respiratory tract with downstream secretions, so they can cause a variety of symptoms in the ear, nose, pharynx, larynx and lower respiratory tract.
Local symptoms of adenoid hypertrophy clinical manifestations
1, nasal symptoms: nasal congestion is the main symptom of the disease. It is caused by hypertrophic adenoids and local accumulation of secretions obstruction. If accompanied by rhinitis and sinusitis, nasal congestion can be aggravated, and at the same time there can be runny nose and other manifestations. Due to nasal congestion, speech with an occlusive nasal sound.
2.Ear symptoms: Adenoid hypertrophy can compress the pharyngeal orifice of the eustachian tube and cause eustachian tube obstruction, while acute nasopharyngitis can affect the mucous membrane of the eustachian tube. In the presence of eustachian tube obstruction and inflammation, pathogenic microorganisms and toxins in nasopharyngeal secretions can easily retrograde to the middle ear, thus causing secretory otitis media and even purulent otitis media, resulting in symptoms such as ear stuffiness, ear pain and hearing loss.
3. Pharyngeal and lower respiratory tract symptoms: As the secretions flow down and stimulate the respiratory tract mucosa, they cause pharyngeal discomfort, paroxysmal cough and symptoms of bronchitis.
Adenoid hypertrophy clinical manifestations of systemic symptoms
The main symptoms are chronic toxicity, impaired nutritional development and reflex neurological symptoms. Children with adenomatous hypertrophy have poor general development and nutritional status, as well as dreamy sleep with easy awakening, teeth grinding, slow reaction, inattention and irritability.
Symptoms associated with obstructive sleep apnea hypoventilation syndrome (OSAHS)
Adenoid hypertrophy is one of the most common causes of OSAHS in children. Loud snoring and breath-holding during sleep are the two main symptoms. Open-mouth breathing during sleep, excessive sweating, morning headache, daytime drowsiness and learning difficulties are also common symptoms.
Examination
1. Adenoid face: Due to long-term open-mouth breathing, the jaw and facial bones become stunted, the maxilla becomes longer, the palate is high arched, the teeth are not aligned, the upper incisors protrude, the lips are thick, and the expression is lacking, which is called “adenoid face”.
2.Oropharyngeal examination: the posterior wall of the oropharynx can be seen to have secretions from the nasopharynx attached, often accompanied by palatal tonsillar hypertrophy.
3.Anterior nasal microscopy: After the nasal mucosa is fully converged, a red lumpy bulge in the nasopharynx can be seen in some children.
4.Indirect nasopharyngoscopy or nasal endoscopy, fiberoptic, electronic nasopharyngoscopy: red mass-like elevation of the posterior wall of the nasopharyngeal apex is seen, and the surface is mostly orange flap-like with longitudinal grooves. Digital endoscopic imaging system inspection image is clear (our department has this instrumentation), but also can observe the obstruction of the posterior nostril and the pressure of the pharyngeal orifice of the pharynx.
5.Nasopharyngeal palpation: palpation of the nasopharynx with the finger can palpate the soft mass at the posterior wall of the nasopharynx.
6.X-ray nasopharyngeal lateral film: it can be seen that the soft tissue in the nasopharynx is thickened.
Treatment
If adenoid hypertrophy and the above symptoms appear, adenoidectomy should be performed as soon as possible. If there is tonsillar hypertrophy, it can be performed simultaneously with tonsillectomy. In children with secretory otitis media and adenoid hypertrophy, adenoidectomy has become a routine procedure for the treatment of pediatric secretory otitis media (combined with adenoid hypertrophy).
The procedure can be performed under surface or general anesthesia. The traditional surgical methods are adenoidectomy and adenoidectomy by placing an adenoid scraper or resector into the posterior wall of the nasopharyngeal apex and scraping or removing the adenoids (which is becoming obsolete because of its effectiveness and complications). At present, adenoidectomy with an electric cutter under direct endoscopic view is a routine procedure, which is safe, effective, and has few complications.