Adenoids

The adenoids are part of a group of lymphoid tissues (like the glands in the neck or the tonsils) situated at the back of the nose. The adenoids enlarge naturally in children at around the age of three and usually shrink away again by the time child attains puberty. The term adenoids in clinical practice refers to enlarged or hypertrophied adenoids due to repeated upper respiratory tract infection. The enlargement happens because children are exposed to a lot of new infections at this age and have many colds. Large adenoids can result in a blocked or runny nose.

One of the main symptoms is nasal obstruction, which results in the child becoming a mouth breather. They may make your child snore and rarely can result in a child to briefly stop breathing while asleep.
The other common symptom is nasal discharge. Adenoids can cause maxillary sinusitis while sinusitis can also lead to adenoiditis.
Adenoids may block the Eustachian tube and cause otitis media with effusion, resulting in a hearing loss. Ascending infection through the Eustachian tube may cause recurrent acute otitis media.

If not treated in time this give rise to Adenoid facies. This is a result of chronic nasal obstruction and mouth breathing. The child has a pinched nose, dull facial expression, open mouth, prominent and crowded upper teeth, and high arched palate.

Diagnosis is made by nasal endoscopy or a lateral view x-ray of the soft tissue neck , which demonstrates the size of the adenoids and the extent of airway compromise.

Initially and in cases of mild adenoid hypertrophy conservative treatment is carried out. This includes nasal breathing exercises, antibiotics, nasal sprays, systemic decongestants and antihistiminics.
In cases where the symptoms do not respond to conservative treatment an adenoidectomy is performed. Nowadays nasal endoscopes are used to improve visualisation during adenoidectomy and soft tissue shavers (microdebrider) or coablation is are used to perform the adenoidectomy.

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