What is Adenoid Hypertrophy?
Adenoid hypertrophy is a condition where the adenoids, a type of tissue at the back of the throat, become enlarged. This can obstruct the throat and may happen with or without an associated infection. Structurally, the adenoids are part of a collection of tissue called Waldeyer’s ring, which is situated at the entrance of the throat and includes tonsils. It’s important to remember that the adenoids get their blood supply from several arteries, with the ascending pharyngeal artery being the primary source.
Sensitivity in the adenoids is provided by the glossopharyngeal and vagus nerves, which carry information from the adenoids to the brain. Adenoid size generally increases during childhood; usually, they reach the largest size by age 6 or 7, before shrinking by adolescence.
What Causes Adenoid Hypertrophy?
The swelling of the adenoids, known as adenoid hypertrophy, can happen due to various reasons, both infectious and non-infectious. Infectious causes include a wide range of viruses and bacteria. Some of the viruses linked to this condition are adenovirus, coronavirus, coxsackievirus, cytomegalovirus, Epstein-Barr virus, herpes simplex virus, parainfluenza virus, and rhinovirus.
Many types of bacteria can contribute to this infection-induced adenoid hypertrophy. These include several species of Streptococcus, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, Neisseria gonorrhoeae, Corynebacterium diphtheriae, Chlamydophila pneumoniae, and Mycoplasma pneumoniae. Other bacteria, such as Fusobacterium, Peptostreptococcus, and Prevotella species, which grow without oxygen, have also been associated with this condition.
Adenoid hypertrophy can also result from non-infectious causes, such as acid reflux from the stomach to the esophagus, allergies, or exposure to cigarette smoke. In adults, an enlarged adenoid could also indicate a more severe illness, such as HIV infection, lymphoma (a type of cancer), or a tumor in the sinus or nasal area.
Risk Factors and Frequency for Adenoid Hypertrophy
Adenoid hypertrophy, or enlarged adenoids, is more often found in children than adults. This is because adenoids typically shrink and become smaller during the teenage years. A recent study revealed that about 34.46% of a random population sample of children and teenagers had enlarged adenoids.
Signs and Symptoms of Adenoid Hypertrophy
Adenoid hypertrophy is a condition where the adenoids (a patch of tissue at the back of the nasal cavity) become enlarged. This can cause obstruction and lead to various symptoms. If the nose is blocked by enlarged adenoids, a person might experience a runny nose, difficulty breathing through the nose, chronic cough, post-nasal drip, snoring, or breathing difficulties during sleep. If the blockage is severe, it can lead to sinusitis, causing facial pain or pressure.
The blockage could also affect the Eustachian tube (the tube that connects the middle ear to the back of the nose). This can lead to muffled hearing, ear pain, crackling or popping sounds in the ear, or repeated middle ear infections.
When examined by a healthcare provider, the individual might often breathe through the mouth, have a nasal tone to their voice, and show features known as adenoid facies. These include a high-arched palate, increased facial height, and mid-face retrusion. A thorough physical exam should also rule out other possible causes of nasal obstruction such as foreign bodies in the nose, rhinosinusitis, nasal polyps, and birth defects like blocked or narrow nasal passages.
- Runny nose
- Difficulty breathing through the nose
- Chronic cough
- Post-nasal drip
- Snoring
- Sleep-disordered breathing
- Sinusitis with facial pain or pressure
- Muffled hearing
- Ear pain
- Crackling or popping sounds in the ear
- Recurrent middle ear infections
- Mouth-breathing
- Nasal tone to the voice
- Adenoid facies: high arched palate, increased facial height, mid-face retrusion
Testing for Adenoid Hypertrophy
A simple physical check-up and a conversation about your symptoms often let a doctor know if you have adenoid hypertrophy, which is when your adenoids are swollen. If needed, a doctor might use a type of x-ray scan known as lateral head and neck radiography to examine the adenoids. This method is particularly helpful with young children who can get upset or uncooperative during a check-up.
A video-based x-ray, or videofluoroscopy, can also help determine how enlarged the adenoids have become. Both of these methods can make the diagnosis of adenoid hypertrophy more reliable. However, they both use radiation, which occasionally can cause harm.
Another way to examine the adenoids without radiation is by using a special device called a fiberoptic nasopharyngoscope. This device allows doctors to see the adenoids directly. It’s a reliable way to examine the adenoids and does not risk unnecessary exposure to radiation.
Treatment Options for Adenoid Hypertrophy
In cases of acute and chronic adenoid swelling due to infection, initial treatment usually involves antibiotics. Amoxicillin is a commonly used for a straightforward, acute adenoid infection. However, for chronic or repeated infections, a drug like clavulanic acid is usually added to the mix. Some people might have an allergy to penicillin, such medications. In this case, alternatives like clindamycin or azithromycin may be used. There’s been some success with using nasal steroids as additional treatment, but the results have been mixed. Also, the advantages of reducing adenoid size with these medications involve daily, long-term use.
If medical treatments fail, surgery to remove the adenoids (adenoidectomy) may be considered. This is generally done for patients with ongoing or recurrent issues related to enlarged adenoids. The procedure is performed under general anesthesia, with the patient lying on their back and the surgeon positioned at the head of the operating table. To give the surgeon a clear view of the adenoids, an oral retractor is used to open the mouth wider. Sharp instruments, like an adenoid curette or adenotome, are usually used to remove the adenoid tissue.
In addition to it, various methods have been described in the literature for the procedure, using instruments like suction electrocautery, co-ablation, plasma, laser and microdebrider. Regardless of the specific technique or tools used, the goal of the procedure is to reduce the size of the swollen adenoids and/or to clear away bacterial buildup on the adenoid’s surface.
What else can Adenoid Hypertrophy be?
Adenoid hypertrophy, or enlarged adenoids, can show symptoms mainly related to blocked nasal passages and issues with the Eustachian tubes, which connect your middle ear to the back of your throat. However, there could be other reasons for these general symptoms, such as:
- Choanal atresia (blockage of the back side of the nasal passage)
- Pyriform aperture stenosis (narrowing of the nasal opening)
- Allergies causing runny or stuffy nose
- Short-term or long-term sinus infections
- Nasal polyps (small growths in the nose)
- Intranasal encephalocele (brain tissue that protrudes into the nasal space)
- Nasal dermoid (skin-like growth in the nasal area)
- Nasopharyngeal neoplasm (tumor in the upper part of the throat)
- Acute otitis media (middle ear infection)
- Chronic serous otitis media (long-term fluid buildup in the middle ear)
- Cholesteatoma (skin growth that occurs in the middle ear)
- Nasopharyngeal malignancy (cancer in the upper part of the throat)
- Inverting papilloma (a type of sinus and nasal tumor)
- HIV
If a young adult or adult experiences significant adenoid-related symptoms, the doctor should strongly consider the possibility of a tumor, or systemic causes like mononucleosis or HIV.
What to expect with Adenoid Hypertrophy
Enlarged adenoids, or adenoid hypertrophy, usually get smaller on their own once children hit adolescence. However, because it can cause serious complications and significantly affect a person’s quality of life, many people each year choose to have surgery to treat it. This is evidenced by statistics from 2006, which show that roughly 506,778 surgeries to remove the adenoids and tonsils, and another 129,540 surgeries to remove only the adenoids, were performed in the United States.
Possible Complications When Diagnosed with Adenoid Hypertrophy
Adenoid hypertrophy, or enlarged adenoids, can lead to several issues if left untreated. These issues are often tied to problems with the middle ear or sleep-related problems. Children with enlarged adenoids run the risk of facing troubles with their speech, language or learning due to conductive hearing loss. This type of hearing loss can happen because of continuous middle ear issues.
Enlarged adenoids also increase the chances of developing sleep-related problems and sleep apnea. In children, this can result in behavioural problems, bedwetting, and even pulmonary hypertension, which is a type of high blood pressure that affects the arteries in the lungs. It’s also associated with certain psychiatric disorders, such as depression and ADHD.
The complications of adenoid hypertrophy include:
- Persistent middle ear issues
- Sleep-disordered breathing
- Conductive hearing loss
- Speech, language, and learning difficulties
- Sleep apnea
- Behavioral problems
- Bedwetting
- Pulmonary hypertension
- Depression and ADHD
Recovery from Adenoid Hypertrophy
The chances of experiencing bleeding after an adenoidectomy are quite low, roughly 1 in 1000. The good news is that most of these bleeding instances stop on their own and don’t require any medical treatment. There’s also a slight chance that the adenoids could grow back, especially in patients who have the operation when they’re young.
Preventing Adenoid Hypertrophy
Teaching patients, doctors, and other healthcare professionals is a crucial part of delivering the highest quality care based on the most up-to-date research. This education is key to improving the health results of patients.
