Adenoids are hypertrophied pharyngeal tonsils located in the nasopharynx. Adenoid vegetation refers to the enlargement of lymphoid tissue that may obstruct the nasopharyngeal airway, especially in children. The hypertrophy can be physiological (ages 2–7) or pathological due to chronic inflammation or infection.
Etiology and Risk Factors
- Recurrent upper respiratory tract infections
- Genetic predisposition
- Allergic diseases (e.g., allergic rhinitis)
- Immature immune system in children
- Chronic nasopharyngeal inflammation
- Passive smoking
- Air pollution
Classification
By degree of enlargement (J. Clemens):
Grade I — obstruction of choanae up to 1/3
Grade II — obstruction 1/3 to 2/3
Grade III — obstruction more than 2/3
By clinical course:
· Hypertrophy without inflammation
· Adenoiditis (acute or chronic inflammation)
Clinical Symptoms
- Nasal obstruction, especially at night
- Snoring and sleep apnea
- Hyponasal speech (open rhinolalia)
- Recurrent otitis media and hearing loss
- Persistent nasal discharge
- Poor concentration, fatigue
- Sleep disturbances, restlessness
- Adenoid facies in severe cases
Diagnosis
- Posterior rhinoscopy
- Nasopharyngoscopy (gold standard)
- Lateral X-ray of the nasopharynx
- Nasopharyngeal endoscopy
- Tympanometry and audiometry
- Allergy and immune testing in recurrent cases
Treatment
1. Conservative therapy (Grades I–II):
- Intranasal corticosteroids
- Nasal irrigation with isotonic/hypertonic saline
- Antihistamines if allergic component present
- Management of chronic infection and immunotherapy
2. Surgical treatment (Grade III or failure of conservative therapy):
- Adenoidectomy under general or local anesthesia
- Endoscopic adenoidectomy for better precision and bleeding control
Indications for surgery:
- Sleep apnea
- Recurrent otitis media with hearing loss
- Persistent nasal obstruction
- Formation of adenoid facies
Complications
- Chronic otitis media with effusion
- Conductive hearing loss
- Recurrent rhinosinusitis
- Behavioral and sleep disturbances
- Malocclusion, adenoid facies
- Delayed speech and cognitive development
When to See a Doctor
- Persistent mouth breathing
- Recurrent ear infections or hearing loss
- Snoring, sleep apnea
- Nasal speech, speech difficulties
- Frequent URTIs or chronic nasal discharge
- Suspicion of adenoid facies in children