Causes and age-related changes
The pharyngeal (nasopharyngeal) tonsil enlarges primarily due to frequent viral infections that stimulate lymphoid tissue hyperplasia. The condition is most commonly observed in children aged 3 to 7 years, although it can occasionally occur earlier.
Interestingly, during puberty (around 13–14 years of age), the lymphoid tissue of the pharyngeal tonsil undergoes physiological involution, naturally shrinking to minimal dimensions.
Grades of adenoid hypertrophy
The severity of the condition is assessed by the degree to which the lymphoid tissue blocks the nasopharyngeal lumen (choanae). There are three grades:
- Grade 1: obstruction of the upper third of the nasopharyngeal lumen.
- Grade 2: blockage of two-thirds of the lumen.
- Grade 3: total obstruction, with the nasopharynx completely blocked.
Clinical presentation and complications
The symptoms of adenoid vegetations are diverse and affect not only the respiratory system. The main manifestations include:
- Local symptoms: chronic nasal breathing impairment (the child breathes through the mouth, especially during sleep), prolonged rhinitis, nasal voice, and occasional morning cough.
- Facies adenoidea ("adenoid face"): due to continuous mouth breathing, the mouth remains semi-open, the lower jaw elongates, and malocclusion (progenia) develops.
- Systemic effects: impaired nasal breathing causes chronic hypoxia, leading to increased nervous irritability and poor academic performance.
- Otological problems: the enlarged tonsil blocks the pharyngeal opening of the auditory (Eustachian) tube. This reduces tympanic membrane mobility, causes hearing loss, and is the primary cause of frequent acute otitis media.
If inflammation joins the tonsillar enlargement (adenoiditis), prolonged rhinitis is accompanied by mucopurulent discharge and low-grade fever.
Diagnostics and treatment
The diagnosis is established after ruling out other causes of nasal obstruction, such as allergic and vasomotor rhinitis, nasal septal deviation, sinusitis, and nasal cavity neoplasms.
Treatment is divided into two stages:
- Conservative: nasal irrigation with saline and antiseptic solutions (irrigation therapy), as well as courses of intranasal glucocorticosteroids (e.g., mometasone furoate). Signs of adenoiditis require mandatory anti-inflammatory therapy before considering surgery.
- Surgical (adenoidectomy): performed in consultation with an otolaryngologist if conservative methods prove ineffective.
It should be noted that there is a risk of recurrence after adenoidectomy: the lymphoid tissue may regrow within 6–12 months. Failure to treat, on the other hand, carries the risk of permanent hearing loss and chronic otitis media.
Class and exam questions
What is "adenoid facies" and why does it occur?
This is a characteristic alteration of the facial skeleton due to forced mouth breathing. It manifests as a semi-open mouth, elongation of the lower jaw, and the formation of malocclusion (progenia).
Why does hearing decrease in adenoid hypertrophy?
The enlarged pharyngeal tonsil mechanically blocks the pharyngeal opening of the Eustachian tube. This disrupts tympanic cavity ventilation and decreases tympanic membrane mobility, leading to hearing impairment and frequent otitis media.
Is surgical removal of adenoids strictly necessary?
No, adenoidectomy is indicated only when conservative treatment is ineffective. Irrigation therapy and intranasal glucocorticosteroids are always prescribed first.
What else to study on this topic
- Mechanisms of hypoxia in chronic nasal obstruction
- Differential diagnosis with allergic rhinitis
- Mechanism of action of intranasal glucocorticosteroids
- Anatomy of the pharyngeal tonsil and Eustachian tube
- Causes of recurrence after adenoidectomy
Master the entire topic in the Pediatrics course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Adenoids and Adenoiditis" and 3,738 other subject pages
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 71 video lessons on the subject
Other topics in "Chapter 4. Respiratory Diseases"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.