Adenoids

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ENT: Adenoids & Adenoid Hypertrophy

High-Yield Revision Notes for Board Review & PG Entrance Examinations

The Adenoid (Pharyngeal Tonsil) is a mass of lymphoid tissue located in the roof and posterior wall of the nasopharynx. It is part of Waldeyer’s Ring. It typically undergoes physiological hypertrophy during childhood (peaks at 3–6 years) and undergoes atrophy after puberty (usually disappearing by age 15–16).

1. Clinical Manifestations of Hypertrophy

Obstruction of the nasopharyngeal airway leads to a characteristic clinical presentation:

  • Adenoid Facies: Long, open-mouthed face, protruding upper incisors, crowded teeth, high-arched palate, and a dull expression.
  • Nasal Symptoms: Chronic mouth breathing, “nasal voice” (rhinolalia clausa), and persistent mucopurulent rhinorrhea.
  • Sleep Disorders: Snoring and Obstructive Sleep Apnea (OSA), leading to restlessness and daytime sleepiness.
  • Otologic Complications: Obstruction of the Eustachian tube orifice causes recurrent Otitis Media with Effusion (OME) and chronic suppurative otitis media.

2. Diagnostic Evaluation

  • Lateral Neck X-ray (Soft Tissue): The most classic screening tool. Assesses the “Adenoid-Nasopharyngeal ratio” (A/N ratio).
  • Fiberoptic Nasopharyngoscopy: Gold standard for direct visualization of the size of the adenoids and their relationship to the Eustachian tube and choanae.

3. Management

  • Medical: Nasal corticosteroids may be used in mild cases to reduce lymphoid size.
  • Surgical: Adenoidectomy.

    • Indications: Recurrent/persistent OSA, significant nasal obstruction, and recurrent otitis media associated with adenoid hypertrophy.

    • Contraindications: Absolute: Palatopharyngeal insufficiency (risk of hypernasal speech) and Submucous cleft palate. Relative: Acute infection and blood dyscrasias.

4. Key Board Examination Facts

Point High-Yield Detail
Epithelium Pseudostratified ciliated columnar epithelium (unlike the squamous epithelium of the palatine tonsils).
Blood Supply Ascending pharyngeal artery (primary supply).
Tornwaldt’s Cyst A midline nasopharyngeal cyst resulting from the entrapment of the notochord remnant in the adenoid tissue.
Complication Post-adenoidectomy hemorrhage (primary or secondary) is the most significant concern.