KARODPATI 2013 WEBMED

Article ID: WMC004079 ISSN 2046-1690

Adenoid Hypertrophy in Adults - A Myth or RealityCorresponding Author:Dr. Nayanna Karodpati,Associate Professor, Dept of otorhinolaryngology, Dr D Y Patil Medical college, A1/501,Hari Ganga,near RTO,Yerwada,Pune, 411006 - India

Submitting Author:Dr. Nayanna Karodpati,Associate Professor, Dept of otorhinolaryngology, Dr D Y Patil Medical college, A1/501,Hari Ganga,near RTO,Yerwada,Pune, 411006 - India

Article ID: WMC004079Article Type: Original ArticlesSubmitted on:28-Feb-2013, 09:30:44 AM GMT Published on: 05-Mar-2013, 12:29:44 PM GMTArticle URL: http://www.webmedcentral.com/article_view/4079Subject Categories:OTORHINOLARYNGOLOGYKeywords:Adenoids; Hypertrophy; Adults

How to cite the article:Karodpati N, Shinde V, Deogawkar S, Ghate G. Adenoid Hypertrophy in Adults - A Mythor Reality . WebmedCentral OTORHINOLARYNGOLOGY 2013;4(3):WMC004079Copyright: This is an open-access article distributed under the terms of the Creative Commons AttributionLicense(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided theoriginal author and source are credited.

Source(s) of Funding:None

Competing Interests:None

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Adenoid Hypertrophy in Adults - A Myth or RealityAuthor(s): Karodpati N, Shinde V, Deogawkar S, Ghate G

Abstract

Adenoid enlargement is uncommon in adults. Usually,enlarged adenoids are misdiagnosed in adults andaccordingly maltreated. In our study, 13 cases ofadenoid hypertrophy were seen between the agegroup of 18 to 39 years. Patients came withcomplaints of nasal obstruction, snoring and mouthbreathing. Diagnostic nasal endoscopy showedenlarged soft tissue in the nasopharynx, probablyhypertrophied adenoids. Computerised tomographywas done to rule out other differential diagnosis. Aftersurgical excis ion the t issue was sent forhistopathological examination that confirmed ourdiagnosis. For complete removal transnasalendoscopes were used in assistance. Patients wereregularly followed up for any recurrence. At the end ofthe study we came to the conclusion that instead ofregressing in a natural physiological way with age,adenoids can remain in the nasopharynx, sometimesgetting enlarged due to infection. We should keepenlarged adenoids as differential diagnosis in adultswhile dealing with a nasopharyngeal lesion.

Introduction

We are familiar with palatine tonsils and tonsillitis.There is tonsil like lymphoid tissue in the nasopharynx,which is the part of inner Waldeyers ring. Adenoidsalong with tonsils help the body to fight infections. Astonsils guard against the oral infections, adenoidsprotect us from air borne diseases. Adenoids alongwith tonsils produce antibodies and provide immunity.In the natural physiological way tonsils and adenoidsregress from 12 to 18 years of age. Thus adenoidhypertrophy as such is rare in adults. Children withenlarged adenoids clinically present with difficulty inbreathing, repeated upper respiratory tract infection,snoring, mouth breathing, secretory otitis media, nasalspeech and sometimes obstructive sleep apnoea. Onexamination they show the typical adenoid facies withovercrowding of teeth, broadened nasal bridge, andprominent upper lip. Adults can also present with thesame symptoms except the adenoid facies. Owing tothe strategic location of the adenoids, sometimes it isdifficult to examine with the traditional posteriorrhinoscopy mirror examination even in adults. But theadvanced technologies in the form of endoscope and

CT scan have helped us to diagnose and treat thedifficult cases.

Methods

In our hospital we have seen enlarged adenoids in 13adult cases. These adults came to the OPD with onand off nasal obstruction, snoring, mouth breathing.No history of epistaxis, nasal discharge or excessivesneezing. No history of blood stained nasal discharge,headache and weight loss. Out of 13, 5 patientscomplained of nasal obstruction and snoring, 3complained of snoring and mouth breathing, rest of the5 patients complained of fullness in ears, diminishedhearing and nasal obstruction. On examination,external appearance of nose and anterior rhinoscopywas normal. Posterior rhinoscopy revealed a softtissue mass in the nasopharynx in all patients. 2patients showed hypertrophied tonsils in examinationof oropharynx and no palpable cervical nodes. 5patients showed retracted tympanic membrane andfluid in the middle ear. All the patients were subjectedto diagnostic nasal endoscopy. Pinkish, lobulatedmass was seen in the nasopharynx which did notbleed on probing (Fig.1). X-Ray nasopharynx lateralview for soft tissue showed a soft tissue shadow in thenasopharynx compromising the airway at the junctionof the roof of the nasopharynx and the posterior wall inthe midline. CT scan of paranasal sinuses and neckwas done. It showed no bony erosion and no necknodes (Fig.2). Pure tone audiometry of the patientswith aural symptoms showed bilateral mild conductivehearing loss. Endoscopy assisted biopsy was takenand sent for histopathological evaluation. It revealedthe diagnosis of hypertrophied lymphoid tissue.

Hence the patients were subjected to excision of theenlarged adenoids under GA. In all our subjects weused the nasal endoscopes to ensure the completeremoval of the tissue so as to reduce chances ofresidual tissue and further recurrence [1]. All thepatients were followed regularly over a period of 18months. We didnt get recurrence in any of the patient.

Results

All the patients did not have any postoperativecomplications. All the patients were satisfied with the



improvement in breathing difficulty, snoring and mouthbreathing. When the patients were followed over 18months there was no residual t issue in thenasopharynx or any recurrence.

Discussion

Anatomically adenoids are situated at the junction ofroof of the nasopharynx & posterior wall of thenasopharynx. Along with the palatine tonsils, lingualtonsils, tubal tonsils & the lateral pharyngeal bands, itforms the inner Waldeyers ring. The function ofadenoids is to protect the body from airborneinfections and produce antibodies providing immunity.In the natural course, the adenoids start regressing atpuberty and are not seen in adults.[2] Enlargement ofadenoids can be seen from 2 years to 12 years of ageafter exposure to repeated infections causing nasalobstruction. In young children this obstruction givesrise to oral breathing, nasal speech, snoring, sorethroat, dry mouth, overcrowding of teeth, high archedpalate, broadening of the nasal bridge & Eustachiantube obstruction. This is described as typical adenoidfacies. Due to Eustachian tube blockage the patientcan develop secretory otitis media (glue ear). Nasalobstruction in adults can have various underlyingconditions such as Deviated Nasal Septum, inferiorturbinate hypertrophy, nasal polyposis, juvenile nasalangiofibroma, nasopharyngeal malignancies, andreactive hypertrophy of adenoids in HIV positivepatients.

After evaluating the patient thoroughly for nasal andnasopharyngeal obstruction ruling out the othercauses for the present symptomatology, we foundenlargement of Luschkas tonsil as a root cause. Thepatients were subjected to diagnostic nasalendoscopic examination and CT scan to rule out anyerosion of bones.

The endoscopic finding was a soft lymphoid tissue atthe junction of roof and posterior wall of nasopharynx.Macroscopically, it looked like a benign tumour. Buttissue sampling established a positive final diagnosisof adenoids.

Even CT scan established the diagnosis as a benignnon-eroding mass not very vascular. But only thebiopsy showed it as hypertrophied lymphoid tissue.

There must have been large number of cases ofhypertrophy of adenoids which must have beenmissed earlier. But nowadays with the advent of newer

diagnostic modalities of nasal endoscopy and CTscans, adenoids in adults are getting diagnosed morefrequently and accurately.

Reference

1. R. H. Kamel and E.S. Ishak, Enlarged adenoid andadenoidectomy in adults: endoscopic approach andhistopathological study, Journal of laryngology andotology, vol. 104, no.12, pp.965-967, 1990.2. F. J. Buchinsky,M. A. Lowery, and G. Isaacson, doadenoid regrow after excision? Otolaryngology Headand Neck Surgery, vol 123, no.5, pp.576-581, 2000.3. Huang H. M., Chao MC, Chen YL Hsiao HR, Acombined method of conventional and endoscopicadenoidectomy, Laryngoscope 1998; 108:1104-6.4. YM Wan.,KC Wong.,KH Ma.,Endoscopic-guidedadenoidectomy using a classic adenoid curette: asimple way to improve adenoidectomy, Hong KongMed J, vol.11,no. 1,pp.42-44, 20055. S. R. Schaffre and G. H. Wong, Endoscopicvisual izat ion faci l i tates adenoidectomy,Otolaryngology_Head and Neck Surgery, vol.136, no.3. p. 510, 2007.



IllustrationsIllustration 1

DNE showing enlarged adenoid in nasopharynx



Illustration 2

saggital CT scan showing soft tissue shadow in nasopharynx



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IntroductionArticleIllustrationsIllustration 1Illustration 2

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KARODPATI 2013 WEBMED