What is Hypertrophy

Definition : Hypertrophy of the nasopharyngeal tonsil sufficient enough to obstruct the airway.

Age incidence : Usually 3-7 years
Regress : From 10 years
Complete regress : Within 20 years


Clinical features are due to –
Hypertrophy of the adenoid causing mechanical obstruction

Fig:Enlarge adenoid

Inflammation
Generalized symptoms

Symptoms due to nasal obstruction --    Mouth breathing
     Dryness of throat
     Dribbling of saliva
     Sore throat due to associated pharyngitis
     Deafness, earache( Due to blockage of Eustachian tube)
   
 Due to inflammation :
     I.  Nasal discharge
     II. Post-nasal drip
     III. Recurrent acute suppurative otitis 
          media
      IV. Persistence of chronic suppurative
          otitis media
       V. Rhinitis/Sinusitis

Generalized disturbances :
Mental apathy
Mental dullness
Nocturnal enuresis
Night terror

In long standing cases patient may develop adenoid facies.

Adenoid facies :
Open mouth
Pinched nose
Retraction of upper lip
Prominent upper incisor
High arched palate
Flat chest and rounded shoulder

Sign :
Mouth breath
Digital examination
Posterior rhinoscopy

Diagnosis :
By symptoms and Xray nasopharynx lateral view


Differential diagnosis :
Deviated nasal septum
Hypertrophied posterior end of inferior turbinate
Antrochoanal polyp
Congenital chonal atresia

Complications :
Pharyngitis
Tonsillitis
Secretory otitis media
Recurrent acute suppurative otitis media
Persistance of chronic suppurative otitis media
Sleep apnoea
Mental dullness

Treatment :
When symptoms are mild-
Nasal decongestants
Antihistamine

When there is recurrent symptoms and/or complications- Adenoidectomy
In secretory otitis media, myringotomy and possibly insertion of ventilation tube(Grommet) are done together with adenoidectomy.