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Adenoidal hypertrophy

Adenoidal hypertrophy or enlargement is common in childhood and is due to increase in size of the adenoid tonsils.

Clinical presentation

  • nasal congestion: adenoid facies
  • chronic or recurrent otitis media due to their proximity to the Eustachian tubes
  • swallowing difficulties
  • speech anomalies (hyponasal speech)
  • rhinorrhea
  • sleep-disordered breathing


Although present at birth, they are usually invisible until 3-6 months. They can grow until about age 6, then involute through adulthood. Enlargement is pathological when they encroach on the nasopharyngeal airway, and this usually does not occur until 1-2 years of age.


Both inflammatory and infectious causes should be considered. Common infectious causes include:

  • Haemophilus influenzae
  • group A beta-hemolytic Streptococcus
  • Staphylococcus aureus
  • Moraxella catarrhalis
  • Streptococcus pneumoniae

Radiographic features

Plain radiographs

The lateral neck x-ray is the main imaging study. The size of the adenoids is less of a consideration than the degree to which they encroach on the nasopharyngeal airway (adenoid grades):

  • if no adenoidal tissue after 6 months, suspect immune deficiency
  • if enlarged adenoids well after childhood, suspect lymphatic malignancy

Treatment and prognosis

Management options include:

  • wait until they involute
  • surgical removal

Indications for an adenoidectomy includes:

  • enlargement causing nasal airway obstruction
  • recurrent or persistent otitis media in children aged 3-4 years and older
  • recurrent and/or chronic sinusitis

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