Adenoidal hypertrophy

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

Although present at birth, they are usually invisible until age 3 to 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 age 1 to 2 years.

Aetiology

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
Plain radiograph

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 age 6 months, suspect an immune deficiency
  • if enlarged adenoids persist well after childhood, suspect lymphatic malignancy

Management options include:

  • waiting until they spontaneously involute
  • surgical removal

Indications for an adenoidectomy include:

  • enlargement causing nasal airway obstruction
  • recurrent or persistent otitis media in children aged 3 to 4 or older; it should be taken into account that treating otitis media resolves the resultant hearing impairment as well
  • recurrent or chronic sinusitis
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Article information

rID: 7021
Tag: refs
Synonyms or Alternate Spellings:
  • Adenoidal enlargement
  • Adenoid hypertrophy
  • Adenoid enlargement

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Cases and figures

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    Case 1: prominent adenoids in child
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    Case 2: adenoidal and palatine tonsil enlargement
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    Case 3
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    Case 4: enlarged adenoids and palatine tonsil
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    Case 5
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    Case 6
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    Case 7
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    Case 8
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    Prominent nasopha...
    Case 9: adenoid hypertrophy in elderly person
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    5 years male
    Case 10: adenoid hypertrophy
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    Case 11: adenoid hypertrophy
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    Case 12
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