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16-September-2008 16:15:15 - Adenoid hypertrophy Adenoid hypertrophy Classification and external resources Adenoid hilighted in green. ICD-10 J35.2 ICD-9 474.12 MedlinePlus 001649 Adenoid hypertrophy or enlarged adenoids is the unusual growth hypertrophy of the adenoid tonsil. There is very little lymphoid tissue in the nasopharynx of young babies; humans are born without substantial adenoids. The mat of lymphoid tissue called adenoids starts to get sizable during the first year of life. Just how big the adenoids become is quite variable between individual children. Contents 1 Presentation 2 Diagnosis 3 Symptoms 4 Treatment 5 See also 6 References Presentation Enlarged adenoids can become nearly the size of a ping pong ball and completely block airflow through the nasal passages. Even if enlarged adenoids are not substantial enough to physically block the back of the nose, they can obstruct airflow enough so that breathing through the nose requires an uncomfortable amount of work, and inhalation occurs instead through an open mouth. Adenoids can also obstruct the nasal airway enough to affect the voice without actually stopping nasal airflow altogether. Nasal blockage is determined by at least two factors: 1 the size of the adenoids, and 2 the size of the nasal pharynx passageway. The adenoid usually reaches is greatest size by about age 5 years or so, and then fades away atrophies by late childhood - generally by the age of 7 years. The lymphoid tissue remains under the mucosa of the nasopharynx, and could be seen under a microscope if the area was biopsied, but the mass is so reduced in size that the roof of the nasopharynx becomes flat rather than mounded. Just as the size of the adenoids is variable between individuals, so is the age at which adenoids atrophy. The adenoids, like all lymphoid tissue, enlarge when infected. Although lymphoid tissue does act to fight infection, sometimes bacteria and viruses can lodge within it and survive. Chronic infection, either viral or bacterial, can keep the pad of adenoids enlarged for years, even into adulthood. Some viruses, such as the Epstein-Barr Virus, can cause dramatic enlargement of lymphoid tissue. Primary or reactivation infections with Epstein Barr Virus, and certain other bacteria and viruses, can even cause enlargement of the adenoidal pad in an adult whose adenoids had previously become atrophied. Diagnosis Adenoids are rarely visible on physical examination without the skilled use of mirrors or fiber optic endoscopes. A lateral X-ray view of the skull taken to show soft tissue density can show the adenoids, as can other imaging studies such as CT scans and MRI. Symptoms The symptoms caused by enlarged adenoids are mostly due to where this lymphoid tissue is located. The adenoids are in the midline of the nasopharynx, and the Eustachian tubes open from either ear to the right and left of them. Eustachian tubes ventilate the middle ear. Very large adenoids will block air passage in both the nose and the ears. This obstruction of normal air ventilation can lead to both sinusitis and otitis media. In children with excessive middle ear infections and chronic middle ear fluid, there is a high bacterial count in the adenoids as compared to children without problematic otitis media, even if the size of the adenoids is small. The adenoids in these cases provides a reservoir of pathogenic bacteria that cause ear infections and subsequent middle ear effusions fluid. The nasopharynx lies right above the throat. Splashes of excessive drip from infected adenoids may land directly on the vocal cords. Although the larynx and vocal cords do not ordinarily become infected from adenoiditis, their mucosa does become irritated. The vocal cords are extremely sensitive to touch, and any fluid drops falling on them cause an irresistible urge to cough. Adenoiditis therefore is one of the causes of cough. Treatment Surgical removal of the adenoids is a procedure called adenoidectomy. Carried out through the mouth under a general anaesthetic, adenoidectomy involves the adenoids being curetted, cauterised, lasered, or otherwise ablated. Adenoidectomy is most often performed because of nasal obstruction, but is also performed to reduce middle ear infections and fluid otitis media. The procedure is often carried out at the same time as a tonsillectomy, since the adenoids can be clearly seen and assessed by the surgeon at that time. Adenoidectomy is also performed on patients who have chronic ear infections caused by the adenoids blocking the eustachian tube. See also Adenoid hypertrophy was first described and adenoidectomy performed by the Danish physician Wilhelm Meyer 1824-1895 in Copehangen in 1868. References Gates G 1996. Sizing up the adenoid.. Arch Otolaryngol Head Neck Surg 122 3: 239-40. PMID 8607949. Kenna, Margaret A.; Bluestone, Charles D.; Stool, Sylvan E. 1996. Chapters 58-59, Pediatric otolaryngology 2. Philadelphia: Saunders. ISBN 0-7216-5248-4. BUPA Health Fact Sheet. Adenoidectomy v d e Pathology of respiratory system J, 460-519, respiratory diseases Upper RT including URTIs, Common cold Head sinuses: Sinusitis nose: Rhinitis Vasomotor rhinitis, Atrophic rhinitis, Hay fever - Nasal polyp - Deviated septum tonsil: Tonsillitis - Adenoid hypertrophy - Peritonsillar abscess Neck pharynx: Pharyngitis Strep throat larynx: Laryngitis - Croup - Laryngospasm - vocal folds: Vocal fold nodule - epiglottis: Epiglottitis trachea: Tracheitis - Tracheal stenosis Lower RT/lung disease including LRTIs Pneumonia Viral - Bacterial/Atypical pneumonia Mycoplasma - Fungal pneumonia Pneumocystis pneumonia - Parasitic pneumonia - Bronchopneumonia - Chemical pneumonia Mendelson's syndrome Bronchial/ obstructive Acute: Bronchitis Acute, Chronic - Bronchiolitis Chronic: Emphysema - COPD - Asthma Status asthmaticus - Diffuse panbronchiolitis - Bronchiectasis Interstitial/ restrictive External agents/ occupational lung disease Pneumoconiosis Asbestosis, Baritosis, Bauxite fibrosis, Berylliosis, Caplan's syndrome, Chalicosis, Coalworker's pneumoconiosis, Siderosis, Silicosis, Byssinosis Hypersensitivity pneumonitis Bagassosis, Bird fancier's lung, Farmer's lung Other ARDS - Pulmonary edema - Löffler's syndrome/Eosinophilic pneumonia - Respiratory hypersensitivity Allergic bronchopulmonary aspergillosis Hamman-Rich syndrome - Idiopathic pulmonary fibrosis Obstructive or restrictive Atelectasis - Bronchiolitis obliterans Pleural cavity/mediastinum Suppuration Empyema - Lung abscess Pleural disease/pleural effusion Hemothorax - Pneumothorax - Hemopneumothorax - Hydrothorax - Pleurisy Mediastinal disease Mediastinal emphysema - Mediastinitis Other/general Respiratory failure - Influenza - SARS - Idiopathic pulmonary haemosiderosis see also congenital, neoplasia Retrieved from http://en..org/wiki/Adenoid_hypertrophy Categories: Muscular system | Tissues | Exercise physiology | Exercise | Gross pathology Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages ქ�რთული This page was last modified on 26 July 2008, at 03:14
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