EN4.23 | Adenoids — Summary & Reflection

KEY TAKEAWAYS

Adenoid hypertrophy is the most common cause of nasal obstruction in children aged 3–10 years. The adenoids — part of Waldeyer's ring — are lymphoid tissue on the posterior nasopharyngeal wall, not visible on anterior rhinoscopy; diagnosed by nasal endoscopy or lateral soft tissue neck X-ray. Hypertrophy causes posterior choanal obstruction (mouth breathing, adenoid facies, snoring, OSA) and Eustachian tube obstruction (OME, conductive hearing loss, recurrent ASOM). Adenoid facies is a preventable consequence of untreated chronic mouth breathing: elongated face, high-arched palate, narrow maxilla, prognathism. Adenoids regress spontaneously at puberty — mild cases may be observed. Medical therapy with intranasal corticosteroids offers modest benefit. Adenoidectomy is indicated for significant obstruction, OSA, recurrent ASOM, or chronic OME with hearing loss — often combined with grommets. Critical pre-operative check: exclude submucous cleft palate (bifid uvula, palatal translucency) — adenoidectomy in this condition causes permanent VPI. Complications of adenoidectomy include haemorrhage (most important), VPI (if submucous cleft missed), and recurrence in young children.

REFLECT

Think about a child you may have encountered in paediatric OPD or during your ENT posting who was brought for inattentiveness at school or repeated ear infections. Were the adenoids considered? Would you have made the connection between a child's school performance and a nasopharyngeal lymphoid pad? The lesson from adenoid disease is that ENT pathology presents in unexpected contexts — hearing loss and school failure in a 6-year-old is an ENT problem as much as it is a developmental one. How will you screen for adenoid hypertrophy in every child with recurrent ear infections or unexplained hearing loss?