Nasal Obstruction: Adenoiditis vs Adenoid Hypertrophy

Background: Adenoid hypertrophy (AH) is a common cause of upper airway obstruction and obstructive sleep apnea syndrome (OSAS) in children having major impact on child’s growth and development. Symptoms like nasal congestion, mouth breathing, nasal discharge, snoring, day time sleepiness, hyponasal voice, ear popping, and craniofacial abnormalities are observed. Adenoidectomy is considered the treatment of choice for symptomatic children. Co-existing medical illnesses and choice of surgical treatment is governed by the paediatricians and apprehensive parents. Need for conservative treatments in alleviating symptoms have been tried. Topical, intranasal administered, steroid preparations have been proven effective in the literature.Methods: In this prospective study, 35 symptomatic children (3-12 years) with adenoid hypertrophy were included. Each of the symptoms was scored from 0 (absent) to 4 (severe) over Visual Analogue Scale (VAS). Nasal obstruction index was calculated. Results of mometasone furoate nasal spray 100 microgram/day used once daily at the interval of 8 weeks and 12 weeks were analysed using statistical tests. Results: A statistically significant reduction in nasal obstruction index and other symptoms were noted at the end of third month follow up.Conclusions: Mometasone furoate nasal spray caused improvements in outcomes of nasal obstruction, snoring, total nasal symptoms, ear symptoms and overall quality of life.

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Using nasal steroids to treat nasal obstruction caused by adenoid hypertrophy: Does it work?

Otolaryngology ◽

10.1016/j.otohns.2008.11.008 ◽

2009 ◽

Vol 140 (2) ◽

pp. 139-147 ◽

Cited By ~ 22

Author(s):

Neil K. Chadha ◽

Linjie Zhang ◽

Raúl A. Mendoza-Sassi ◽

Juraci A. César

Keyword(s):

Nasal Obstruction ◽

Adenoid Hypertrophy ◽

Nasal Steroids

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Impact of adenoid hypertrophy on the open bite in children

Otolaryngologia Polska ◽

10.5604/01.3001.0013.1536 ◽

2019 ◽

Vol 73 (2) ◽

pp. 1-5

Author(s):

Justyna Poddębniak ◽

Beata Zielnik-Jurkiewicz

Keyword(s):

Nasal Obstruction ◽

Open Bite ◽

Adenoid Hypertrophy ◽

Research Material ◽

Pharyngeal Tonsil

Nasal obstruction caused by adenoid hypertrophy can lead to malocclusion. The research material consisted of children aged 7-12 years with adenoid hypertrophy qualified for adenoidectomy. On the basis of the conducted tests (laryngological, orthodontic, pediatric), the occurrence of open frontal bite in children with pharyngeal tonsil hypertrophy, in particular in boys, was confirmed in comparison to children without hypertrophy correctly breathing through the nose.

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Adenoid hypertrophy existence in adulthood- a truth revealed

National Journal of Clinical Anatomy ◽

10.1055/s-0039-1700711 ◽

2014 ◽

Vol 03 (01) ◽

pp. 12-16

Author(s):

Atul M Bage ◽

Anand Karthikeyan D. ◽

Nutan N Bage

Keyword(s):

Nasal Obstruction ◽

Strong Association ◽

Endoscopic Examination ◽

P Value ◽

Adenoid Hypertrophy ◽

Macroscopic Appearance ◽

True Incidence ◽

Presenting Symptoms ◽

Waldeyer’S Ring ◽

Adenoidal Tissue

Abstract Background and aims: The adenoids (nasopharyngeal tonsils) are part of Waldeyer’s ring of lymphoid tissue. Endoscopic examination of the nasopharynx increasingly recognized that adenoidal tissue in adults is not an uncommon finding. The aims of this study were to determine prevalence of adult adenoid tissue and the possible reasons behind it. Methods: A retrospective study of 1,100 adult patients, who had routine nasal endoscopic examination for nasal obstruction and related pathologies, was undertaken. 84 cases with incidental hypertrophied adenoid were reviewed to determine the probable cause, presenting symptoms, clinical suspicion and final histological diagnosis. Results: The age of patients ranged from 18 years to 77 years. Median age was 32 years. 59 (70.24%) of adenoid hypertrophy patients were smokers and only 25 (29.76%) were nonsmokers suggesting strong association between smoking and adult adenoid hypertrophy with odds ratio=5.3251, χ2value of 54.23 and an extremely significant p value. All the 84 cases were confirmed histopathologically as Reactive adenoid hyperplasia and no signs of malignancy in any of them. Conclusions: The true incidence of adenoidal hypertrophy in adults is unknown. Adenoidal tissue in adults, if present, must always be biopsied or removed irrespective of their macroscopic appearance. The result underlines the importance of considering adenoid hypertrophy as a cause or contributing factor in nasal obstruction and related pathologies in adults. It also supports the theory that it represents a long-standing inflammatory process rather than being a novel clinical entity.

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Fiberscopic Imaging of the Pediatric Nasopharynx

Diagnostic and Therapeutic Endoscopy ◽

10.1155/dte.1.153 ◽

1995 ◽

Vol 1 (3) ◽

pp. 153-157 ◽

Cited By ~ 1

Author(s):

Deyun Wang ◽

Peter Clement

Keyword(s):

Otitis Media ◽

Nasal Obstruction ◽

Eustachian Tube ◽

Correct Diagnosis ◽

Adenoid Hypertrophy ◽

Endoscopic Findings ◽

Adenoid Tissue

This study describes the endoscopic findings about the size of the adenoid tissue and the condition of the nasopharyngeal orifice of the eustachian tube. Results confirmed that only fiberscopic examination allows a thorough inspection of the nasopharyngeal anatomy to make a correct diagnosis and design therapeutic planning. When the presence of adenoid hypertrophy resulting in nasal obstruction, snoring, and/or otitis media was confirmed endoscopically, adenoidectomy proved to be highly efficacious in relieving these symptoms.

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Diagnostic accuracy of the nasal obstruction index in detecting adenoid hypertrophy in children without allergy

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2010.10.007 ◽

2011 ◽

Vol 75 (1) ◽

pp. 57-61 ◽

Cited By ~ 8

Author(s):

S. Torretta ◽

P. Marchisio ◽

S. Esposito ◽

M. Cappadona ◽

M. Fattizzo ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Nasal Obstruction ◽

Adenoid Hypertrophy

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Efficacy of Mometasone Nasal Spray in Children with Snoring due to Adenoids

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1179 ◽

2014 ◽

Vol 7 (1) ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Vipan Gupta ◽

Sunder Singh ◽

Prithpal S Matreja

Keyword(s):

Observational Study ◽

Nasal Obstruction ◽

Nasal Spray ◽

Pediatric Population ◽

Symptomatic Relief ◽

Alternative Therapy ◽

Adenoid Hypertrophy ◽

Intranasal Steroids ◽

Before And After

ABSTRACT Background Snoring and OSA is very commonly seen among the pediatric population, most commonly due to adenoid and tonsil hypertrophy which requires adenotonsillectomy. The effect of this surgery on the immunity is controversial. This study was planned to see any alternative therapy which can delay or avoid the surgery by providing symptomatic relief to the patient. Objective To see the effect of intranasal mometasone on nasal obstruction due to adenoids, hence relieving the OSA and snoring. Design Prospective and observational study. Materials and methods Fifty-five children having snoring and or OSA due to adenoids were given intranasal mometasone. The symptoms before and after treatment were compared using OSA 18 questionnaire. Results There was significant improvement in all the domains of OSA 18. The average total score showed improvement from 56.33 to 51.51 which is significant (p < 0.001). Conclusion The use of intranasal steroids is easy and effective method to improve nasal obstruction, snoring and OSA among children having adenoid hypertrophy. How to cite this article Gupta V, Gupta M, Matreja PS, Singh S. Efficacy of Mometasone Nasal Spray in Children with Snoring due to Adenoids. Clin Rhinol An Int J 2014;7(1):1-4.

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Influence of Adenoid Hypertrophy on Secretory Otitis Media

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948109000103 ◽

1981 ◽

Vol 90 (1) ◽

pp. 7-11 ◽

Cited By ~ 9

Author(s):

Hans H. Elverland ◽

Olav K. Haugeto ◽

Iain W. S. Mair ◽

Knut E. Schrøder

Keyword(s):

Otitis Media ◽

Nasal Obstruction ◽

Clinical Course ◽

Adenoid Hypertrophy ◽

Secretory Otitis Media ◽

Pathogenetic Mechanisms ◽

Tympanostomy Tubes ◽

First Recurrence ◽

Observation Period

The prognostic influence of adenoidectomy on the clinical course of chronic secretory otitis media (SOM) is reported after an observation period of five years in 166 children. Adenoidectomy was performed in connection with the first tubulation on the basis of concurrent symptoms of nasal obstruction, and resulted in a significant reduction in the need for repeated insertion of tympanostomy tubes in patients younger than eight years of age. The tubulation rate was also significantly reduced when adenoidectomy was performed in association with the first recurrence of SOM. This effect was, however, absent when the operation was performed at later stages, and both the otoscopic and audiological findings after five years revealed no significant differences between the adenoidectomy and nonadenoidectomy groups. Possible pathogenetic mechanisms leading to the development of SOM in the presence of large adenoids are discussed.

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Odor Perception in Children in Relation to Nasal Obstruction

PEDIATRICS ◽

10.1542/peds.72.4.510 ◽

1983 ◽

Vol 72 (4) ◽

pp. 510-516 ◽

Cited By ~ 1

Author(s):

S. Nasrin Ghorbanian ◽

Jack L. Paradise ◽

Richard L. Doty

Keyword(s):

Nasal Obstruction ◽

Therapeutic Intervention ◽

Adenoid Hypertrophy ◽

Olfactory Sensitivity ◽

Odor Perception ◽

Detection Thresholds ◽

Varied Degree ◽

Olfactory Detection ◽

Olfactory Detection Thresholds ◽

Nasal Function

To determine whether nasal obstruction in children results in impaired nasal function, olfactory sensitivity was assessed in 65 children with various degrees of nasal obstruction and in 13 children without nasal obstruction. Overall, olfactory detection thresholds were directly related to clinical ratings of degree of nasal obstruction. Of the subjects with nasal obstruction attributable to adenoid hypertrophy, 28 received adenoidectomy; when retested 2 to 28 months later, 20 of the 28 subjects showed generally commensurate reductions in nasal obstruction ratings and olfactory detection thresholds. In a comparison subgroup of 16 subjects retested after intervals of 5 to 13 months without having received intervening adenoidectomy, both the nasal obstruction ratings and the olfactory detection thresholds remained relatively unchanged. These results suggest that, in children, nasal obstruction of varied degree is associated with commensurate impairment of the ability to smell, and that reduction in the degree of nasal obstruction results in commensurate recovery of the ability to smell. Olfactory function, although hitherto accorded little pediatric attention, deserves consideration both in weighing the importance of nasal obstruction in children and in deciding about therapeutic intervention.

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Lateral Neck Radiography in Preoperative Evaluation of Adenoid Hypertrophy

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419895035 ◽

2019 ◽

Vol 129 (5) ◽

pp. 482-488

Author(s):

Liuba Soldatova ◽

Hansel J. Otero ◽

David A. Saul ◽

Christian A. Barrera ◽

Lisa Elden

Keyword(s):

Airway Obstruction ◽

Nasal Obstruction ◽

Small Sample Size ◽

Preoperative Evaluation ◽

Small Sample ◽

Adenoid Hypertrophy ◽

Lateral Neck ◽

Level Of Evidence ◽

Data Set ◽

Nasopharyngeal Airway

Objective: To assess the value of lateral neck radiographs in quantifying adenoid hypertrophy to help guide treatment decisions in patients with symptoms of nasal obstruction. Study Design: Retrospective review. Methods: Quantitative radiologic grading of adenoids was correlated with the intraoperative grading to select cases in agreement between the two methods. The percent airway obstruction was calculated as a ratio of adenoid size to the size of the nasopharyngeal airway near the level of the choanae on the lateral neck radiographs for adenoidectomy cases in which radiographic and intraoperative grading of adenoid size were in agreement. Results: A total of 426 adenoidectomy cases with preoperative lateral neck radiographs were reviewed (M:F = 254:172 for age range 9 months to 16 years), and only cases in agreement between radiographic and intraoperative adenoid grading were included in radiographic analysis (N = 234). The percent airway obstruction values were significantly different between “severely obstructive” (N = 137, mean = 94.71, SD = 6.55, range [72.00; 100.00]) and “moderately obstructive” adenoid categories (N = 97, mean = 78.53, SD = 6.91, range [63.67; 98.08]), not only within clinically relevant age groups (1-3 years, 4-7 years, 8-15 years), but also for the entire data set (95% CI [14.41; 17.95], P < .0001). “Mildly obstructive” category was omitted due to small sample size (N = 4). Conclusion: Lateral neck radiographs can provide useful supplemental information on the degree of nasopharyngeal airway obstruction when other clinical findings do not clearly point toward adenoid hypertrophy as a primary cause of nasal obstruction. In our data set, a 65% nasopharyngeal airway obstruction represents a value two standard deviations below the mean for “moderately” obstructive adenoid category, and can be viewed as a simplified cut-off to indicate that the degree of adenoid enlargement is clinically relevant. This cut-off value can assist in evaluation of patients with symptoms of nasal obstruction. Level of Evidence: 4

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