Doctors Revision

ENT (Ear, Nose, Throat Conditions)

Adenoid Hypertrophy / Adenoiditis

Enlargement (hypertrophy) and/or inflammation (adenoiditis) of the adenoid tissue (pharyngeal tonsil) located in the nasopharynx, common in young children, potentially causing nasal obstruction and related complications.

Also known as: Enlarged Adenoids, Adenoid Disease

Open in the interactive guide
On this page

Referral and warning signs

When to refer

Refer to ENT Specialist if: Symptoms are significant and persistent (marked mouth breathing, snoring, suspected OSA). Associated with recurrent AOM or persistent OME needing potential surgery. Failure of conservative management.

Red flags

  • Signs of Obstructive Sleep Apnoea (witnessed apnoeas, gasping, daytime sleepiness, failure to thrive).
  • Unilateral nasal obstruction or discharge (consider other pathology).
  • Significant hearing loss or speech delay.

Signs and symptoms

  • Nasal Obstruction: Persistent mouth breathing, Snoring, Obstructive sleep apnoea (pauses in breathing during sleep), Hyponasal speech ('talking through nose').
  • Nasal Discharge: Persistent or recurrent rhinorrhoea (often mucoid).
  • Eustachian Tube Dysfunction: Recurrent Acute Otitis Media (AOM), Otitis Media with Effusion (OME / 'Glue Ear'), Conductive hearing loss.
  • Facial Appearance ('Adenoid Facies'): Prolonged mouth breathing can lead to open mouth posture, elongated face, high arched palate, dental malocclusion.
  • Other: Recurrent cough (from postnasal drip), Difficulty eating (especially infants), Halitosis (bad breath), Developmental delay (if severe sleep apnoea/hypoxia).

Risk factors

  • Young age (adenoids naturally largest in early childhood, regress later).
  • Recurrent URTIs / Viral infections.
  • Allergies.
  • Passive smoking.
  • Genetic predisposition.

Diagnosis

Clinical assessment

Diagnosis often based on characteristic history (mouth breathing, snoring, recurrent ear infections) and clinical findings (adenoid facies). Examination of oropharynx may show postnasal drip, high arched palate. Direct visualization difficult without specialized tools.

Investigations

  • Lateral Neck Soft Tissue X-ray: Can show enlarged adenoid tissue narrowing the nasopharyngeal airway.
  • Nasal Endoscopy: Flexible or rigid endoscopy allows direct visualization of adenoids (Specialist procedure).
  • Tympanometry/Audiometry: Assess for associated OME/hearing loss.
  • Sleep Study (Polysomnography): If obstructive sleep apnoea suspected (Specialist).

Diagnostic criteria

Clinical symptoms suggestive of nasopharyngeal obstruction +/- confirmation of adenoid enlargement on lateral neck X-ray or endoscopy.

Differential diagnosis

  • Allergic Rhinitis.
  • Chronic Rhinosinusitis.
  • Nasal polyps.
  • Deviated nasal septum.
  • Nasal foreign body.
  • Choanal atresia (congenital).
  • Nasopharyngeal tumour (rare in children).

Management

Non-pharmacological management

  • Watchful waiting if symptoms are mild and not impacting quality of life (adenoids often regress with age).
  • Management of associated conditions (allergic rhinitis, OME).

Pharmacological treatment

  • Mild Symptoms / Possible Adenoiditis:
  • - Trial of Intranasal Corticosteroids (INCS): May reduce inflammation/size temporarily (e.g., Fluticasone, Mometasone spray). (LOC: HC3/4)
  • - Antihistamines (if allergy component suspected): UCG suggests Chlorphenamine 1-2mg daily for 7 days for mild cases. (LOC: HC2)
  • - Antibiotics: Generally NOT indicated for hypertrophy alone. May be used if acute bacterial adenoiditis suspected (fever, purulent discharge - use Amoxicillin).

Monitoring

Monitor symptom severity (snoring, mouth breathing, ear infections, hearing). Monitor growth and development.

Complications

  • Obstructive Sleep Apnoea (OSA) -> Daytime fatigue, poor concentration, behavioural issues, failure to thrive, pulmonary hypertension (rare, severe).
  • Recurrent Acute Otitis Media / Chronic Otitis Media with Effusion -> Hearing loss, speech delay.
  • Chronic rhinosinusitis.
  • Altered facial growth ('adenoid facies') / Dental malocclusion.

Prevention

  • Management of allergies.
  • Avoidance of passive smoke.

Patient education

  • Explanation of enlarged adenoids and their common effects.
  • Natural history (often improves with age).
  • Management options (watchful waiting, nasal sprays, surgery).
  • Indications for adenoidectomy.
  • Importance of managing allergies/infections.
  • Recognizing signs of sleep apnoea.

Uganda-specific notes

Adenoid hypertrophy common cause of nasal obstruction/mouth breathing in children. Often associated with recurrent ear infections. Lateral neck X-ray often used for assessment when endoscopy unavailable. Adenoidectomy performed at referral centres.

Surgical Management

  • Adenoidectomy: Surgical removal of adenoid tissue. Main indication for significant nasal obstruction causing mouth breathing, obstructive sleep apnoea, or contributing to recurrent AOM / persistent OME requiring grommets. (LOC: ENT Surgeon)

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 21, Section 21.2.6

Scroll to Top