Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 9  |  Issue : 2  |  Page : 216-218  

Adult adenoid hypertrophy, is it persistent childhood adenoid hypertrophy?


Department of Otorhinolaryngology, K. S. Hegde Medical Academy, Mangalore, Karnataka, India

Date of Web Publication1-Mar-2016

Correspondence Address:
Rajeshwary Aroor
Department of Otorhinolaryngology, K. S. Hegde Medical Academy, Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.177668

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  Abstract 

Objectives: Adult adenoid hypertrophy is not common. More number of cases of adult adenoid hypertrophy is detected in recent years due to the free availability of endoscopes. The aim of this study is to know the etiopathology of adenoid hypertrophy in adults. Materials and Methods: Twenty-five cases of adult adenoid hypertrophy who underwent adenoidectomy were studied in our institution over a period of 5 years from 2008 to 2013. All the patients underwent diagnostic nasal endoscopy, and associated sinus and nasal pathology were studied. Results: Of 25 cases, 12 were males and 13 were females. In our study adult adenoid hypertrophy was more common in second and third decade. Nasal obstruction was main symptom in 80% of our cases. Allergic symptoms were seen in 28%, headache in 24%, and repeated throat infection in 20%. Adenoidectomy with tonsillectomy was done in 5 cases, adenoidectomy with septoplasty in 5 cases, septoplasty with turbinectomy along with adenoidectomy in 7 cases, functional endoscopic sinus surgery with adenoidectomy in 3 cases, adenoidectomy with tympanoplasty in 2 cases, myringotomy with grommet insertion in 2 patients, and isolated adenoidectomy in 1 patient. Conclusion: Since highest number of cases in our study is in early adulthood, we believe that adenoid hypertrophy is persistence of childhood hypertrophy.

Keywords: Adult adenoid hypertrophy, allergy, infection


How to cite this article:
Shetty S, Aroor R, Bhandary SK, Bhat VS, Saldanha M, Alva S. Adult adenoid hypertrophy, is it persistent childhood adenoid hypertrophy?. Med J DY Patil Univ 2016;9:216-8

How to cite this URL:
Shetty S, Aroor R, Bhandary SK, Bhat VS, Saldanha M, Alva S. Adult adenoid hypertrophy, is it persistent childhood adenoid hypertrophy?. Med J DY Patil Univ [serial online] 2016 [cited 2024 Mar 29];9:216-8. Available from: https://journals.lww.com/mjdy/pages/default.aspx/text.asp?2016/9/2/216/177668


  Introduction Top


The term adenoid hypertrophy indicates nonphysiological enlargement of the nasopharyngeal tonsils and is the most prevalent cause of nasal obstruction in childhood. [2] It has been demonstrated that adenoid hypertrophy is also seen in the normal adult population and may cause nasal obstruction. [3],[4],[5] It is believed that chronic infection, allergic rhinitis, malignancy, human immunodeficiency virus (HIV) infection, smoking predisposes individual to adenoid hypertrophy. [1] This study aimed to investigate the etiology and clinical characteristics of adult adenoid hypertrophy and its clinical importance.


  Materials and Methods Top


Twenty-five cases of adult adenoid hypertrophy (>17 years) who underwent adenoidectomy over a period of 5 years from 2008 to 2013 in our institution were studied. Youngest patient in our study was 17 years of old and oldest is 42 years old with a mean age of 22 years [Table 1].
Table 1: Age and sex distribution of the patients with adenoid hypertrophy (n = 25)

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Among 25 patients, 12 were males and 13 were females. Nasal obstruction was the main complaint among 20 patients. Nine patients in addition to nasal obstruction gave a history of mouth breathing and snoring. Allergic symptoms (sneezing, itching, watering of the nose, etc.,) were observed in 7 cases. A headache was seen in 6 cases. Five cases presented with throat pain and repeated upper respiratory tract infections. Conductive hearing loss was seen in 4 cases and 2 cases presented with persistent ear discharge. One patient presented with a nasal twang of voice [Table 2].
Table 2: Symptoms of adenoid hypertrophy

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All patients were treated earlier with repeated antibiotic course and topical nasal spray.

All patients were subjected to diagnostic nasal endoscopy. Suspected cases of sinusitis underwent computed tomography of nose and paranasal sinuses.

Observation

Among 25 patients, 5 patients underwent tonsillectomy with adenoidectomy. Seven patients with allergic symptoms had deviated nasal septum and turbinate hypertrophy along with adenoid hypertrophy, they underwent septoplasty with turbinectomy along with adenoidectomy. These patients were treated with topical steroid spray in the postoperative period. Three cases that were radiologically diagnosed as sinusitis along with adenoid hypertrophy underwent functional endoscopic sinus surgery (FESS) along with adenoidectomy. Among the 2 patients with ear discharge, 1 patient underwent adenoidectomy followed by tympanoplasty. Other patient who had undergone cortical mastoidectomy and tympanoplasty 6 months back, presented with persistence ear discharge after initial surgery. She was found to have adenoid hypertrophy on thorough Ear, Nose and Throat examination. Subsequently she underwent adenoidectomy followed by revision tympanoplasty. The graft was taken up in the postoperative period with complete closer of perforation. The 2 cases diagnosed as otitis media with effusion, underwent adenoidectomy along with myringotomy and grommet insertion. Only one patient in our series presented with only nasal obstruction underwent only adenoidectomy and was symptomatically better after the surgery.

Conventional adenoidectomy was done in 16 cases, and endoscopic adenoidectomy using microdebrider in 9 cases, and all patients were symptomatically better after surgery. Though endoscopic adenoidectomy is preferred by the surgeon because of adenoid removal under direct vision, we did not find any difference in the results when comparing the endoscopic adenoid removal with that of conventional adenoidectomy.

Adenoid hypertrophy was confirmed by postoperative histopathological study.


  Discussion Top


Adenoid is a part of waldeyers ring and has an important role in the development of "immunological memory" in younger children. [6] Adenoid hypertrophy occurs in first 4 years of life and is known to involute between ages of 6 and 16 years. [7]

In young children this obstruction gives rise to mouth breathing, nasal speech, snoring, sore throat, dry mouth, overcrowding of teeth, high arched palate, broadening of the nasal bridge and  Eustachian tube More Details obstruction. This is described as typical adenoid facies. Due to Eustachian tube blockage the patient can develop secretory otitis media (glue ear). [8]

Although adenoidal tissue normally undergoes involution during late childhood period, it may persist into adult life and becomes a cause of nasal obstruction. In adults, it may be overlooked because of incomplete nasopharyngeal examination or due to overlap by accompanying rhinological disorders; hence, it can be misdiagnosed and accordingly maltreated. We believe that free availability of endoscopes helps in early diagnosis of adult adenoid hypertrophy.

In the English literature, very few articles are available regarding adult adenoid hypertrophy. According to German literature incidence of adult adenoid hypertrophy is 2.5%. [3] Hamdan et al. stated that adenoid hypertrophy is often underestimated in adults with nasal obstruction, because it is overlooked by underlying sinus and nasal pathology in adults since it is a disease of children. [9] Largest series of adult adenoid hypertrophy published in the English literature is 127 patients between 15 and 48 years by Protasevich et.al., the large number probably attributed to the long period of the study or due to age range (<18 years). [10] Lower limits in their age group are 15 years, this probably contributing to high number of cases in their series. Even in our study, large number of patients are in the age group of 17-20 years. We believe that high number of cases in young adult population is probably due to continuation of pediatric adenoid hypertrophy in early adulthood. Kamel and Ishak in Egypt reported 35 cases of enlarged adenoids with ages ranging between 20 and 42 years. [5] In a 5 years period we have done FESS in 206 patients for sinonasal polyposis and 244 patient for chronic sinusitis, but only 3 cases of sinusitis had associated adenoid hypertrophy. It is controversial whether adenoid hypertrophy leads to sinusitis or vice versa. Since 241 patients of chronic sinusitis did not have associated adenoid tissue hypertrophy we believe that infection is not the main cause for adult adenoid hypertrophy. None of our nasal polyposis patient had associated adenoid hypertrophy. We have 7 cases of allergic rhinitis associated with adenoid hypertrophy but none of these patients had nasal polyposis. There was no sex difference in incidence of adenoid hypertrophy (12 M-13F) in our study.

Nasal obstruction in adults can have various underlying conditions such as deviated nasal septum, inferior turbinate hypertrophy, nasal polyposis, juvenile nasal angiofibroma, nasopharyngeal malignancies, and reactive hypertrophy of adenoids in HIV-positive patients. [8],[11]

Various etiopathogenic mechanisms have been proposed to explain the presence of lymphoid hyperplasia in the adult nasopharynx, including the persistence of childhood adenoids due to chronic inflammation or re-proliferation of regressed adenoidal tissue in response to irritants or infections. [5],[4]

Finkelstein et al. reported that the presence of obstructive adenoids in 30% of heavy smokers. [12] None of our patients are smokers.

Adenoid hypertrophy caused by viruses in adults with compromised immunity, especially those receiving organ transplants and those with HIV. Nasopharyngeal adenoidal tissue may become hypertrophied in patients who are HIV positive. France et al. found adenoidal hypertrophy in 33 (60%) of 55 HIV-positive patients in their series. [13] None of our patients are immunocompromised or HIV positive.


  Conclusion Top


Adult adenoid hypertrophy is a persistent childhood adenoid hypertrophy in early adulthood. We believe that adenoid hypertrophy in adult is a separate entity rather than due to overlying sinus pathology giving rise to lymphoid tissue hypertrophy in nasopharynx. Diagnostic nasal endoscopy is the gold standard investigation for adenoid hypertrophy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Rout MR, Mohanty D, Vijaylaxmi Y, Bobba K, Metta C. Adenoid hypertrophy in adults: A case series. Indian J Otolaryngol Head Neck Surg 2013;65:269-74.  Back to cited text no. 1
    
2.
Gates GA, Muntz HR, Gaylis B. Adenoidectomy and otitis media. Ann Otol Rhinol Laryngol Suppl 1992;155:24-32.  Back to cited text no. 2
    
3.
Minnigerode B, Blass K. Persistent adenoid hypertrophy (author′s transl). HNO 1974;22:347-9.  Back to cited text no. 3
    
4.
Frenkiel S, Black MJ, Small P. Persistent adenoid presenting as a nasopharyngeal mass. J Otolaryngol 1980;9:357-60.  Back to cited text no. 4
    
5.
Kamel RH, Ishak EA. Enlarged adenoid and adenoidectomy in adults: Endoscopic approach and histopathological study. J Laryngol Otol 1990;104:965-7.  Back to cited text no. 5
    
6.
Wysocka J, Hassmann E, Lipska A, Musiatowicz M. Naive and memory T cells in hypertrophied adenoids in children according to age. Int J Pediatr Otorhinolaryngol 2003;67:237-41.  Back to cited text no. 6
    
7.
Brodsky L, Koch RJ. Bacteriology and immunology of normal and diseased adenoids in children. Arch Otolaryngol Head Neck Surg 1993;119:821-9.  Back to cited text no. 7
    
8.
Karodpati N, Shinde V, Deogawkar S, Ghate G. Adenoid hypertrophy in adults - A myth or reality. Webmedcentral Otorhinolaryngol 2013;4:WMC004079.  Back to cited text no. 8
    
9.
Hamdan AL, Sabra O, Hadi U. Prevalence of adenoid hypertrophy in adults with nasal obstruction. J Otolaryngol Head Neck Surg 2008;37:469-73.  Back to cited text no. 9
    
10.
Protasevich GS, Iashan IA, Iashan AI. Adenoids in adults. Vestn Otorinolaringol 1999;5:11-3.  Back to cited text no. 10
    
11.
Jamal TS. Adenoids in adults. JKAU Med Sci 1995-1997;5: 29-34.  Back to cited text no. 11
    
12.
Finkelstein Y, Malik Z, Kopolovic J, Bernheim J, Djaldetti M, Ophir D. Characterization of smoking-induced nasopharyngeal lymphoid hyperplasia. Laryngoscope 1997;107(12 Pt 1): 1635-42.  Back to cited text no. 12
    
13.
France AJ, Kean DM, Douglas RH, Chiswick OM, St Clair D, Best JJ, et al. Adenoidal hypertrophy in HIV-infected patients. Lancet 1988;2:1076.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2]


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