Adenoid

• Common cause of serous otitis media in children is growth of adenoid; hence treatment aims at removal of cause (adenoidectomy) and drainage of middle ear by grommet.
• Serous otitis media in adults should arouse suspicion of nasopharyngeal carcinoma and hence the treatment aims at removal of carcinoma
• Adenoiditis is an acute condition and requires treatment conservatively.

Hypertrophic adenoid tissue causes nasal obstruction, mouth-breathing, and similarly, obstruction of the Eustachian tube orifices.

Removing large adenoids enhances the patency of the nasopharyngeal airway, relieving the overall pressure in the nasopharynx, in turn allowing improved aeration of the middle ear cleft.  

Child in the question is showing features of adenoid hyperplasia as indicated by mouth breathing, nasal obstruction and recurrent URTI. He has impaired hearing as a result of serous otitis media which occur as a complication of adenoid hyperplasia. So the treatment of choice is adenoidectomy with grommet insertion which will take care of both the adenoid as well as serous otitis media.

Child is presenting with mouth breathing. Palate is high arched.There is nasal obstruction and recurrent respiratory tract infections along with hearing impairment. All these features are suggestive of adenoid hyperplasia. In case of adenoid hyperplasia, impairment of hearing is due to secretory otitis.

Thus the logical step in the management would be myringotomy with grommet insertion (to treat SOM) and adenoidectomy or tonsilectomy (to remove the causative factor). 

• High arched palate and mouth breathing are features of hypertrophied adenoids which leads to adenoid facies
• In adenoids as a consequence of recurrent nasal obstruction and URTI, child develops failure to thrive
• Size of adenoids may well be assessed using lateral radiograph of nasopharynx, and CT scan is not necessary

Submandibular nodes do not form part of Waldeyer’s lymphatic ring.

They form part of the outer group of lymph nodes into which efferents from the constituents of the Waldeyer’s lymphatic ring may drain.

Torticollis can occur as a complication of adenoidectomy due to ligamentous laxity secondary to inflammatory process following adenoidectomy. It is called as Grisel syndrome.

This is M/C in patients of Down syndrome as children with Down’s already have asymptomatic atlantoaxial instability which mani­fests after surgery.

• Rhinolalia clausa is lack of nasal resonance (hyponasality).
• It is seen in conditions which block the nose or nasopharynx as in case of allergic rhinitis, adenoids and nasal polpys.
• Palatal paralysis will lead to hypernasality and not hyponasality.

 Hyponasality of speech is not a complication of adenoidectomy. Adenoidectomy results in hypernasality.

• It is the unusual growth (“hypertrophy”) of the adenoid tonsil.
• Firstly described and adenoidectomy performed by the Danish physician Wilhelm Meyer (1824-1895) in Copenhagen in 1868.
• He described that a long term adenoid hypertrophy will cause an obstruction of the nasal airways.
• These will lead to a dentofacial growth anomaly that was defined as adenoid facies.
• There is very little lymphoid tissue in the nasopharynx of young babies; humans are born without substantial adenoids.

Ans. is ‘a’ i.e., Adenoidectomy

The triad of nasal and aural symptoms with adenoid facies points to the diagnosis of enlarged adenoids.

For the treatment of enlarged adenoids when symptoms are not marked breathing excercise, decongenstant nasal drops and antihistaminics are used and when symptoms are marked, adenoidectomy is done.

We have a patient with marked and recurrent symptoms thus adenoidectomy is the treatment of choice.