Tag: Adenoid

Adenoid

Adenoid


ADENOID/NASOPHARYNGEAL TONSIL/LUSCHKA’S TONSIL

ANATOMY OF ADENOID

  • Sub epithelial collection of lymphoid tissue at the junction of posterior wall and roof of nasopharynx.
  • Forms a part of inner waldeyer ring along with palatine and tubal tonsils.
  • Increases in size up to 6 yrs, tends to atrophy after that, completely disappears at the age of 20yrs
  • No crypts, no capsule (present in palatine tonsil)
  • Blood supply
  1. Ascending palatine branch of facial artery
  2. Ascending pharyngeal branch of external carotid artery
  3. Pharyngeal branch of third part of maxillary artery
  4. Ascen
  5. ding cervical branch of inferior thyroid artery

 ADENOID ENLARGEMENT

CLINICAL FEATURES OF ADENOID ENLARGEMENT

  • Nasal obstruction is the commonest symptom
  • Mouth breathing.
  • Recurrent URTI,Nasal discharge, sinusitis, epistaxis, voice change-Rhinolalia Clausa.
  • ET obstruction: Conductive hearing loss- CSOM, SOM
  • Adenoid is a common cause of Eustachian Disease
  • Adenoid facies: elongated face with dull expression, open mouth, prominent and crowded upper teeth, hitched up upper lip, high arched palate
  • Pulmonary hypertension and Cor pulmonale
  • Aprosexia – lack of concentration.
  • Failure to thrive.

ASSESMENT OF ADENOID ENLARGEMENT

  • Size of adenoids may well be assessed using lateral radiograph of nasopharynx and Nasal Endoscopy and CT scan is not necessary

TREATMENT

  • 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.

ADENOIDECTOMY

  • In the conventional method, St Clair Thompson’s adenoid curette is used.
  • Newer methods of Adenoid removal include Electrocautery,Laser,Coblation,Debrider 

Indications

  • Adenoid hypertrophy causing snoring, mouth breathing, sleep apnea or speech abnormalities
  • Recurrent URTI
  • Chronic otitis media with effusion.
  • Common cause of serous otitis media in children is growth of adenoid.
  • In that case Adenoidectomy with grommet insertion is done.
  • Serous otitis media in adults should arouse suspicion of nasopharyngeal carcinoma and hence the treatment aims at removal of carcinoma
  • Dental malocclusion
  • Recurrent ear discharge

Contraindications

  • Cleft palate or submucous palate
  • Hemorrhagic diathesis
  • Acute upper respiratory tract infection

Complications

Hemorrhage:

  • Primary,Reactionary,Secondary
  • Damage to the Eustachian Tube Orifice- leading to Otits media and Conductive hearing loss
  • Hypernasality of speech
  • Velopharyngeal insufficiency
  • Grisel’s Syndrome:
  • 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.
  • Retropharyngeal Abscess

Exam Question

  • Adenoidectomy with grommet insertion is treatment of choice for Serous otitis media in children .
  • Best line of management in a patient presenting with mouth breathing, recurrent serous otitis media and adenoid facies is Adenoidectomy.
  • Treatment of a  child with recurrent URTI with mouth breathing and failure to grow with high arched palate and impaired hearing is Grommet insertion  with Adenoidectomy and tonsillectomy (to remove the causative factor).
  • Common cause of eustachian diseases is due to Adenoids.
  • Next step of management in a child has adenoidectomy done but has effusion in middle ear is Grommet insertion.
  • Regarding adenoids ,there is failure to thrive,high arched palate and mouth breathing is seen.
  • The inner Waldeyer’s group of lymph nodes constitutes of Tonsils, Lingual tonsils ,Adenoids.
  • Indication for Adenoidectomy in children include Recurrent respiratory tract infections, Chronic serous otitis media and Multiple adenoids.
  • Torticollis can occur as a complication of adenoidectomy due to ligamentous laxity secondary to inflammatory process following adenoidectomy.
  • In a patient with hypertrophied adenoids, the voice abnormality that is seen is Rhinolalia Clausa.
  • Complications of adenoid­ectomy include Retro pharyngeal abscess,Velopharyngeal insufficiency and Grisel syndrome.
  • Adenoidectomy results in hypernasality of speech.
  • CT scan is not routinely preferred to assess Adenoid size.
Don’t Forget to Solve all the previous Year Question asked on Adenoid

Adenoid

Adenoid

Q. 1

Adenoidectomy with grommet insertion is treatment of choice for

 A

Serous otitis media in children

 B

Serous otitis media in adults

 C

Adenoiditis in children

 D

All of the above

Q. 1

Adenoidectomy with grommet insertion is treatment of choice for

 A

Serous otitis media in children

 B

Serous otitis media in adults

 C

Adenoiditis in children

 D

All of the above

Ans. A

Explanation:

 

  • 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.

Q. 2

6 year old child with recurrent URTI with mouth breathing and failure to grow with high arched palate and impaired hearing is :

 A

Tonsillectomy

 B

Grommet insertion

 C

Myringotomy with grommet insertion

 D

Adenoidectomy with grommet insertion

Q. 2

6 year old child with recurrent URTI with mouth breathing and failure to grow with high arched palate and impaired hearing is :

 A

Tonsillectomy

 B

Grommet insertion

 C

Myringotomy with grommet insertion

 D

Adenoidectomy with grommet insertion

Ans. D

Explanation:

Q. 3

What is the treatment of choice in a 6 year old child with recurrent URTI with mouth breathing having high arched palate, impaired hearing and growth failure?

 A

Tonsillectomy

 B

Grommet insertion

 C

Myringotomy with grommet insertion

 D

Adenoidectomy with grommet insertion

Q. 3

What is the treatment of choice in a 6 year old child with recurrent URTI with mouth breathing having high arched palate, impaired hearing and growth failure?

 A

Tonsillectomy

 B

Grommet insertion

 C

Myringotomy with grommet insertion

 D

Adenoidectomy with grommet insertion

Ans. D

Explanation:

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.  

The goal of placement of tympanostomy tubes is to aerate the middle ear space and prevent accumulation of middle ear inflammation and effusion.

In effect, ventilation of the middle ear enhances hearing thresholds. 
 

Q. 4

A 6 year old child presented with recurrent URTI, mouth breathing and failure to grow. On examination he has high arched palate and impaired hearing. What is the management of choice in this child?

 A

Myringotomy

 B

Myringotomy with grommet insertion

 C

Adenoidectomy with grommet insertion

 D

Tonsillectomy

Q. 4

A 6 year old child presented with recurrent URTI, mouth breathing and failure to grow. On examination he has high arched palate and impaired hearing. What is the management of choice in this child?

 A

Myringotomy

 B

Myringotomy with grommet insertion

 C

Adenoidectomy with grommet insertion

 D

Tonsillectomy

Ans. C

Explanation:

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.


Q. 5

Rhinolalia clausa is associated with all of the following, EXCEPT:

 A

Allergic rhinitis

 B

Palatal paralysis

 C

Adenoids

 D

Nasal polyps

Q. 5

Rhinolalia clausa is associated with all of the following, EXCEPT:

 A

Allergic rhinitis

 B

Palatal paralysis

 C

Adenoids

 D

Nasal polyps

Ans. B

Explanation:

Palatal paralysis is a cause of Rhinolalia Aperta (Hypernasality) and not Rhinolilia Clausa (Hyponasality).
 
Rhinolalia Aperta (Hypernasality or hyperrhinolalia or open nasality) is defined as excess resonance of vowels and voiced consonants within the nasal cavities. The anatomic-physiologic basis is open coupling between the oral and nasal cavities due to incomplete closure of the hard palate and/or velopharyngeal sphincter.
 

Q. 6

Common cause of eustachian diseases is due:

 A

Adenoids

 B

Siegle’s

 C

Otitis media

 D

Pharyngitis

Q. 6

Common cause of eustachian diseases is due:

 A

Adenoids

 B

Siegle’s

 C

Otitis media

 D

Pharyngitis

Ans. A

Explanation:

Q. 7

6 year old child with recurrent URTI with mouth breathing and failure to grow with high arched palate and impaired hearing is:

 A

Tonsillectomy

 B

Grommet insertion

 C

Myringotomy with grommet insertion

 D

Adenoidectomy with grommet insertion

Q. 7

6 year old child with recurrent URTI with mouth breathing and failure to grow with high arched palate and impaired hearing is:

 A

Tonsillectomy

 B

Grommet insertion

 C

Myringotomy with grommet insertion

 D

Adenoidectomy with grommet insertion

Ans. D

Explanation:

Q. 8

A child presents with recurrent respiratory tract infec­tion, mouth breathing and decreased hearing. Treatment is:

 A

Tonsillectomy

 B

Adenoidectomy

 C

Grommet insertion

 D

All

Q. 8

A child presents with recurrent respiratory tract infec­tion, mouth breathing and decreased hearing. Treatment is:

 A

Tonsillectomy

 B

Adenoidectomy

 C

Grommet insertion

 D

All

Ans. D

Explanation:

 

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). 



Q. 9

A child has Adenoidectomy done but he has effusion in middle ear. What is the next step in management?

 A

Grommet insertion

 B

Mastoidectomy

 C

Tympanoplasty

 D

None

Q. 9

A child has Adenoidectomy done but he has effusion in middle ear. What is the next step in management?

 A

Grommet insertion

 B

Mastoidectomy

 C

Tympanoplasty

 D

None

Ans. A

Explanation:

Q. 10

6-year-old child with recurrent URTI with mouth breath­ing and failure to grow with high arched palate and impaired hearing is:

 A

Tonsillectomy

 B

Grommet insertion

 C

Myringotomy with grommet insertion

 D

Adenoidectomy with grommet insertion

Q. 10

6-year-old child with recurrent URTI with mouth breath­ing and failure to grow with high arched palate and impaired hearing is:

 A

Tonsillectomy

 B

Grommet insertion

 C

Myringotomy with grommet insertion

 D

Adenoidectomy with grommet insertion

Ans. D

Explanation:

Q. 11

Regarding adenoids true is/are:

 A

There is failure to thrive

 B

Mouth breathing is seen

 C

CT scan should be done to assess size

 D

a and b

Q. 11

Regarding adenoids true is/are:

 A

There is failure to thrive

 B

Mouth breathing is seen

 C

CT scan should be done to assess size

 D

a and b

Ans. D

Explanation:

 

  • 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

Q. 12

Indication for Adenoidectomy in children include all except:

 A

Recurrent respiratory tract infections

 B

Recurrent Middle ear infection with deafness

 C

Chronic serous otitis media

 D

Multiple adenoids

Q. 12

Indication for Adenoidectomy in children include all except:

 A

Recurrent respiratory tract infections

 B

Recurrent Middle ear infection with deafness

 C

Chronic serous otitis media

 D

Multiple adenoids

Ans. B

Explanation:

Q. 13

The inner Waldeyer’s group of lymph nodes does not include:

 A

Submandibular lymph node

 B

Tonsils

 C

Lingual tonsils

 D

Adenoids

Q. 13

The inner Waldeyer’s group of lymph nodes does not include:

 A

Submandibular lymph node

 B

Tonsils

 C

Lingual tonsils

 D

Adenoids

Ans. A

Explanation:

 

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.


Q. 14

A 6-year-old boy presented to ENT OPD with recurrent URTI, mouth breathing and impaired hearing. The boy was diagnosed as having adenoid hypertrophy for which adenoidectomy was done and grommet inserted; 1 week after surgery,the boy was again brought to the OPD with torticollis. Which of the following are true about above clinical scenario.

 A

Antlantoaxial subluxation is the cause for his torticollis

 B

The condition is M/C in children with Down’s syndrome

 C

Torticollis is not a complication after adenoid surgery and it is a sheer coincidence

 D

a and b

Q. 14

A 6-year-old boy presented to ENT OPD with recurrent URTI, mouth breathing and impaired hearing. The boy was diagnosed as having adenoid hypertrophy for which adenoidectomy was done and grommet inserted; 1 week after surgery,the boy was again brought to the OPD with torticollis. Which of the following are true about above clinical scenario.

 A

Antlantoaxial subluxation is the cause for his torticollis

 B

The condition is M/C in children with Down’s syndrome

 C

Torticollis is not a complication after adenoid surgery and it is a sheer coincidence

 D

a and b

Ans. D

Explanation:

 

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.


Q. 15

Rhinolalia clausa is associated with all of the following except:

 A

Allergic rhinitis

 B

Palatal paralysis

 C

Adenoids

 D

Nasal polyps

Q. 15

Rhinolalia clausa is associated with all of the following except:

 A

Allergic rhinitis

 B

Palatal paralysis

 C

Adenoids

 D

Nasal polyps

Ans. B

Explanation:

Q. 16

In a patient with hypertrophied adenoids, the voice abnormality that is seen is:

 A

Rhinolalia clausa

 B

Rhinolalia aperta

 C

Hot potato voice

 D

Staccato voice

Q. 16

In a patient with hypertrophied adenoids, the voice abnormality that is seen is:

 A

Rhinolalia clausa

 B

Rhinolalia aperta

 C

Hot potato voice

 D

Staccato voice

Ans. A

Explanation:

 

  • 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.



Q. 17

Which of the following is not a complication of adenoid­ectomy?

 A

Hyponasality of speech

 B

Retro pharyngeal abscess

 C

Velopharyngeal insufficiency

 D

Grisel syndrome

Q. 17

Which of the following is not a complication of adenoid­ectomy?

 A

Hyponasality of speech

 B

Retro pharyngeal abscess

 C

Velopharyngeal insufficiency

 D

Grisel syndrome

Ans. A

Explanation:

 

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


Q. 18

NOT true for adenoid hypertrophy:

 A

Mouth breathing is seen

 B

High arched palate present

 C

There is failure to thrive

 D

CT scan should be done to assess size

Q. 18

NOT true for adenoid hypertrophy:

 A

Mouth breathing is seen

 B

High arched palate present

 C

There is failure to thrive

 D

CT scan should be done to assess size

Ans. D

Explanation:

 

Adenoid hypertrophy/ Enlarged adenoids

  • 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.

Q. 19

Patient presents with mouth breathing, recurrent serous otitis media and adenoid facies. What is the best line of management ?

 A

Adenoidectomy

 B

Tonsillectomy

 C

Antibiotics

 D

Supportive therapy

Q. 19

Patient presents with mouth breathing, recurrent serous otitis media and adenoid facies. What is the best line of management ?

 A

Adenoidectomy

 B

Tonsillectomy

 C

Antibiotics

 D

Supportive therapy

Ans. A

Explanation:

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.



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