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| {{SK}} Inflamed adenoids; Adenoid inflamed; [[Tonsillitis|Tonsilitis]]; Adenotonstilis | | {{SK}} Inflamed adenoids; Adenoid inflamed; [[Tonsillitis|Tonsilitis]]; Adenotonstilis |
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| ==Overview==
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| [[Adenoid]] is a [[lymphoid tissue]] that form [[Waldeyer's ring|Waldeyer]] ring which is situated adjacent to the [[choanae]] and the [[pharyngeal]] [[ostium]] of the [[Eustachian tube|eustachian tubes]] in the posterior wall of [[nasopharynx]]. This [[lymphoid tissue]] is involved in [[immunoglobin]] production and maturation of [[Lymphatic|lymphatic cells]] and defense against [[pathogens]]. The [[adenoid]] usually undergoes a degree of [[atrophy]] and involution from the age of 8-10 years so it is rarely found in adults.
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| [[Adenoiditis]] is the inflammation of [[Adenoid|adenoid tissue]]. [[Adenoid]] infection is mostly due to [[viral]] [[Infection|infections]]. Some [[bacterial]] [[pathogens]] include [[Haemophilus influenzae|H. influenzae]], [[Streptococcus|group A β-hemolytic streptococcus]], and [[Staphylococcus aureus|S. aureus]] ''can cause'' the disease as well. [[Adenoid|Adenoids]] can cause [[Sinusitis|recurrent sinusitis]] and [[Chronic otitis media|chronic persistent]] or [[Recurrent otitis media|recurrent otitis]] if remain untreated and develop to [[Adenoiditis|chronic adenoiditis]].
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| [[Medications]] ([[antibiotics]] or [[steroids]]) or [[surgical]] approach may be required for the management of [[adenoiditis]], depending on the causative agent.
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| == Historical perspective ==
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| [[Adenoid]] was though to be a part of [[tonsils]] and responsible for the symptoms of [[Nasal congestion|nasal congestion and obstruction]]. As a result [[Tonsilectomy|adenotonsilectomy]] was performed for at least 2000 years. In the early beginning of 19th century, [[adenoid]] and [[tonsil]] tissue were known as remnants of an unknown [[infectious disease]], and so they were removed with adenotonsilectomy. Willhelm Meyer of Copenhagen, Denmark in 1800 firstly describe [[adenoiditis]] due to adenoid vegetations responsible for nasal symptoms and impaired hearing. He probably was the first one who performed an [[adenoidectomy]] separately.
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| == Pathophysiology ==
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| [[Adenoid|Adenoids]] are involved in the production of mostly secretory [[IgA]], which is transported to the surface providing local [[immune]] protection. Studies suggest that a reduction in [[IgA]] will happen postoperative of [[adenoidectomy]].<ref name="pmid12117336">{{cite journal |vauthors=Havas T, Lowinger D |title=Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy |journal=Arch. Otolaryngol. Head Neck Surg. |volume=128 |issue=7 |pages=789–91 |year=2002 |pmid=12117336 |doi= |url=}}</ref>
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| Oral cavity normal [[flora]] [[bacteria]] are found in adenoid flora as well, which include:
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| * [[Streptococcus|Alpha-hemolytic streptococci]]
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| * [[Enterococcus|Enterococci]]
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| * [[Corynebacterium]] species
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| * [[Coagulase-negative staphylococci]]
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| * [[Neisseria species]]
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| * [[Haemophilus|Haemophilus species]]
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| * [[Micrococcus|Micrococcus species]]
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| * Stomatococcus species
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| [[Adenoiditis]] can happen as a result of infection and harbor [[pathogenic]] bacterial activity, which may lead to the development of disease of the ears, nose, and sinuses. Adenoiditis can progress to chronic disease if remain untreated for a long term.
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| ==Causes==
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| [[Adenoiditis]] is mainly due to [[viral]] infection but [[bacterial]] infections can cause the disease as well<ref name="pmid22339566">{{cite journal |vauthors=Karlıdağ T, Bulut Y, Keleş E, Alpay HC, Seyrek A, Orhan İ, Karlıdağ GE, Kaygusuz İ |title=Presence of herpesviruses in adenoid tissues of children with adenoid hypertrophy and chronic adenoiditis |journal=Kulak Burun Bogaz Ihtis Derg |volume=22 |issue=1 |pages=32–7 |year=2012 |pmid=22339566 |doi= |url=}}</ref>:
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| ===Viral Causes===
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| *[[Epstein Barr virus|Epstein-barr virus]] (EBV)
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| *[[Adeno virus|Human adenovirus]]
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| *[[Enterovirus]]
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| *[[Rhinovirus]]
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| *[[Respiratory syncytial virus]]
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| *[[Mononucleosis]]
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| *[[Cytomegalovirus|Cytomegalovirus (CMV)]]
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| *[[Toxoplasmosis]]
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| *[[Herpes virus]]
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| ===Bacterial Causes===
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| *[[Haemophilus influenzae]]
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| *[[Streptococcus|Group A β-hemolytic streptococcus]]
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| *[[Staphylococcus aureus]]
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| * [[Moraxella catarrhalis]]
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| * [[Streptococcus pneumoniae]]
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| === Other causes ===
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| * Sensitivity to [[Mold allergy|mold allergens]]<ref name="pmid11686429">{{cite journal |vauthors=Huang SW, Giannoni C |title=The risk of adenoid hypertrophy in children with allergic rhinitis |journal=Ann. Allergy Asthma Immunol. |volume=87 |issue=4 |pages=350–5 |year=2001 |pmid=11686429 |doi=10.1016/S1081-1206(10)62251-X |url=}}</ref>
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| ==Epidemiology and Demographics==
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| [[Adenoiditis]] occurs mostly in children. As a result of close location adenoiditis is often associated with acute [[tonsillitis]]. Adenoid tissue go through atrophy process after 10 so adeoiditis is rarely seen after 15. [[Adenoiditis]] can be seen in adults too. However due to improvement in diagnosis, it is usually treated or removed during childhood.
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| ==Natural History, Complications and Prognosis==
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| The symptoms of [[adenoiditis]] usually develop in the first decade of life, and start with symptoms such as recurrent [[Upper respiratory tract infection|upper respiratory tract infections]], [[sleep apnea]], and nasal airway obstruction. Without treatment, the patient will develop symptoms of [[sinusitis]] and [[otitis media]], which may eventually lead to [[hearing loss]].
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| ===Complications===
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| Chronic adenoiditis is contributed to other head and neck diseases. These diseases are as a result of bacterial overload in adenoids and include<ref name="pmid23641372">{{cite journal |vauthors=Rajeshwary A, Rai S, Somayaji G, Pai V |title=Bacteriology of symptomatic adenoids in children |journal=N Am J Med Sci |volume=5 |issue=2 |pages=113–8 |year=2013 |pmid=23641372 |pmc=3624711 |doi=10.4103/1947-2714.107529 |url=}}</ref>:
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| * [[Sinusitis|Recurrent sinusitis]]
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| * [[Chronic otitis media|Chronic persistent otitis media]]
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| * [[Recurrent otitis media]]
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| * [[Conductive hearing loss]]
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| * [[Pneumonia]]
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| ==History and Symptoms==
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| === History ===
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| Obtaining the history is one of the most important aspect of making a diagnosis of [[adenoiditis]]. It provides insight into diagnosis. Complete history will help determine the correct therapy. Adenoiditis patients are mostly young children who are not able to give a good history by themselves, therefore the patient interview may be difficult. In these cases history from the care givers or the family members may need to be obtained. Specific histories about the [[symptoms]] (duration, onset, progression), and associated symptoms have to be obtained. Specific areas of focus when obtaining the history, are outlined below:
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| * Onset, duration and progression of symptoms
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| * Associated symptoms ([[fever]], [[headache]], ear pain)
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| * Recurrent episodes of [[upper respiratory tract infection]]
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| * [[Poor feeding]]
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| * [[Attention deficit]] problems
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| * Impairment of smell
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| === Symptoms ===
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| The symptoms of adenoiditis can last for 10 or more days. Acute adenoiditis is usually presented with nasal symptoms:
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| * Nasal [[airway obstruction]]
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| * [[Snoring]]
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| * [[sleep apnea]]
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| * Oral breathing
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| * Sore or dry throat from breathing through the mouth
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| Other symptoms that mainly observed during [[chronic inflammation]] are usually correlated to [[adenoiditis]] complications and include:
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| * [[Rhinorrhea|Purulent rhinorrhea]]
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| * Nasal obstruction
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| * Fever
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| * Ear pain
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| * [[Headache]]
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| * [[Sore throat]]
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| == Diagnostic criteria ==
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| [[Adenoiditis]] diagnosis can be confirmed if during flexible or rigid nasopharyngoscopy inflamed adenoid tissue is seen. Flexible or rigid nasopharyngoscopy can provide a direct visualization of [[Nasopharyngeal carcinoma|nasopharynx]] and [[Waldeyer's ring|Waldeyer]] ring so the inflamed adenoid tissue can be seen too.
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| Other ways that can help beside history and symptoms to be close to diagnosis include:
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| * [[Throat]] examinations using swabs to obtain samples of bacteria and other organisms and culture them
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| * Blood tests to determine the presence of [[Organism|organisms]] in blood (especially in ill patients with acute disease)
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| * Lateral neck graphy to determine the size of adenoids
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| === Differential Diagnosis: ===
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| * [[Tonsillitis|Tonsilitis]]
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| * Adenoid disorders
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| * Tonsil disorders
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| * Throat infection
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| * Chronic tonsilitis
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| ==Medical Therapy==
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| * [[Antibiotic]] therapy:
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| ** There are no proven evidence of medical therapy effectiveness in recurrent or chronic [[adenoiditis]] cases.
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| ** Systemic oral antibiotics can be used if the suspected organism is a bacteria and should be prescribed for a long-term (ie, 6 wk) for lymphoid tissue infection.
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| ** The most appropriate antibiotics are [[amoxicillin]] - [[clavulanic acid]] or a [[cephalosporin]].
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| ** Although antibiotic therapy can treat acute adenoiditis, it usually fail to eradicate the bacteria in chronic or recurrent adenoiditis.
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| ** Nowadays with the current trend of resistant bacteria, the use of prophylactic or long-term antibiotics has been decreased.
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| * Topical therapy:
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| ** Topical nasal steroids in children can be used to treat adenoid hypertrophy.
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| ** Topical nasal steroids can lead to adenoid shrinkage slightly (ie, up to 10%), which may help relieve some nasal obstruction symptoms. However, it is not a permanent therapy and all symptoms may raise again after discontinuation of topical nasal steroid.
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| ** A combination trial of topical nasal steroid spray and saline spray may be considered for effective control of symptoms in children.
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| * In cases of viral adenoiditis, treatment with [[analgesic]]s or [[antipyretic]]s is often sufficient.
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| == Surgical Therapy ==
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| In case of adenoid hypertrophy, [[adenoidectomy]] may be performed to remove the adenoid. Adenoidectomy has been shown to be effective independent of the size of the adenoids.
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| ==Related Chapters==
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| * [[Tonsilitis]]
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| ==References==
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| {{reflist|2}}adenoids can contribute to recurrent sinusitis and chronic persistent or recurrent ear disease because they can harbor a chronic infection.adenoids can contribute to recurrent sinusitis and chronic persistent or recurrent ear disease because they can harbor a chronic infection.
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| [[Category:Disease]] | | [[Category:Disease]] |
| [[Category:Otolaryngology]] | | [[Category:Otolaryngology]] |