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{{CMG}}{{AE}}{{MIR}}
{{CMG}}{{AE}}{{MIR}}
==Overview==
==Overview==
[[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.
[[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. [[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]]. [[Medications]] ([[antibiotics]] or [[steroids]]) or [[surgical]] approach may be required for the management of [[adenoiditis]], depending on the causative agent.
 
[[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]].
 
[[Medications]] ([[antibiotics]] or [[steroids]]) or [[surgical]] approach may be required for the management of [[adenoiditis]], depending on the causative agent.
==Historical perspective==
==Historical perspective==
[[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.
[[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.
==Pathophysiology==
==Classification==
Adenoiditis can be classified to the following types including acute adenoiditis, recurrent acute adenoiditis, and chronic/persistant adenoiditis.<ref name="urlHead & Neck Surgery--otolaryngology - Google Books">{{cite web |url=https://books.google.com/books/about/Head_Neck_Surgery_otolaryngology.html?id=mFlV1-v_eVwC |title=Head & Neck Surgery--otolaryngology - Google Books |format= |work= |accessdate=}}</ref>
 
== Pathophysiology ==
[[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>
[[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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[[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.
[[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.
==Causes==
==Causes==
[[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>:
Acute adenoiditis is mainly due to [[viral]] infection but [[bacterial]] infections can cause the disease as well, while bacterial infections have a more important role in recurrent and chronic adenoiditis. The most important viral causes include [[EBV]], [[CMV]], [[RSV]]. The most important bacterial causes include [[Haemophilus influenzae]], [[Streptococcus|group A β-hemolytic streptococcus]], [[Staphylococcus aureus]].<ref name="pmid121173362">{{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>
===Viral Causes===
==Differentiating tonsillitis from other diseases==
*[[Epstein Barr virus|Epstein-barr virus]] (EBV)
Diagnosis of adenoiditis can be challenging as majority of [[Upper respiratory tract infection|upper respiratory tract infections]] show the same pattern. The most important differential diagnosis include [[Tonsillitis|tonsilitis]], viral [[upper respiratory tract infection]], [[sinusitis]] and [[pharyngitis]].
*[[Adeno virus|Human adenovirus]]
*[[Enterovirus]]
*[[Rhinovirus]]
*[[Respiratory syncytial virus]]
*[[Mononucleosis]]
*[[Cytomegalovirus|Cytomegalovirus (CMV)]]
*[[Toxoplasmosis]]
*[[Herpes virus]]
===Bacterial Causes===
*[[Haemophilus influenzae]]
*[[Streptococcus|Group A β-hemolytic streptococcus]]
*[[Staphylococcus aureus]]


*[[Moraxella catarrhalis]]
*[[Streptococcus pneumoniae]]
===Other causes===
*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>
==Epidemiology and Demographics==
==Epidemiology and Demographics==
[[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.
The prevalence of adenoiditis is not completely known. Research indicates that 15-30% of sore throats in children and 5-10% sore throats in adults are [[bacterial]] adenotonsillitis. The prevalence of adenoiditis decreases with age. Adenoid tissue go through atrophy process after 10 so adeoiditis is rarely seen after 15.<ref name="pmid3534166">{{cite journal |vauthors=Komaroff AL, Pass TM, Aronson MD, Ervin CT, Cretin S, Winickoff RN, Branch WT |title=The prediction of streptococcal pharyngitis in adults |journal=J Gen Intern Med |volume=1 |issue=1 |pages=1–7 |year=1986 |pmid=3534166 |doi= |url=}}</ref><ref name="pmid5115179">{{cite journal |vauthors=Kaplan EL, Top FH, Dudding BA, Wannamaker LW |title=Diagnosis of streptococcal pharyngitis: differentiation of active infection from the carrier state in the symptomatic child |journal=J. Infect. Dis. |volume=123 |issue=5 |pages=490–501 |year=1971 |pmid=5115179 |doi= |url=}}</ref><ref name="pmid12613739">{{cite journal |vauthors=Schroeder BM |title=Diagnosis and management of group A streptococcal pharyngitis |journal=Am Fam Physician |volume=67 |issue=4 |pages=880, 883–4 |year=2003 |pmid=12613739 |doi= |url=}}</ref><ref name="Oroface">{{cite book |last1=Sharav |first1=Yair |last2=Benoliel |first2=Rafael |date=2008 |title=Orofacial Pain and Headache |url= |location= |publisher=Elsevier |page= |isbn=0723434123}}</ref><ref name="pmid26478108">{{cite journal |vauthors=Pagella F, De Amici M, Pusateri A, Tinelli G, Matti E, Benazzo M, Licari A, Nigrisoli S, Quaglini S, Ciprandi G, Marseglia GL |title=Adenoids and clinical symptoms: Epidemiology of a cohort of 795 pediatric patients |journal=Int. J. Pediatr. Otorhinolaryngol. |volume=79 |issue=12 |pages=2137–41 |year=2015 |pmid=26478108 |doi=10.1016/j.ijporl.2015.09.035 |url=}}</ref>
==Natural History, Complications and Prognosis==
==Risk Factors==
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]].
The most potent risk factor in the development of adenoiditis is being a young child. Other risk factors include immuno-deficiencies, living in an urban environment with more exposure to [[viruses]] or [[bacteria]] and usage of immuno-suppressant drugs.
 
== Screening ==
There is insufficient evidence to recommend routine screening for Adenoiditis.
==Natural history, complications and prognosis==
===Natural History===
Acute adenoiditis will usually present with [[erythema]] and [[edema]] of the adenoids rapidly upon infiltration of the pathogen.<ref name="urlTonsillitis - NHS Choices">{{cite web |url=http://www.nhs.uk/conditions/Tonsillitis/Pages/Introduction.aspx |title=Tonsillitis - NHS Choices |format= |work= |accessdate=}}</ref>
*Symptoms, including [[fever]] and [[sore throat]], will usually manifest within 24 hours of infection.
*It is usually combined with [[Tonsillitis|tonsilitis]] due to close anatomical location.
===Complications===
===Complications===
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>:
Complications of adenoiditis are caused by persistence and/or spread of the responsible pathogen - usually [[bacterial]] - and include speech abnormalities [[otitis media]], acute [[sinusitis]], [[pneumonia]], adenoid [[hyperplasia]], [[peritonsillar abscess]], [[sleep apnea]]
*[[Sinusitis|Recurrent sinusitis]]
 
*[[Chronic otitis media|Chronic persistent otitis media]]
===Prognosis===
*[[Recurrent otitis media]]
The prognosis for acute adenoiditis without treatment is usually good; the disease is usually self-limited and will resolve itself within 3-4 days.<ref name="urlTonsillitis - NHS Choices3">{{cite web |url=http://www.nhs.uk/conditions/Tonsillitis/Pages/Introduction.aspx |title=Tonsillitis - NHS Choices |format= |work= |accessdate=}}</ref>
*[[Conductive hearing loss]]
 
*[[Pneumonia]]
==Diagnosis==
==History and Symptoms==
 
===History===
=== Diagnostic criteria ===
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:
There are no criteria for the diagnosis of adenoiditis. However, seeing inflamed and [[Adenoid hypertrophy|hypertrophied adenoid]] tissue with flexible or rigid nasopharyngoscopy can be used as a criteria for [[adenoidectomy]] in patients suspected to chronic adenoiditis.
*Onset, duration and progression of symptoms
 
*Associated symptoms ([[fever]], [[headache]], ear pain)
===History and Symptoms===
*Recurrent episodes of [[upper respiratory tract infection]]
A positive history of fever and nasal obstruction and [[snoring]] are suggestive of adenoiditis. The most common symptoms of adenoiditis include [[nasal discharge]] which may be purulent, mouth breathing, nasal pain and [[sore throat]].<ref name="pmid259506862">{{cite journal |vauthors=Kosikowska U, Korona-Głowniak I, Niedzielski A, Malm A |title=Nasopharyngeal and Adenoid Colonization by Haemophilus influenzae and Haemophilus parainfluenzae in Children Undergoing Adenoidectomy and the Ability of Bacterial Isolates to Biofilm Production |journal=Medicine (Baltimore) |volume=94 |issue=18 |pages=e799 |year=2015 |pmid=25950686 |pmc=4602522 |doi=10.1097/MD.0000000000000799 |url=}}</ref><ref name="pmid276059882">{{cite journal |vauthors=Kajan ZD, Sigaroudi AK, Mohebbi M |title=Prevalence and patterns of palatine and adenoid tonsilloliths in cone-beam computed tomography images of an Iranian population |journal=Dent Res J (Isfahan) |volume=13 |issue=4 |pages=315–21 |year=2016 |pmid=27605988 |pmc=4993058 |doi= |url=}}</ref><ref name="pmid178831913">{{cite journal |vauthors=Galli J, Calò L, Ardito F, Imperiali M, Bassotti E, Fadda G, Paludetti G |title=Biofilm formation by Haemophilus influenzae isolated from adeno-tonsil tissue samples, and its role in recurrent adenotonsillitis |journal=Acta Otorhinolaryngol Ital |volume=27 |issue=3 |pages=134–8 |year=2007 |pmid=17883191 |pmc=2640046 |doi= |url=}}</ref>
*[[Poor feeding]]
===Physical Examination===
*[[Attention deficit]] problems
Patients with adenoiditis are usually good-appearing. Physical examination of patients with adenoiditis is usually remarkable for fever, and purulent nasal discharges.<ref name="pmid25950686">{{cite journal |vauthors=Kosikowska U, Korona-Głowniak I, Niedzielski A, Malm A |title=Nasopharyngeal and Adenoid Colonization by Haemophilus influenzae and Haemophilus parainfluenzae in Children Undergoing Adenoidectomy and the Ability of Bacterial Isolates to Biofilm Production |journal=Medicine (Baltimore) |volume=94 |issue=18 |pages=e799 |year=2015 |pmid=25950686 |pmc=4602522 |doi=10.1097/MD.0000000000000799 |url=}}</ref><ref name="pmid27605988">{{cite journal |vauthors=Kajan ZD, Sigaroudi AK, Mohebbi M |title=Prevalence and patterns of palatine and adenoid tonsilloliths in cone-beam computed tomography images of an Iranian population |journal=Dent Res J (Isfahan) |volume=13 |issue=4 |pages=315–21 |year=2016 |pmid=27605988 |pmc=4993058 |doi= |url=}}</ref><ref name="pmid178831912">{{cite journal |vauthors=Galli J, Calò L, Ardito F, Imperiali M, Bassotti E, Fadda G, Paludetti G |title=Biofilm formation by Haemophilus influenzae isolated from adeno-tonsil tissue samples, and its role in recurrent adenotonsillitis |journal=Acta Otorhinolaryngol Ital |volume=27 |issue=3 |pages=134–8 |year=2007 |pmid=17883191 |pmc=2640046 |doi= |url=}}</ref>
*Impairment of smell
===Laboratory Findings===
===Symptoms===
Laboratory findings consistent with the diagnosis of adenoiditis include [[neutrophilia]], positive [[Culture collection|culture]] for organism during throat exam sampling, and positive [[blood culture]] for the organism in severe cases.<ref name="pmid17883191">{{cite journal |vauthors=Galli J, Calò L, Ardito F, Imperiali M, Bassotti E, Fadda G, Paludetti G |title=Biofilm formation by Haemophilus influenzae isolated from adeno-tonsil tissue samples, and its role in recurrent adenotonsillitis |journal=Acta Otorhinolaryngol Ital |volume=27 |issue=3 |pages=134–8 |year=2007 |pmid=17883191 |pmc=2640046 |doi= |url=}}</ref>
The symptoms of adenoiditis can last for 10 or more days. Acute adenoiditis is usually presented with nasal symptoms:
 
*Nasal [[airway obstruction]]
=== Imaging Findings ===
*[[Snoring]]
On lateral neck x-ray, adenoiditis is characterized by enlargement of adenoids and narrowing of airways.
*[[sleep apnea]]
 
*Oral breathing
[[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.<ref name="pmid24919758">{{cite journal |vauthors=Ramji M, Biron VL, Jeffery CC, Côté DW, El-Hakim H |title=Validation of pharyngeal findings on sleep nasopharyngoscopy in children with snoring/sleep disordered breathing |journal=J Otolaryngol Head Neck Surg |volume=43 |issue= |pages=13 |year=2014 |pmid=24919758 |pmc=4092353 |doi=10.1186/1916-0216-43-13 |url=}}</ref>
 
==Treatment==
===Medical Therapy===
The mainstay of therapy for adenoiditis is symptomatic therapy. Pharmacologic medical therapy is recommended among patients with recurrent and chronic adenoiditis. The best antibiotic therapy regimen include [[amoxicillin]] - [[clavulanic acid]] or a [[cephalosporin]]


*Sore or dry throat from breathing through the mouth
===Surgery===
Other symptoms that mainly observed during [[chronic inflammation]] are usually correlated to [[adenoiditis]] complications and include:
Surgery is not the first-line treatment option for patients with adenoiditis. [[Adenoidectomy]] is usually reserved for patients with chronic persistent adenoiditis whom developed [[adenoid hypertrophy]]. 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.<ref name="pmid20111586">{{cite journal |vauthors=El-Badrawy A, Abdel-Aziz M |title=Transoral endoscopic adenoidectomy |journal=Int J Otolaryngol |volume=2009 |issue= |pages=949315 |year=2009 |pmid=20111586 |pmc=2809357 |doi=10.1155/2009/949315 |url=}}</ref>
*[[Rhinorrhea|Purulent rhinorrhea]]
*Nasal obstruction
*Fever
*Ear pain
*[[Headache]]
*[[Sore throat]]
==Diagnostic criteria==
[[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.


Other ways that can help beside history and symptoms to be close to diagnosis include:
==Prevention==
*[[Throat]] examinations using swabs to obtain samples of bacteria and other organisms and culture them
===Primary Prevention===
*Blood tests to determine the presence of [[Organism|organisms]] in blood (especially in ill patients with acute disease)
[[Primary prevention]] strategies to prevent adenoiditis include hygienic practices.
*lateral X-rays of the neck, besides being a noninvasive procedure, still remains a very reliable and valid diagnostic test in the evaluation of hypertrophied adenoids.<ref name="pmid23120124">{{cite journal |vauthors=Kurien M, Lepcha A, Mathew J, Ali A, Jeyaseelan L |title=X-Rays in the evaluation of adenoid hypertrophy: It's role in the endoscopic era |journal=Indian J Otolaryngol Head Neck Surg |volume=57 |issue=1 |pages=45–7 |year=2005 |pmid=23120124 |pmc=3451545 |doi=10.1007/BF02907627 |url=}}</ref>
===Differential Diagnosis:===
*[[Tonsillitis|Tonsilitis]]
*Adenoid disorders
*Tonsil disorders
*Throat infection
*Chronic tonsilitis
==Medical Therapy==
*[[Antibiotic]] therapy:
**There are no proven evidence of medical therapy effectiveness in recurrent or chronic [[adenoiditis]] cases.
**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.
**The most appropriate antibiotics are [[amoxicillin]] - [[clavulanic acid]] or a [[cephalosporin]].
**Although antibiotic therapy can treat acute adenoiditis, it usually fail to eradicate the bacteria in chronic or recurrent adenoiditis.
**Nowadays with the current trend of resistant bacteria, the use of prophylactic or long-term antibiotics has been decreased.
*Topical therapy:
**Topical nasal steroids in children can be used to treat adenoid hypertrophy.
**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.
**A combination trial of topical nasal steroid spray and saline spray may be considered for effective control of symptoms in children.
*In cases of viral adenoiditis, treatment with [[analgesic]]s or [[antipyretic]]s is often sufficient.
==Surgical Therapy==
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.


===Secondary Prevention===
[[Secondary prevention]] involves usage of antibiotics to prevent recurrence of adenoiditis. It can be helpful in certain circumstances:<ref name="pmid96247642">{{cite journal| author=Dagnelie CF, Bartelink ML, van der Graaf Y, Goessens W, de Melker RA| title=Towards a better diagnosis of throat infections (with group A beta-haemolytic streptococcus) in general practice. | journal=Br J Gen Pract | year= 1998 | volume= 48 | issue= 427 | pages= 959-62 | pmid=9624764 | doi= | pmc=1409991 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9624764  }}</ref>
*History of [[rheumatic fever]], to prevent pharyngitis cause by [[group A beta-hemolytic streptococci]].
==Related Chapters==
==Related Chapters==
*[[Tonsilitis]]
*[[Tonsilitis]]
==References==
==References==
{{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.
{{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.

Revision as of 16:15, 2 June 2017

Adenoiditis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Adenoiditis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

Adenoid is a lymphoid tissue that form Waldeyer ring which is situated adjacent to the choanae and the pharyngeal ostium of the eustachian tubes in the posterior wall of nasopharynx. This lymphoid tissue is involved in immunoglobin production and maturation of 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. Adenoiditis is the inflammation of adenoid tissue. Adenoid infection is mostly due to viral infections. Some bacterial pathogens include H. influenzae, group A β-hemolytic streptococcus, and S. aureus can cause the disease as well. Adenoids can cause recurrent sinusitis and chronic persistent or recurrent otitis if remain untreated and develop to chronic adenoiditis. Medications (antibiotics or steroids) or surgical approach may be required for the management of adenoiditis, depending on the causative agent.

Historical perspective

Adenoid was though to be a part of tonsils and responsible for the symptoms of nasal congestion and obstruction. As a result 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.

Classification

Adenoiditis can be classified to the following types including acute adenoiditis, recurrent acute adenoiditis, and chronic/persistant adenoiditis.[1]

Pathophysiology

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.[2]

Oral cavity normal flora bacteria are found in adenoid flora as well, which include:

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.

Causes

Acute adenoiditis is mainly due to viral infection but bacterial infections can cause the disease as well, while bacterial infections have a more important role in recurrent and chronic adenoiditis. The most important viral causes include EBV, CMV, RSV. The most important bacterial causes include Haemophilus influenzae, group A β-hemolytic streptococcus, Staphylococcus aureus.[3]

Differentiating tonsillitis from other diseases

Diagnosis of adenoiditis can be challenging as majority of upper respiratory tract infections show the same pattern. The most important differential diagnosis include tonsilitis, viral upper respiratory tract infection, sinusitis and pharyngitis.

Epidemiology and Demographics

The prevalence of adenoiditis is not completely known. Research indicates that 15-30% of sore throats in children and 5-10% sore throats in adults are bacterial adenotonsillitis. The prevalence of adenoiditis decreases with age. Adenoid tissue go through atrophy process after 10 so adeoiditis is rarely seen after 15.[4][5][6][7][8]

Risk Factors

The most potent risk factor in the development of adenoiditis is being a young child. Other risk factors include immuno-deficiencies, living in an urban environment with more exposure to viruses or bacteria and usage of immuno-suppressant drugs.

Screening

There is insufficient evidence to recommend routine screening for Adenoiditis.

Natural history, complications and prognosis

Natural History

Acute adenoiditis will usually present with erythema and edema of the adenoids rapidly upon infiltration of the pathogen.[9]

  • Symptoms, including fever and sore throat, will usually manifest within 24 hours of infection.
  • It is usually combined with tonsilitis due to close anatomical location.

Complications

Complications of adenoiditis are caused by persistence and/or spread of the responsible pathogen - usually bacterial - and include speech abnormalities otitis media, acute sinusitis, pneumonia, adenoid hyperplasia, peritonsillar abscess, sleep apnea

Prognosis

The prognosis for acute adenoiditis without treatment is usually good; the disease is usually self-limited and will resolve itself within 3-4 days.[10]

Diagnosis

Diagnostic criteria

There are no criteria for the diagnosis of adenoiditis. However, seeing inflamed and hypertrophied adenoid tissue with flexible or rigid nasopharyngoscopy can be used as a criteria for adenoidectomy in patients suspected to chronic adenoiditis.

History and Symptoms

A positive history of fever and nasal obstruction and snoring are suggestive of adenoiditis. The most common symptoms of adenoiditis include nasal discharge which may be purulent, mouth breathing, nasal pain and sore throat.[11][12][13]

Physical Examination

Patients with adenoiditis are usually good-appearing. Physical examination of patients with adenoiditis is usually remarkable for fever, and purulent nasal discharges.[14][15][16]

Laboratory Findings

Laboratory findings consistent with the diagnosis of adenoiditis include neutrophilia, positive culture for organism during throat exam sampling, and positive blood culture for the organism in severe cases.[17]

Imaging Findings

On lateral neck x-ray, adenoiditis is characterized by enlargement of adenoids and narrowing of airways.

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 nasopharynx and Waldeyer ring so the inflamed adenoid tissue can be seen too.[18]

Treatment

Medical Therapy

The mainstay of therapy for adenoiditis is symptomatic therapy. Pharmacologic medical therapy is recommended among patients with recurrent and chronic adenoiditis. The best antibiotic therapy regimen include amoxicillin - clavulanic acid or a cephalosporin

Surgery

Surgery is not the first-line treatment option for patients with adenoiditis. Adenoidectomy is usually reserved for patients with chronic persistent adenoiditis whom developed adenoid hypertrophy. 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.[19]

Prevention

Primary Prevention

Primary prevention strategies to prevent adenoiditis include hygienic practices.

Secondary Prevention

Secondary prevention involves usage of antibiotics to prevent recurrence of adenoiditis. It can be helpful in certain circumstances:[20]

Related Chapters

References

  1. ↑ "Head & Neck Surgery--otolaryngology - Google Books".
  2. ↑ Havas T, Lowinger D (2002). "Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy". Arch. Otolaryngol. Head Neck Surg. 128 (7): 789–91. PMID 12117336.
  3. ↑ Havas T, Lowinger D (2002). "Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy". Arch. Otolaryngol. Head Neck Surg. 128 (7): 789–91. PMID 12117336.
  4. ↑ Komaroff AL, Pass TM, Aronson MD, Ervin CT, Cretin S, Winickoff RN, Branch WT (1986). "The prediction of streptococcal pharyngitis in adults". J Gen Intern Med. 1 (1): 1–7. PMID 3534166.
  5. ↑ Kaplan EL, Top FH, Dudding BA, Wannamaker LW (1971). "Diagnosis of streptococcal pharyngitis: differentiation of active infection from the carrier state in the symptomatic child". J. Infect. Dis. 123 (5): 490–501. PMID 5115179.
  6. ↑ Schroeder BM (2003). "Diagnosis and management of group A streptococcal pharyngitis". Am Fam Physician. 67 (4): 880, 883–4. PMID 12613739.
  7. ↑ Sharav, Yair; Benoliel, Rafael (2008). Orofacial Pain and Headache. Elsevier. ISBN 0723434123.
  8. ↑ Pagella F, De Amici M, Pusateri A, Tinelli G, Matti E, Benazzo M, Licari A, Nigrisoli S, Quaglini S, Ciprandi G, Marseglia GL (2015). "Adenoids and clinical symptoms: Epidemiology of a cohort of 795 pediatric patients". Int. J. Pediatr. Otorhinolaryngol. 79 (12): 2137–41. doi:10.1016/j.ijporl.2015.09.035. PMID 26478108.
  9. ↑ "Tonsillitis - NHS Choices".
  10. ↑ "Tonsillitis - NHS Choices".
  11. ↑ Kosikowska U, Korona-Głowniak I, Niedzielski A, Malm A (2015). "Nasopharyngeal and Adenoid Colonization by Haemophilus influenzae and Haemophilus parainfluenzae in Children Undergoing Adenoidectomy and the Ability of Bacterial Isolates to Biofilm Production". Medicine (Baltimore). 94 (18): e799. doi:10.1097/MD.0000000000000799. PMC 4602522. PMID 25950686.
  12. ↑ Kajan ZD, Sigaroudi AK, Mohebbi M (2016). "Prevalence and patterns of palatine and adenoid tonsilloliths in cone-beam computed tomography images of an Iranian population". Dent Res J (Isfahan). 13 (4): 315–21. PMC 4993058. PMID 27605988.
  13. ↑ Galli J, Calò L, Ardito F, Imperiali M, Bassotti E, Fadda G, Paludetti G (2007). "Biofilm formation by Haemophilus influenzae isolated from adeno-tonsil tissue samples, and its role in recurrent adenotonsillitis". Acta Otorhinolaryngol Ital. 27 (3): 134–8. PMC 2640046. PMID 17883191.
  14. ↑ Kosikowska U, Korona-Głowniak I, Niedzielski A, Malm A (2015). "Nasopharyngeal and Adenoid Colonization by Haemophilus influenzae and Haemophilus parainfluenzae in Children Undergoing Adenoidectomy and the Ability of Bacterial Isolates to Biofilm Production". Medicine (Baltimore). 94 (18): e799. doi:10.1097/MD.0000000000000799. PMC 4602522. PMID 25950686.
  15. ↑ Kajan ZD, Sigaroudi AK, Mohebbi M (2016). "Prevalence and patterns of palatine and adenoid tonsilloliths in cone-beam computed tomography images of an Iranian population". Dent Res J (Isfahan). 13 (4): 315–21. PMC 4993058. PMID 27605988.
  16. ↑ Galli J, Calò L, Ardito F, Imperiali M, Bassotti E, Fadda G, Paludetti G (2007). "Biofilm formation by Haemophilus influenzae isolated from adeno-tonsil tissue samples, and its role in recurrent adenotonsillitis". Acta Otorhinolaryngol Ital. 27 (3): 134–8. PMC 2640046. PMID 17883191.
  17. ↑ Galli J, Calò L, Ardito F, Imperiali M, Bassotti E, Fadda G, Paludetti G (2007). "Biofilm formation by Haemophilus influenzae isolated from adeno-tonsil tissue samples, and its role in recurrent adenotonsillitis". Acta Otorhinolaryngol Ital. 27 (3): 134–8. PMC 2640046. PMID 17883191.
  18. ↑ Ramji M, Biron VL, Jeffery CC, Côté DW, El-Hakim H (2014). "Validation of pharyngeal findings on sleep nasopharyngoscopy in children with snoring/sleep disordered breathing". J Otolaryngol Head Neck Surg. 43: 13. doi:10.1186/1916-0216-43-13. PMC 4092353. PMID 24919758.
  19. ↑ El-Badrawy A, Abdel-Aziz M (2009). "Transoral endoscopic adenoidectomy". Int J Otolaryngol. 2009: 949315. doi:10.1155/2009/949315. PMC 2809357. PMID 20111586.
  20. ↑ Dagnelie CF, Bartelink ML, van der Graaf Y, Goessens W, de Melker RA (1998). "Towards a better diagnosis of throat infections (with group A beta-haemolytic streptococcus) in general practice". Br J Gen Pract. 48 (427): 959–62. PMC 1409991. PMID 9624764.

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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