Enlarged Tonsils
and Adenoids
General Considerations
- Lymphoid
tissue on the posterior wall of the nasopharynx and part of
Waldeyer’s ring, which consists primarily off the adenoids, palatine
tonsils and lingual tonsils
- Natural
history of the adenoids
- Although
present at birth, they are usually invisible until 3-6 months
- Newborns
do not have visible adenoids
- They
can grow until about age 6
- They
then involute through adulthood
- Adults
do not have visible adenoids
- Enlargement
is pathological when they encroach on nasopharyngeal airway
- Does
not usually occur until 1-2 years of age
- Clinical
findings
- Nasal
congestion
- Mouth-breathing
- Chronic
or recurrent otitis media due to their proximity to the Eustachian tubes
- Painful
swallowing
- Sleep
apnea
- Most
commonly cultured bacteria
- Haemophilus
influenzae
- Group
A beta-hemolytic Streptococcus
- Staphylococcus
aureus
- Moraxella catarrhalis
- Streptococcus
pneumoniae
- Imaging
findings
- Measurements
are not reliable
- The
lateral neck x-ray is the main imaging study
- The
size of the adenoids is less of a consideration than the degree to which
they do or do not impinge on the nasopharyngeal airway
- There
is good correlation between direct visualization of the adenoids and the
lateral neck radiograph is assessing size
- If
the nasopharyngeal stripe of air is half the size of the soft palate,
significant obstruction occurs.
- If
no adenoidal tissue after 6 months
- Suspect
immune deficiency
- If
enlarged adenoids well after childhood
- Suspect
lymphatic malignancy
- Lymphoma
- Leukemia
- Treatment
- Wait
until they involute
- Surgically
remove them
- Indications
for adenoidectomy are
- Enlargement
causing nasal airway obstruction
- Recurrent
or persistent otitis media in children aged 3-4 years and older
- Recurrent
and/or chronic sinusitis
Enlarged Adenoids and Tonsils. The
adenoids (A) are enlarged and are
narrowing the nasopharyngeal airway (black arrow), The lingual tonsils (T) are
also enlarged.
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