CSR

ADENOID AND ADENOIDECTOMY

04 Jul 2020 | 3 mins

Adenoid is lymphoid aggregation present in the nasopharynx and is a part of waldeyers ring.

Function
To produce antibodies. Adenoid produces B cells which give rise to IgG and IgA antibodies and provide immunological memory in younger children.
1. Acts as the first line of defense as a part of the immune system
2. The pathological manifestation of adenoid
3. Rhinitis
4. Rhinosinusitis
5. Recurrent otitis media – adenoid acts as a bacterial reservoir from which the infection enters ME through the Eustachian tube.
6. Otitis media without effusion – due to block and infection
7. Obstructive sleep apnea – due to hypertrophy of adenoid 
8. Poor appetite – due to decreased olfaction
9. Malignancy – non-hodgkins lymphoma is reported in adenoid 
10. Hypertrophy of adenoid is classified into
Grade I     - enlargement so as to occupy 1/3rdof choana
Grade II     - enlargement so as to occupy 1/3rd to 2/3rd of the choana
Grade III     - enlargement so as to occupy 2/3rd to full of the choana
Grade IV     - complete choanal obstruction with extension to the posterior part of the nasal cavity 

Indication of adenoidectomy
Recurrent otitis media – Adenoid acts as a bacterial reservoir from where bacteria enter ME through ET
C/c rhinosinusitis in children – hypertrophy of adenoid is one of the common cause 
OSA – This condition is due to hypertrophy of adenoid in which the child is not able to breathe during sleep, resulting in disturbance of sleep.

Adenoidectomy 
Different techniques are available
1)    Using current – adenoid is curated out. This is an outdated procedure now.
2)    Endoscopic adenoidectomy – using endoscope adenoid is visualized and removed in toto using various instruments – debrided or coblator 
This is the accepted procedure in the best centers now. By doing endoscopic adenoidectomy, we can prevent the regrowth of adenoid if done properly. 

Dr. John Mathai, MBBS, DLO, MS (ENT)
Senior Consultant, ENT
 

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