ADENOIDS (NASOPHARYNGEAL TONSIL)

Definition

 A subepithelial collection of lymphoid tissue at the junction of roof of posterior wall of nasopharynx. It increases in size up to 6 years of age and then atrophies

  

Etiology:

·        Common in 3-6 years of age

·        Allergy of upper respiratory tract

·        Sinusitis

·        Chronic tonsillitis

·        Viral infection by influenzae, adeno-virus, rhinovirus, common cold

·        Bacterial infections like streptococci, pneumococci, H. influenzae

Clinical features:

·        Persistent nasal discharge

·        Nasal obstruction leading to mouth breathing

·        Toneless voice

·        Snoring in children

·        Wet and bubbling nose

·        Adenoid face (elongated face, dull expression, open mouth, prominent upper teeth, hitched up lips)

Investigations:

·        Characteristic clinical features

·        X-ray

·        Blood culture

·        Nasopharyngoscopy

Medical treatment:

·        Antibiotics – erythromycin

·        penicillin

·        NSAID

·        Decongestant nasal drops

Surgical treatment:

·        Adenoidectomy

Indications for surgery:

·        Adenoid hypertrophy causing sleep apnea

·        Recurrent rhinosinusitis

·        Otitis media

Contraindications:

·        Acute infection of upper respiratory tract

·        Age below 3 years

·        Cleft palate or submucous palate

·        Severe anemia

Physiotherapy Management:

·        Breathing exercises (diaphragmatic breathing)

·        Coughing and huffing techniques

·        Bronchial hygiene technique

·        General care

Ø  Salt water gargling 3-4 times/day

Ø  Ice sucking for relief of pain

Ø  Encourage fluid intake and avoid dehydration

·        Steam inhalations

·        Active movements of neck, shoulder and jaws

Complications:

·        Hemorrhage

·        Respiratory tract infection

·        Aspiration pneumonia

·        Nasopharyngeal stenosis