The disease affects males and females to the same extent and is rarely encountered after the age of 15 years because adenoid tissue undergoes a normal process of involution beyond this age [1] [2]. Patients usually present between the ages of 3 and 5 because adenoid growth causes nasopharyngeal airway narrowing [3]. Children from high socioeconomic classes are infrequently affected.

In incipient stages, adenoid hypertrophy is asymptomatic. As the disease progresses, patients manifest with chronic mouth breathing, sleep disturbances, nasal obstruction, rhinorrhea, swallowing difficulties, snoring, cough, epistaxis, and halitosis. Hearing loss develops gradually as a consequence of persistent or recurring middle ear infections. If left untreated for a long period of time, the patient presents with hyponasal voice and a typical facies, characterized by elongated middle facial area and narrow palate [4].

When obstructive sleep apnea develops as a consequence of adenoid hypertrophy, it can cause more severe, long-term morbidity such as failure to thrive, learning difficulties, delayed speech [5], decreased intelligence quotient, and hyperactivity. Possible cardiovascular impairment consists of elevated diastolic blood pressure, left ventricular hypertrophy, and decreased right ventricular ejection fraction [1] [6].

Clinical examination may reveal signs consistent with atopy such as a cough, expiratory wheezing and rhonchi, and prolonged expiratory time.

Adenoid hypertrophy is best diagnosed by means of flexible nasopharyngoscopy. This investigation is indicated when the manifestations presented above are present or when the patient presents with recurrent sinusitis, otitis media, or persistent ear effusions. When obstructive sleep apnea is suspected, a sleep study is called for in order to gather information about its severity. Radiological evaluation, such as the lateral neck X-ray should be avoided unless more severe pathology, such as neoplasia or angiofibroma, is suspected. However, if a radiography is performed, due to the fact that it is still considered a valid and reliable test [7] [8], the physician should assess not the absolute dimensions of the adenoids, but the degree of obstruction they cause. If adenoids are very small or absent, an immune deficiency should be investigated, while severely enlarged masses may suggest lymphatic malignancy.

Adenoid flora occasionally needs to be assessed. It is usually composed of group A beta-hemolytic streptococci, but Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae may also be encountered. Anaerobic bacteria may be found in the core of the adenoids [9]. Other possibly present bacteria include Enterococcus species, Staphylococcus epidermidis, Streptococcus viridans, Escherichia coli, Pseudomonas, Moraxella, Klebsiella, Neisseria, Prevotella, Fusobacterium, Peptostreptococcus, and Bacteroides species [10] [11]. Chronic adenoid infection could lead to the obstruction of the nasopharyngeal Eustachian tube orifice and consequent recurrent otitis media. Therefore, a complete examination of an ear, nose, and throat is useful in all patients.

Biopsy specimens reveal reactive hyperplasia of B-cells and inflammatory infiltrates consisting of polymorphonuclears, plasmocytes, or eosinophils [2] [12].

Treatment for adenoid hypertrophy depends on the severity of the symptoms. Mild cases may be managed with medications such as nasal steroids to reduce inflammation. In more severe cases, surgical removal of the adenoids, known as adenoidectomy, may be recommended. This procedure is often performed on an outpatient basis and can significantly improve symptoms.

The prognosis for patients with adenoid hypertrophy is generally good, especially when treated appropriately. Many children outgrow the condition as their immune system matures and the adenoids naturally shrink. Surgical intervention, when necessary, is typically successful in alleviating symptoms and improving quality of life.

Adenoid hypertrophy can be caused by recurrent infections, allergies, or genetic factors. The adenoids may become enlarged as they repeatedly respond to infections or allergens. In some cases, a family history of adenoid problems may increase the likelihood of developing the condition.

Adenoid hypertrophy is most common in children between the ages of 3 and 7, as the adenoids are largest during this period. It is less common in adults, as the adenoids usually shrink after childhood. The condition affects both boys and girls equally and is a frequent reason for pediatric ENT (ear, nose, and throat) consultations.

The pathophysiology of adenoid hypertrophy involves the chronic stimulation of the adenoids by infectious agents or allergens, leading to their enlargement. This hypertrophy can obstruct the nasal passages and Eustachian tubes, which connect the middle ear to the throat, resulting in the symptoms associated with the condition.

While it may not be possible to prevent adenoid hypertrophy entirely, reducing exposure to infections and allergens can help minimize the risk. Encouraging good hygiene practices, such as regular handwashing, and managing allergies effectively can contribute to maintaining healthy adenoids.

Adenoid hypertrophy is a common condition in children characterized by the enlargement of the adenoids, leading to symptoms such as nasal obstruction and sleep disturbances. Diagnosis involves a combination of clinical evaluation and imaging studies. Treatment options range from medication to surgical removal, with a generally favorable prognosis. Understanding the causes and risk factors can aid in managing and potentially preventing the condition.

For patients and caregivers, it's important to recognize the signs of adenoid hypertrophy, such as persistent mouth breathing, snoring, and frequent ear infections. If these symptoms are present, consulting a healthcare provider can help determine the best course of action. Treatment is often effective, and many children experience significant improvement in their symptoms.

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