Ishwar Singh, Avani Jain*, Purodha Prasad and Pragya Rajpurohit
Department of ENT, MAMC, New Delhi, India
Received: 06 January, 2017; Accepted: 12 January, 2017; Published: 19 January, 2017
Dr. Avani Jain, Senior Resident, Department of ENT, MAMC, New Delhi, India C-8, Tower 1, New Moti Bagh, New Delhi-110023, Tel: +919910341347; E-mail:
Singh I, Jain A, Prasad P, Rajpurohit P (2017) Adenoid Hypertrophy in Adults: An Underdiagnosed Entity?. Arch Otolaryngol Rhinol 3(1): 006-008. DOI: 10.17352/2455-1759.000033
© 2017 Singh I, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Adenoid; Adults; Obstruction; Adenoidectomy
Adenoid enlargement is uncommon in adults. We studied the varied presentation of adenoid hypertrophy in two adults. A 45 year old male who presented with nasal obstruction and snoring, and a 35 year old male who presented with non resolving chronic otitis media. In both the patients, adenoid hypertrophy was diagnosed by nasal endoscopy and confirmed by CT scan. Adenoidectomy in these patients resulted in symptomatic improvement. Therefore, adenoid hypertrophy should also be considered as a cause or contributing factor in nasal obstruction and related pathologies in adults.
The adenoids (or pharyngeal tonsil) is a condensation of lymphoid tissue in the posterosuperior wall of the nasopharynx. It forms a part of Waldeyer’s ring of lymphoid tissue at the portal of entry of the upper respiratory tract . In early childhood it is the first site for immunological contact of inhaled allergens. Adenoids are present at birth, show physiological enlargement upto 6 years of age, atrophy at puberty and almost completely disappear by 20 years of age . Clinical symptoms are common in young age due to small volume of nasopharynx and the increased frequency of upper respiratory tract infections. It appears to have an important role in the development of immunological memory in younger children . Adenoid hypertrophy was considered uncommon in adults as examination of the nasopharynx by posterior rhinoscopy was inadequate. Many cases were misdiagnosed and accordingly maltreated . However, in the current clinical practice, with the advent of nasal endoscopes and improved imaging modalities, adenoidal tissue is not uncommonly found in adults. Insipite of these developments, there is lack of data regarding adenoid hypertrophy in adults. We studied the varied presentation of two cases of adult adenoid hypertrophy who presented with nasal obstruction and snoring; and non-resolving chronic otitis media.
A 45 year old male presented to the ENT OPD, Lok Nayak Hospital, with complaints of nasal obstruction, snoring and repeated awakening at night due to apnea spells. On detailed history, it was found that patient was a chronic smoker for past 25 years. On examination, nasal endoscopy revealed a pale lobulated mass in the nasopharynx (Figure 1). Contrast enhanced CT scan showed a non-enhancing mass in the nasopharynx, extending upto bilateral nasal cavity, suggestive of adenoid hypertrophy (Figure 2). Nasal endoscopic biopsy was done which was suggestive of lymphoid hyperplasia. The patient was managed conservatively for 3 months with steroid nasal spray. However, there was no improvement in the symptoms and patient was planned for surgery. Transnasal endoscopic powered adenoidectomy was done under general anesthesia. Post-operative biopsy report was suggestive of adenoid hyperplasia. Adenoidectomy resulted in resolution of symptoms and immediate improvement in sleep. Topical steroid nasal spray was continued for one year postoperatively. After one year follow up, the patient was asymptomatic. There was no residual tissue in the nasopharynx or any recurrence.
- Grist WJ (1990) The Tonsils and Pharynx. Chapter 132, in: Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Walker HK, Hall WD, Hurst JW (Ed). Butterworth Publishers, a division of Reed Publishing 626-627. Link: https://goo.gl/L4dJAQ
- Yildrim N, Sahan M, Karsliglu Y (2008) Adenoid hypertrophy in adults: clinical and morphological characteristics. J Int Med Res 36: 157–162. Link: https://goo.gl/4gIB6V
- Wysocka J, Hassmann E, Lipska A, Musiatowicz M (2003) Naive and memory T cells in hypertrophied adenoids in children according to age. Int J Pediatr Otorhinolaryngol 67: 237–241. Link: https://goo.gl/1e1AEc
- Kamel RH, Ishak EA (1990) Enlarged adenoid and adenoidectomy in adults: endoscopic approach and histopathological study. J Laryngol Otol 104: 965-967. Link: https://goo.gl/23tXbI
- Rout MR, Mohanty D, Vijaylaxmi Y, Bobba K, Metta C (2013) Adenoid Hypertrophy in Adults: A case Series. Indian J Otolaryngol Head Neck Surg 65: 269-274. Link: https://goo.gl/R8wHf4
- Frenkiel S, Black MJ, Small P (1980) Persistent adenoid presenting as a nasopharyngeal mass. J Otolaryngol 9: 357-360. Link: https://goo.gl/1lNwa4
- Finkelstein Y, Malik Z, Kopolovic J, Bernheim J, Djaldetti M, et al. (1997) Characterization of smoking-induced nasopharyngeal lymphoid hyperplasia. Laryngoscope 107: 1635-1642. Link: https://goo.gl/it6APs
- France AJ, Kean DM, Douglas RH, Chiswick OM, St Clair D, et al. (1998) Adenoidal hypertrophy in HIV-infected patients. Lancet 2: 1076. Link: https://goo.gl/zXPJT4
- Kapusuz Z , Ozkırış M , Okur A , Saydam L (2012) The prevalence of adenoid hypertrophy in adults in a rural area of Turkey. Kulak Burun Bogaz Ihtis Derg 22: 225-227. Link: https://goo.gl/73Z8uL
- Hamad KD, Alhemed R, Jessim AA (2014) Adenoid hypertrophy in adults and nasal obstruction. Research study KCMJ 1: 8-10. Link: https://goo.gl/aU3khk
- Demirhan H, Aksoy F, Ozturan O, Yildirim YS, Veyseller B (2010) Medical treatment of adenoid hypertrophy with fluticasone propionate nasal drop. Int J Pediatr Otorhinolaryngol 74: 733–736. Link: https://goo.gl/kKx3w2