General Medical Information

Adenoidal Hypertrophy

Richard L. Mabry

Adenoidal hypertrophy is most common among children but occasionally occurs among adults. The classic clinical presentation of a child with chronic adenoidal hypertrophy has been called adenoidal facies. This mouth-open, head-up posture is caused by chronic nasal obstruction that decreases when the head is tilted. Maintenance of this posture is associated with improper orofacial development, such as a dry, thin upper lip, retrognathic mandible, narrowed maxilla, broad nasal arch, and an upturned nose with visible nostrils. Cervical spinal complications attributed to the head-tilted position include lordosis and kyphosis. The pathophysiologic cause of these conditions is lack of use or atypical use of the involved anatomic structures with associated effects in the supporting muscles. Because of the anatomic placement of the adenoid glands, adenoidal hypertrophy has been associated with eustachian tube dysfunction and associated conditions of serous and recurrent purulent otitis media. Severe cases can manifest in conditions such as sleep apnea, pulmonary hypertension, and enlargement of the right ventricle. In a small-group study, administration of beclomethasone dipropionate was successful in the management of adenoidal hypertrophy among children 5 to 11 years of age. Adenoidectomy is the proper surgical treatment.