Enlarged Tonsils and Adenoids

• General Considerations
  
  
  • Lymphoid tissue on the posterior wall of the nasopharynx  and part of Waldeyer’s ring, which consists primarily off the adenoids, palatine tonsils and lingual tonsils
  • Natural history of the adenoids
    • Although present at birth, they are usually invisible until 3-6 months
      • Newborns do not have visible adenoids
    • They can grow until about age 6
    • They then involute through adulthood
    • Adults do not have visible adenoids
  • Enlargement is pathological when they encroach on nasopharyngeal airway
    • Does not usually occur until 1-2 years of age
• Clinical findings
• Nasal congestion
• Mouth-breathing
• Chronic or recurrent otitis media due to their proximity to the Eustachian tubes
• Painful swallowing
• Sleep apnea
• Most commonly cultured bacteria
• Haemophilus influenzae
• Group A beta-hemolytic Streptococcus
• Staphylococcus aureus
• Moraxella catarrhalis
• Streptococcus pneumoniae
• Imaging findings
• Measurements are not reliable
• The lateral neck x-ray is the main imaging study
• The size of the adenoids is less of a consideration than the degree to which they do or do not impinge on the nasopharyngeal airway
• There is good correlation between direct visualization of the adenoids and the lateral neck radiograph is assessing size
• If the nasopharyngeal stripe of air is half the size of the soft palate, significant obstruction occurs.
• If no adenoidal tissue after 6 months
  • Suspect immune deficiency
• If enlarged adenoids well after childhood
  • Suspect lymphatic malignancy
    • Lymphoma
    • Leukemia
• Treatment
• Wait until they involute
• Surgically remove them
• Indications for adenoidectomy are
• Enlargement causing nasal airway obstruction
• Recurrent or persistent otitis media in children aged 3-4 years and older
• Recurrent and/or chronic sinusitis 

Enlarged Adenoids and Tonsils. The adenoids (A) are enlarged and are
narrowing the nasopharyngeal airway (black arrow), The lingual tonsils (T) are also enlarged.
For this same photo without the arrows, click here
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eMedicine   John E McClay, MD