A fairly common childhood condition, adenoid hyperplasia (also known as adenoid hypertrophy) is enlargement of the lymphoid tissue of the nasopharynx. Normally, adenoidal tissue is small at birth (¾" to 1¼"[2 to 3 cm]), grows until the child reaches adolescence, and then begins to slowly atrophy. In adenoid hyperplasia, however, this tissue continues to grow. Enlarged adenoids commonly accompany tonsillitis.
The cause of adenoid hyperplasia is unknown, but contributing factors may include heredity, chronic infection, chronic nasal congestion, persistent allergy, insufficient aeration, and inefficient nasal breathing. Inflammation resulting from repeated infection increases the patient’s risk of respiratory obstruction.
Typically, adenoid hyperplasia produces symptoms of respiratory obstruction, especially mouth breathing, snoring at night, and frequent, prolonged nasal congestion. Persistent mouth breathing during the formative years produces voice alteration and distinctive changes in facial features — a slightly elongated face, open mouth, highly arched palate, shortened upper lip, and vacant expression.
Occasionally, the child is incapable of mouth breathing, snores loudly at night, and may eventually show effects of nocturnal respiratory insufficiency, such as intercostal retractions and nasal flaring; this may lead to pulmonary hypertension and cor pulmonale. Adenoid hyperplasia can also obstruct the eustachian tube and predispose to otitis media, which in turn can lead to fluctuating conductive hearing loss. Stasis of nasal secretions from adenoidal inflammation can lead to sinusitis.
Adenoidectomy is the treatment of choice for adenoid hyperplasia and is commonly recommended for the patient with prolonged mouth breathing, nasal speech, adenoid facies, recurrent otitis media, constant nasopharyngitis, and nocturnal respiratory distress. This procedure usually eliminates recurrent nasal infections and ear complications and reverses any secondary hearing loss.
Care requires sympathetic preoperative care and diligent postoperative monitoring.
Before surgery:
❑ Describe the facility routine, and arrange for the patient and his parents to tour relevant areas.
❑ Explain adenoidectomy to the child, using illustrations if necessary, and detail the recovery process. Advise him that he’ll probably need to be hospitalized. If facility protocol allows, encourage one parent to stay with the child and participate in his care.
After surgery:
❑ Maintain a patent airway. Position the child on his side, with his head down, to prevent aspiration of draining secretions. Frequently check the throat for bleeding. Be alert for vomiting of old, partially digested blood (coffee-ground vomitus). Closely monitor vital signs, and report excessive bleeding, rise in pulse rate, drop in blood pressure, tachypnea, and restlessness.
❑ If no bleeding occurs, offer cracked ice or water when the patient is fully awake.
❑ Tell the parents that their child may temporarily have a nasal voice.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Title: Professional Guide to Diseases (Eighth Edition)
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2005
ISBN: 1-58255-370-X
» Next page: Endometriosis (Handbook of Diseases)
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