Meeting Organ for ENT and Pediatric Pulmonology: Adenoids

The adenoid tissue is a lymphoid aggregate on the posterior and superior nasopharyngeal area. The nasopharynx region is located at the posterior continuing of nasal openings, where the inferior turbinate and the septum terminate. The soft palate divides the oropharynx and nasopharynx. The mucoperiosteum of the upper clivus creates the structure of the nasopharyngeal roof. The mucosa, the prevertebral fascia, the superior pharyngeal constrictor, and the longus capitis muscles comprise the nasopharynx’s posterior side. The rear nasopharyngeal wall stands mid to clivus, the anterior side of the foramen magnum, and the atlas. The orifice of the Eustachian tube exists in the lateral nasopharyngeal wall. The Rosenmüller fossa (pharyngeal recess) is situated at the joint of lateral and posterior nasopharyngeal walls. Adenoids are components of Waldeyer’s ring. Waldeyer’s ring, with its lymphoid nature, is formed by superiorly pharyngeal tonsils (adenoids), laterally two palatine tonsils, inferiorly from the lingual tonsils, and located at the base of the tongue. When adenoid hypertrophy exceeds a certain level, fills the nasopharyngeal space, and extends the choana, it can cause upper-airway obstruction. Adenoid tissue is small in the neonatal period. It begins to grow in the first years of life, reaches its maximum size by age 5, and regresses after age 8. Chronic nasal obstruction due to adenoid hypertrophy may cause symptoms including; hyponasality of voice, obstructive sleep apnea (OSA), daytime sleepiness, behavioral and mouth breathing, snoring, attention problems, growth retardation, rhinorrhea, failure to thrive, enuresis, and craniofacial issues. Severe OSA may cause cor pulmonale with right heart failure.