Adenoid Hypertrophy - Hyperexcision

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Last updated: May 7, 2026Bookmark

Adenoid hypertrophy is the enlargement of the adenoids. It can occur with or without infection of the adenoids.

Clinical features of adenoid hypertrophy

Category	Clinical features
General symptoms	Failure to thrive, anorexia, adenoid facies, pigeon chest, and daytime somnolence
Nasal symptoms	Obstruction, blockage, or congestion; discharge; hyponasal speech (flat and toneless); mouth breathing; snoring; and difficulty breathing or breastfeeding
Aural symptoms	Recurrent acute otitis media, otitis media with effusion, chronic suppurative otitis media, and delayed speech and language
Cardiopulmonary symptoms	Pulmonary hypertension, cor pulmonale, and right ventricular hypertrophy
Others	Cognitive and behavioral problems, recurrent sinusitis, lack of concentration, and obstructive sleep apnoea

In adults, adenoid hypertrophy is seen in immunocompromised states, such as in HIV/AIDS and organ transplant patients.

Causative organisms
- Bacteria
  - Streptococcus spp.
  - Haemophilus influenzae
  - Moraxella catarrhalis
  - Staphylococcus aureus
  - Neisseria gonorrhoeae
  - Corynebacterium diphtheriae
  - Chlamydophila pneumoniae
  - Mycoplasma pneumoniae
  - Fusobacterium
  - Peptostreptococcus
  - Prevotella spp.
- Viral
  - Adenovirus
  - Coronavirus
  - Coxsackievirus
  - Cytomegalovirus (CMV)
  - Epstein-Barr virus (EBV)
  - Herpes simplex virus
  - Parainfluenza virus
  - Rhinovirus
Risk factors
- Physiological – generalized lymphoid hyperplasia up to 6 years
- URTIs
  - Rhinitis
  - Sinusitis
  - Tonsillitis
- Allergies
- Gastroesophageal reflux disease
- Passive smoking
- Immunocompromised states in adults
  - HIV/AIDS
  - Organ transplant
Signs and symptoms
- Rhinorrhea
- Difficulty breathing through the nose (mouth breathing)
- Chronic cough
- Post-nasal drip
- Snoring
- Sleep-disordered breathing
- Sinusitis
- Epistaxis
- Voice change (Hyponasal)
- Failure to thrive
  - Nasal obstruction interferes with feeding since the child is unable to breathe and feed at the same time
- Muffled hearing
- Otalgia
- Crackling or popping sounds in the ear
- Recurrent middle ear infections
- Delayed speech
- Learning difficulties
- Pulmonary hypertension
Physical examination
- Adenoid facies
  - Long and elongated narrow face
  - Short upper lip
  - Underdeveloped thin nostrils
  - Malpositioned and prominent upper teeth
  - High-arched palate
- Aprosexia
  - Inability to maintain concentration
Differentials
- Choanal atresia
- Pyriform aperture stenosis
- Allergic rhinitis
- Acute or chronic sinusitis
- Nasal polyposis
- Intranasal encephalocele
- Nasal dermoid
- Nasopharyngeal neoplasm
- Acute otitis media
- Chronic serous otitis media
- Cholesteatoma
- Nasopharyngeal malignancy
- Inverting papilloma
- HIV/AIDs
Investigations
- Posterior rhinoscopy
- Lateral view X-ray of the postnasal space
- Flexible nasopharyngoscopy
  - Hyperplasia of the adenoids
- CT scan of the paranasal sinuses
- Overnight polysomnography to assess the severity of obstructive sleep apnoea
Treatment
- Topical steroids
- Antibiotics
- Nasal decongestants
- Analgesia and antipyretics
- Adenoidectomy is the definitive treatment

Reference Intervals ›

Biochemistry

ACTH	P: <80 ng/L
ALT	P: 5–35 U/L
Albumin	P: 35–50 g/L
Aldosterone	P: 100–500 pmol/L
Alk. phosphatase	P: 30–130 U/L
α-Amylase	P: 0–180 IU/dL
α-Fetoprotein	S: <10 kU/L
Angiotensin II	P: 5–35 pmol/L
ADH	P: 0.9–4.6 pmol/L
AST	P: 5–35 U/L
Bicarbonate	P: 24–30 mmol/L
Bilirubin	P: 3–17 μmol/L
BNP	P: <50 ng/L
CRP	P: <10 mg/L
Calcitonin	P: <0.1 mcg/L
Calcium (ionized)	P: 1.0–1.25 mmol/L
Calcium (total)	P: 2.12–2.60 mmol/L
Chloride	P: 95–105 mmol/L
Cholesterol	P: <5.0 mmol/L
VLDL	P: 0.128–0.645 mmol/L
LDL	P: <2.0 mmol/L
HDL	P: 0.9–1.93 mmol/L
Cortisol AM	P: 450–700 nmol/L
Cortisol Midnight	P: 80–280 nmol/L
CK ♂	P: 25–195 U/L
CK ♀	P: 25–170 U/L
Creatinine	P: 70–100 μmol/L
Ferritin	P: 12–200 mcg/L
Folate	S: 2.1 mcg/L
FSH	P: 2–8 U/L ♂; >25 menopause
GGT ♂	P: 11–51 U/L
GGT ♀	P: 7–33 U/L
Glucose (fasting)	P: 3.5–5.5 mmol/L
Growth hormone	P: <20 mu/L
HbA1C (DCCT)	B: 4–6%
HbA1C (IFCC)	B: 20–42 mmol/mol
Iron ♂	S: 14–31 μmol/L
Iron ♀	S: 11–30 μmol/L
Lactate (venous)	P: 0.6–2.4 mmol/L
Lactate (arterial)	P: 0.6–1.8 mmol/L
LDH	P: 70–250 U/L
LH	P: 3–16 U/L
Magnesium	P: 0.75–1.05 mmol/L
Osmolality	P: 278–305 mosmol/kg
PTH	P: 0.8–8.5 pmol/L
Potassium	P: 3.5–5.3 mmol/L
Prolactin ♂	P: <450 U/L
Prolactin ♀	P: <600 U/L
PSA	P: 0–4 mcg/mL
Protein (total)	P: 60–80 g/L
Red cell folate	B: 0.36–1.44 μmol/L
Renin (erect)	P: 2.8–4.5 pmol/mL/h
Renin (recumbent)	P: 1.1–2.7 pmol/mL/h
Sodium	P: 135–145 mmol/L
TBG	P: 7–17 mg/L
TSH	P: 0.5–4.2 mU/L
T4	P: 70–140 nmol/L
Free T4	P: 9–22 pmol/L
TIBC	S: 54–75 μmol/L
Triglycerides	P: 0.50–2.3 mmol/L
T3	P: 1.2–3.0 nmol/L
Troponin T	P: <0.1 mcg/L
Urate ♂	P: 210–480 μmol/L
Urate ♀	P: 150–390 μmol/L
Urea	P: 2.5–6.7 mmol/L
Vitamin B12	S: 0.13–0.68 nmol/L
Vitamin D	S: 50 nmol/L

Arterial Blood Gases

pH	7.35–7.45
PaCO₂	4.7–6.0 kPa
PaO₂	>10.6 kPa
Base excess	±2 mmol/L

Urine

Cortisol (free)	<280 nmol/24h
Hydroxyindole acetic acid	16–73 μmol/24h
Hydroxymethylmandelic acid	16–48 μmol/24h
Metanephrines	0.03–0.69 μmol/mmol cr.
Osmolality	350–1000 mosmol/kg
17-Oxogenic steroids ♂	28–30 μmol/24h
17-Oxogenic steroids ♀	21–66 μmol/24h
17-Oxosteroids ♂	17–76 μmol/24h
17-Oxosteroids ♀	14–59 μmol/24h
Phosphate (inorganic)	15–50 mmol/24h
Potassium	14–120 mmol/24h
Protein	<150 mg/24h
Protein/creatinine ratio	<3 mg/mmol
Sodium	100–250 mmol/24h

Haematology

WCC	4.0–11.0 ×10⁹/L
RBC ♂	4.5–6.5 ×10¹²/L
RBC ♀	3.9–5.6 ×10¹²/L
Hb ♂	130–180 g/L
Hb ♀	115–160 g/L
PCV ♂	0.4–0.54 L/L
PCV ♀	0.37–0.47 L/L
MCV	76–96 fL
MCH	27–32 pg
MCHC	300–360 g/L
RDW	11.6–14.6%
Neutrophils	2.0–7.5 ×10⁹/L (40–75%)
Lymphocytes	1.0–4.5 ×10⁹/L (20–45%)
Eosinophils	0.04–0.44 ×10⁹/L (1–6%)
Basophils	0–0.10 ×10⁹/L (0–1%)
Monocytes	0.2–0.8 ×10⁹/L (2–10%)
Platelets	150–400 ×10⁹/L
Reticulocytes	0.8–2.0% / 25–100 ×10⁹/L
Prothrombin time	10–14 s
APTT	35–45 s

Paediatric

Pulse Rate (bpm)
Neonate	140–160
Infant <1yr	120–140
1–5 years	110–130
5–12 years	80–120
>12 years	70–100
Respiratory Rate (tachypnoea)
0–2 months	≥60/min
2–12 months	≥50/min
1–5 years	≥40/min
>5 years	≥30/min
Blood Pressure (mmHg)
Term	65/45
1 year	75/50
4 years	85/60
8 years	95/65
10 years	100/70
Weight Formulas
3–12 months	(a + 9)/2 kg
1–6 years	2a + 8 kg
>6 years	(7a − 5)/2 kg
Haemoglobin (g/dL)
Term newborn	13–20
1 month	11–18
2 months	10–15
1–2 years	10–13
>2 years	11–14
MUAC (6 months–5 years)
Obese	>17.5 cm
Normal	13.5–17.4 cm
At risk	12.5–13.4 cm
Moderate malnutrition	11.5–12.4 cm
Severe malnutrition	<11.5 cm
Developmental Milestones
Social smile	1.5 months
Head control	4 months
Sits unsupported	7 months
Crawls	10 months
Stands unsupported	10–12 months
Walks	12–13 months
Talks	18 months
CSF WBC (/mm³)
Term newborn	0–25
>2 weeks	0–5

Calculator ›

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