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The Pharynx and Oral Cavity
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
The adenoids are rudimentary at birth but enlarge to occupy a substantial part of the nasopharynx between the ages of about 2 and 7 years. Adenoids can obstruct the nasopharyngeal airway and the orifices of the Eustachian tube, contributing respectively to OSA and OME. There has been increasing focus in recent years on the role of the adenoids as a reservoir of chronic infection. ‘Biofilms’ are aggregates of bacteria in a complex mucopolysaccharide matrix which is resistant to conventional antimicrobial therapy and may contribute to recurrent infections in the nose, sinuses and middle ear. Adenoidectomy – often in association with an intervention such as tonsillectomy (typically for OSA) or insertion of grommets – is a common ORL procedure in children. Indications include OSA, OME and persistent rhinitis that has been resistant to medical therapy. Blind curettage with a sharp blade has been the traditional technique, but ORL specialists are increasingly moving towards surgery under direct vision (coblation and suction diathermy) using an endoscope and a screen/monitor, permitting much more accurate and thorough removal of tissue. The main complication of adenoidectomy is bleeding. Velopharyngeal insufficiency, characterised by escape of air from the nasal cavity during phonation (rhinolalia aperta), is often noted in the weeks and months following surgery but is usually temporary. Persistent cases can be troublesome and, very occasionally, warrant corrective pharyngeal or palatal surgery.
Paper 4
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 2 year old girl is brought into the emergency department by her parents with fever, cough and inspiratory stridor. The clinical team request a radiograph of the neck. There is subglottic tracheal narrowing and distension of the hypopharynx. The epiglottis and aryepiglottic folds do not appear thickened. The adenoid tonsils are enlarged. On the lateral view the retropharyngeal soft tissues are equivalent in thickness to approximately half a vertebral body width.
Nose
Published in Marie Lyons, Arvind Singh, Your First ENT Job, 2018
This involves removing adenoidal tissue. It is done through the mouth so there are no cuts or stitches on the outside. A tonsillectomy gag is put in the mouth and opened. The adenoids are felt and the palate can also be examined to rule out a submucosal cleft palate which is a relative contraindication to adenoidectomy, especially if done using suction diathermy. If the adenoids are large or obstructive they are removed using a specially designed curette or removed by suction diathermy under direct vision. If the adenoids are small and non-obstructive they are not removed.
Serologic false-positive reactions for syphilis in children of adenoidal hypertrophy:2 case reports and review of the literature
Published in Acta Clinica Belgica, 2021
Wei Wang, Xuzhou Fan, Xuelian Huang, Jingmei Yan, Jianfeng Luan
Adenoids, also known as pharyngeal tonsils, are located in the posterior wall of the nasopharynx and are part of the pharyngeal lymphatic ring. They are also the body’s immune organs. Lymphocytes in various stages are generated in adenoids. Adenoids consist of dedicated lymphoepithelial tissue and are composed of epithelial cells, lymphocytes, macrophages and dendritic cells [9–11]. So adenoids play a role in humoral immunity and cellular immunity. If it continues to enlarge for some reason, it will affect the role as adjacent organs, even imposing threats to physical health. This pathological phenomenon is called adenoid hypertrophy(AH).It is generally believed that adenoids are physiological hypertrophy: they gradually increase during the first two years after birth, come to a climax at age 6 or 7, gradually shrink after about age 10, and often practically disappear at puberty [12].Usually local immune dysfunction in patients with AH, leading to sustained release of inflammatory mediators and dysfunctions the release of large amounts of immune substances [13].However, TP-EIA is susceptible to cross-reactivity due to interference from some immune substances. Thus it will produce false positive results. In the reports of the two cases, we are concerned about the increase in the levels of IgG and IgE substances in the body, which is consistent with previous reports. These substances may be associated with a positive reaction detected by TP-EIA.
Bacterial biofilm in adenoids of children with chronic otitis media. Part I: a case control study of prevalence of biofilms in adenoids, risk factors and middle ear biofilms
Published in Acta Oto-Laryngologica, 2019
Romain Kania, Pierre Vironneau, Huong Dang, Béatrice Bercot, Emmanuelle Cambau, Benjamin Verillaud, Domitille Camous, Gerda Lamers, Philippe Herman, Eric Vicaut, Natacha Tessier, Thierry Van Den Abbeele
This is a prospective monocentric unrandomized case-control study comparing the prevalence of biofilms between 2 groups of children matched for age and gender. Cases (Group 1) were children who underwent adenoidectomy for COM. Controls (Group 2) were children who underwent adenoidectomy for obstructive adenoids without COM. In group 1, when children with COM needed to have a ventilation tube inserted then a biopsy of ME mucosa and effusion liquid were collected. The specimens were prepared for confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). The main outcome measurement was the prevalence of mucosal biofilm formations in adenoidectomy specimens analyzed using CLSM with double staining to visualize both the bacteria and the glycocalyx matrix. The following clinical features were recorded for searching risk factors: age, sex, breastfeeding, passive smoking, day nursery, young siblings, anemia, acid reflux, allergy, number of previous antibiotics treatments. Institutional review board approval was obtained. Informed consent was obtained for each child.
Longterm results after tonsillotomy: outcome, residual symptoms and need for revision surgery
Published in Acta Oto-Laryngologica, 2020
Anne Bystrup, Tina Kissow Lildal, Therese Ovesen
Obstructive tonsillar and adenoid hypertrophy are the most common causes of obstructive sleep apnoea (OSA) among children. Approximately 8% of all children are affected by snoring, whereas 1–4% suffer from OSA, and the incidence is increasing [1]. It is important to treat OSA because of the associated cognitive, metabolic, and cardiovascular comorbidity [1]. Traditionally, the choice of treatment has been tonsillectomy (TE: removal of the entire tonsil including the capsule) or adeno-tonsillectomy (ATE) in case of simultaneous adenoid hypertrophy. Thereby, symptom relief is achieved among 70% of children with OSA [2,3].