A child presenting with recurrent respiratory tract infections, mouth breathing and decreased hearing. Treatment of choice is
(Adenoidectomy) (228-385- Dhingra 4th, 367- Logan & Turner 10th)* Recurrent RTI, mouth breathing and decreased hearing suggest that child is suffering from adenoids,* Treatment of choice for adenoids is - AdenoidectomyADENOIDS* Adenoids (or nasopharyngeal tonsil / is situated at junction of the roof and posterior wall of the nasopharynx* Adenoids are present at birth, shows physiological enlargement upto the age of 6 years and then tends to atrophy at puberty and almost completely disappears by age of 20 years* Nasal obstruction is the commonest symptoms. This leads to mouth breathing* **. It also interferes with feeding or sucking. As respiration and feeding can not take place simultaneously such a child fails to thrive**** Nasal symptoms - Nasal obstruction, Nasal discharge, chronic sinusitis, Epistaxis, voice change* Aural symptoms - Tubal obstruction, Recurrent attack of acute DM, CSOM, Serous ottitis mediaChronic nasal obstruction and mouth breathing leads to characteristic facial appearance called Adenoid facies the child has an elongatedface with dull expression, open mouth, prominent and crowded upper teeth and hitched up upper lip* Hard palate is highly arched** as moulding action of the tongue or palate is loss* Diagnosis by examination of post nasal space is possible in some children. Soft tissue lateral radiograph will reveal size of adenoids as also the extent to which nasopharyngeal air space which has been compromised.CT scan has no role in diagnosisIndications of Adenoidectomy* Adenoid hypertrophy causing snoring, mouth breathing, sleep apnoea syndrome or speech abnormalities (i.e. rhinolalia)* Recurrent rhinosinusitis* Chronic secretory otitis media a/w adenoid hyperplasia* Recurrent ear discharge in benign CSOM a/w adenoitis / adenoid hyperplasia* Dental malocclusion (Adenoidectomy does't correct dental abnormalities but will prevent its recurrence after orthodontic treatment)
Tonsillectomy
Adenoidectomy
Gromet insertion
Myringotomy
Pharynx