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Adenoid Hypertrophy in Adults: Causes and Precipitating Factors Talal Althobaiti1, Wael Ali Hadaidi2, Ahmad Saeed A

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Adenoid Hypertrophy in Adults: Causes and Precipitating Factors Talal Althobaiti1, Wael Ali Hadaidi2, Ahmad Saeed A Talal Althobaiti et al, 2020;4(11):1792–1796. International Journal of Medicine in Developing Countries https://doi.org/10.24911/IJMDC.51-1599758714 ORIGINAL ARTICLE Adenoid hypertrophy in adults: causes and precipitating factors Talal Althobaiti1, Wael Ali Hadaidi2, Ahmad Saeed A. Alghamdi2, Khaled Fahad J. Alghashmari2, Abdulrahman Ali Hadaidi3, Tamer Mohamed Abd-Elrahman4,5* ABSTRACT Background: Adenoid hypertrophy (AH) is suspected in case of nasal obstruction. Recurrent acute infections and allergic episodes are reported as the most common causes of adenoid hypertrophy. The present study aimed to determine the prevalence, symptoms, and possible causes of adenoid hypertrophy in adults. Methodology: A retrospective cross-sectional study was carried out in the Armed Forces Hospitals, Taif region, Saudi Arabia, during the period from February 2016 to February 2020. All the cases of adenoid hypertrophy diagnosed with nasal obstruction as the chief complaint and patients planned for tonsillectomy were included in this study. Results: Forty-six adult patients were diagnosed with adenoid hypertrophy: 32 in group A (patient’s complaint with nasal obstruction) and 14 in group B (patients planned for tonsillectomy); 33 were male and 13 were female. The most commonly involved age group was 17-26 years (65%). The most presenting symptoms were nasal obstruction (100%), snoring (86.9%), and post-nasal discharge (71.7%). The commonest predisposing factor for adenoid hypertrophy was allergic rhinitis (39.1%). Twenty-five cases (54.4%) had associated nasal polyps, while five cases (10.9%) had adenoid hypertrophy along with inferior turbinate hypertrophy. Conclusion: Adenoid hypertrophy in adults has an increasing incidence nowadays because of chronic infection, allergy, and pollutions. All patients presented with nasal obstruction and other rhinological symptoms, which should be evaluated for adenoid hypertrophy. Keywords: Adenoid hypertrophy, adults, naso-pharynx, rhinological conditions, allergy, nasal obstruction. Introduction The adenoids consist of unencapsulated lymphoid tissue the persistence of adenoid tissues in the non-pediatric age organized in germinal centers in the naso-pharynx, as group [6]. Theobald in 1948 and Heffner in 1987 also a part of inner Waldeyer’s ring. Adenoids, along with reported marked hyperplasia of adenoid tissues in adults palatine tonsils, are first-line defense barriers against [7,8]. A study conducted by Rout et al. [9] showed that antigens from the oral cavity and even air-borne diseases the most frequently involved age group in adults is 16- coming through the nose [1,2]. 25 years and adult males are more commonly involved Symptoms of adenoid hypertrophy, which is non- than females, maybe due to more exposure to outdoor physiological enlargement, include obstructive sleep pollutants. apnea, open-mouth breathing, snoring, hyponasal speech and rhinorrhea [3,4]. The disease is prevalent in children and its symptoms Correspondence to: Tamer Mohamed Abd-Elrahman appear more rapidly at a younger age due to the *Surgery Department, College of Medicine, Taif University, increased frequency of upper respiratory tract infections Taif, Surgery Department, Benha Teaching Hospital, General and small volume of the naso-pharynx. Adenoids are Organization of Teaching Hospital and Institutes, Egypt. Email: [email protected] physiologically enlarged in size from birth up to the age Full list of author information is available at the end of of 6 years, and after that it gradually regresses in size the article. to disappear completely at nearly 16 years of age, but it Received: 03 October 2020 | Accepted: 11 October 2020 may persist into adult life [5]. Cowan in 1982 described © IJMDC. https://www.ijmdc.com 1792 Adenoid hypertrophy in adults: causes and precipitating factors Adenoid hypertrophy can present in many shapes in Results adults; it should be suspected when facing a case of nasal obstruction, especially if presented with purulent Forty-six adult patients diagnosed with adenoid nasal secretions; also, other possible presentations can hypertrophy were included in the study. The demographic be a change in voice or sleep apnea. The symptoms can characteristics of the patients are shown in Tables 1 and 2. vary in severity according to the hypertrophic size of the The results showed that males are more prone to adenoid adenoid and the size of the naso-pharynx; the smaller the hypertrophy than females. And that adult adenoid naso-pharynx, the more severe the symptoms [10]. hypertrophy is an extension of the child period adenoid. In a study conducted by Al-Juboori et al. [11], all patients In the present study, the patients with adenoid hypertrophy complained of snoring, wherein most of the patients presented with different symptoms as shown in Table 3. suffered from nasal discharge and around half of the No case with hearing impairment or impairment of smell patients had headaches and/or pain in the face. Others was encountered. had sneezing, itching, or hearing impairment; also, some The commonest predisposing factors are shown in Table 4 patients reported impairment of their smelling sensation. Recurrent acute infections and allergic episodes are Fourteen cases (30.4%) had adenoid hypertrophy alone reported as the most common causes of adenoid and the majority of the patients were associated with hypertrophy [12]. other rhinological conditions as shown in Table 5. The present research aimed to determine the prevalence Discussion of adenoid hypertrophy in adult patients, to highlight any alarming symptoms owing to the presence of persistent Adenoid hypertrophy is a common presentation in adenoid tissues, and to investigate the possible causes of children. Although adenoidal tissue undergoes regression adenoid hypertrophy in adults. toward the adolescent ages, it may present as the chief cause of nasal obstruction in adults [13]. Subjects and methods Unlike tonsils, which can be seen by looking directly This study was a retrospective cross-sectional study through the mouth, the adenoid is positioned at the carried out in the Department of ENT and Head and backmost part of the nasal cavity and up behind the Neck Surgery, Armed Forces Hospitals, Taif region, soft palate. Since it sits at the backmost part of the Saudi Arabia, for determining the prevalence, symptoms, nasal cavity, its main symptoms affect nasal function. and possible causes of adenoid hypertrophy, during the On the other hand, nasal obstruction in adults is almost period from February 2016 to February 2020. totally attributed to deviated nasal septum or turbinate hypertrophy, with adenoid hypertrophy being the least The inclusion criteria included male and female patients likely causative factor in the minds of clinicians. aged 17 years old and above and diagnosed with adenoid hypertrophy. Patients aged 16 years and below Less has been published on adult obstructive adenoid and patients with missing recorded information were hypertrophy, possibly due to its underdiagnosis as a excluded from the study. result of it being overshadowed by the accompanying rhino-pharyngological disorder or due to incomplete The medical history of all patients included in the study nasopharyngeal examination [14]. was taken from the medical records; data were then entered into a predesigned, validated proforma that included socio-demographic information, possible symptoms, and expected risk factors of adenoid hypertrophy in adults, along with findings of physical examination conducted Table 1. Gender distribution of adenoid hypertrophy. in each patient. Number (%) Total Gender Patients were divided into two groups: all the cases of (group A = 32) (group B = 14) n (%) adenoid hypertrophy diagnosed during examination of Male 24 (75%) 9 (64.3%) 33 (71.7%) patients with nasal obstruction as the chief complaint (group A) and diagnosis discovered during investigation Female 8 (25%) 5 (35.7%) 13 (28.3%) for patients planned for tonsillectomy (group B). The diagnosis of adenoid hypertrophy in all cases was carried Table 2. Age distribution of adenoid hypertrophy. out by indirect nasopharyngoscopy and/or endoscopy Number (%) and imaging (direct films and/or computed tomography); Age Total also, biopsy was conducted in some selected cases. (Years) (group A = 32) (group B = 14) n (%) 17-26 21 (65.6%) 7 (50%) 28 (60.9%) Data were analyzed using Statistical Package for Social Sciences (SPSS) version 24.0 software for Windows 27-36 6 (18.8%) 4 (28.6%) 10 (21.8%) (SPSS, Chicago, IL). Categorical variables are presented 37-46 2 (6.3%) 3 (21.4%) 5 (10.9%) as number and percentage. ≥47 3 (9.4%) 0 (0%) 3 (6.5%) 1793 Adenoid hypertrophy in adults: causes and precipitating factors Table 3. Symptoms of adenoid hypertrophy. Number (%) Total Symptoms (group A = 32) (group B=14) n (%) Nasal obstruction 32 (100%) 14 (100%) 46 (100%) Post-nasal discharge 25 (78.1%) 8 (57.1%) 33 (71.7%) Rhinorrhea 9 (28.1%) 3 (21.4%) 12 (26.1%) Snoring 28 (87.5%) 12 (85.7%) 40 (86.9%) Headache and/or facial pain 8 (25%) 4 (28.5%) 12 (26.1%) Impairment of smell 0 (%) 0 (%) 0 (0%) Hearing impairment 0 (%) 0 (%) 0 (0%) Itching 17 (53.1%) 7 (50%) 24 (52.2%) Sneezing 15 (46.8%) 5 (35.7%) 20 (43.4%) Table 4. Predisposing factors for adenoid hypertrophy. Number (%) Total Factors (group A = 32) (group B = 14) n (%) Allergic rhinitis 12 (37.5%) 6 (42.8%) 18 (39.1%) Chronic tonsillitis, pharyngitis 7 (21.8%) 2 (14.2%) 9 (19.6%) Chronic sinusitis, rhinitis, otitis media 10 (31.2%) 5 (35.7%) 15 (32.6%) Polyps and benign sinonasal tumors 2 (6.25%) 1 (7.1%) 3 (6.5%) Malignant sinonasal tumors 1 (3.1%) 0 (%) 1 (2.2%) Table 5. Association of adenoid hypertrophy with rhinological conditions. Number (%) Disease Total n (%) (group A = 32) (group B = 14) Adenoids + ethmoidal nasal polyps 17 (53.1%) 8 (57.1%) 25 (54.4%) Adenoids + deviated nasal septum 2 (6.2%) 0 (%) 2 (4.4%) Adenoids + inferior turbinate hypertrophy 3 (9.3%) 2 (14.2%) 5 (10.9%) Adenoids 10 (31.2%) 4 (28.5%) 14 (30.4%) In a study among (15,000) adults, adenoid hypertrophy The commonest age group involved was 17-26 years was diagnosed in 2.5% of the cases [15,16].
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