Adenoid auditory tube8/26/2023 A plain x-ray of the nose will show the enlarged adenoids.( Figures 2 & 3) A hearing test may be required if fluid in the middle ear is suspected. In figure 4b it is almost completely blocked. In the endoscopic examination in figure 4a the nasal passage is completely blocked by the adenoids. This condition is called “Obstructive Sleep Apnoea” The diagnosis is established by a detailed examination which may include nasal endoscopy, (examination of the nasal cavity with a flexible endoscope) and oto-endoscopy, (examination of the ears with an endoscope. In some cases the child breathing may be so compromised so as to cause periods of “apnoea” where the breathing stops for periods of more than 10 seconds. ![]() Enlargement of both the tonsils and adenoids may lead snoring and blockage of the upper airway particularly when the child is sleeping. Sometimes the tonsils may be enlarged as well and the problem is compounded. Prolonged accumulation of the mucus in the nasal cavity may cause infection and the child has a constant yellowish discharge from the nose. The mucus which is normally produced in the nose is cleared by being transported to the back part of the nose where it is swallowed. Blockage of the back part of the nose, by the adenoids leads to accumulation of mucus within the nasal cavity. This also may reflect in the child’s behaviour. As a result of this hearing deficit, which may go completely unnoticed by the parents, the child may develop learning disabilities. Glue ears may cause significant conductive hearing loss as the sound now cannot be properly conducted through the ears. With time this fluid can become thick quite akin to “glue” and hence the term, “glue ears”. Prolonged negative pressure in the middle ear may lead to fluid accumulation in the middle ear. ![]() Enlarged adenoids may also block the Eustachian tube opening causing a negative pressure in the middle ear. As a result the child is unable to breathe through the nose and resorts to breathing through the mouth. In some children the adenoids may become so enlarged that they almost completely block the back part nasal passage. At the same time the adenoids start shrinking and by age 8-10 these almost completely disappear. As the child grows older with the growth of the facial skeleton the nasopharynx becomes larger. Adenoids can become enlarged in children. In figure 3a and 3b the adenoids are very enlarged and completely obstructing the nasal passage. In Figure 2 a and 2b the adenoids are enlarged (shaded blue) and almost completely obstructing the back part of the nasal passage. As the nasopharynx normally will have air it appears black on the x-ray. The x-rays show the normal nasopharnx (white arrow heads in Figure 1b). ![]() The Eustachian tubes connect the nasopharynx with the middle ear and helps to equalise the pressure in the middle ear to that of the surrounding atmosphere. ![]() Due to their location the adenoids are closely related to the Eustachian tubes openings (black arrow). As the child grows older and the immune system evolves the function of fighting the infections by the adenoids and tonsilAdenoids (white arrow) are a patch of lymphoid tissue located at an area behind the nose called the s slowly ceases. Along with the tonsils which are located in the throat and are closely related to the adenoids, they are involved in fighting infection particularly in children.
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