Adenoiditis - GOI Standard Treatment Guidelines

Dr J M Hans Ex-HOD Dept. of Otorhinolaryngology Dr.RML Hospital New Delhi has compiled Standard Treatment Guidelines for Adenoiditis on behalf of Ministry of Health and Family Welfare, Government of India which has issued the same.

The nasopharyngeal tonsils, commonly called "adenoids" are situated at the junction of roof and posterior wall of the nasopharynx. Adenoid tissue is present at birth, shows physiological enlargement up to the age of six years, and then tends to atrophy at puberty and almost completely disappears by the age of 20.

Following are the major recommendations:

Definition :

Adenoiditis is the infection of the adenoids. Enlarged and infected adenoids may cause nasal obstruction, mouth breathing, nasal discharge, sinusitis, epistaxis, change of voice, Eustachian tube blockage leading to conductive hearing loss, recurrent attacks of acute otitis media, serous otitis media, typical facial appearance known as adenoid facies, pulmonary hypertension in long-standing cases.

Differential diagnosis:

• Congenital


• infection- bacterial, viral


• allergy


• malignancy- adenoid cystic carcinoma


• nasopharyngealangiofibroma


• causes of nasal obstruction

Clinical Diagnosis:

History, general examination, local examination with posterior rhinoscopy mirror, flexible or rigid nasopharyngoscope, lateral radiograph nasopharynx.

Investigations:

Complete blood count, blood grouping, prothrombin time, bleeding time, clotting time, serum electrolytes, renal and liver function tests, X-ray chest and nasopharynx, electrocardiogram.

Treatment:

• When symptoms are not marked breathing exercises, decongestant nasal drops and antihistaminics.


• When symptoms are marked adenoidectomy is done.


• Adenoidectomy is the standard operating procedure.


• Done under general anaesthesia with oral intubation.


• Boyle Davis mouth gag is inserted, adenoids palpated digitally and removed with the help of adenoid curette with and without a guard. Hemostasis is achieved by packing the area for some time.

For Further reference log on to :

http://clinicalestablishments.gov.in/WriteReadData/4251.pdf