Adenoid Hypertrophy and Otitis Media

ADENOID HYPERTROPHY
&
SEROUS OTITIS MEDIA
Fatima
Objectives
 Adenoid hypertrophy
 Anatomy
 Etiology
 Clinical presentation
 Diagnosis
 Management and complications
 Serous otitis media

 Middle ear anatomy
 Pathogenesis
 Etiology
 Signs and symptoms

 Diagnosis
 Complications
ADENOID
HYPERTROPHY
Anatomy – Waldeyer’s Tonsillar Ring
It is a circular structure of lymphoid tissue located in the

nasopharynx and the oropharynx in a ring fashion.
Function:
 It is the first line of defense against pathogens
 It lines the gateway to the aero-digestive tract which allows it
to maximize immunological memory
Anatomy - Adenoids
 Covered by 3 types of epithelium:

 Ciliated pseudostratified columnar epithelium
 Stratified squamous epithelium
 Transitional epithelium: Lots of folds to increase the surface area
 They lack crypts and a capsule.
 Present at birth.
 Physiological enlargement up to 6 years of age
 Atrophy at puberty
 Regress and disappear by the age of 20.
Anatomy – Adenoids (cont.)
Anatomy – Adenoids (cont.)
 Blood supply:
 Ascending palatine branch of facial artery
 Ascending pharyngeal branch of external carotid artery
 Pharyngeal branch of the 3rd part of maxillary artery
 Ascending branch of the inferior thyroid artery
 Nerve supply:
 Glossopharyngeal nerve (CN IX)
 Vagus nerve (CN X)
 Lymph drainage:
 Upper jugular nodes directly.
 Indirectly through retropharyngeal and parapharyngeal
lymph nodes
Adenoid Hypertrophy
Etiology
 Recurrent rhinitis;
 Pharyngitis;
 Tonsillitis
 Allergy of upper respiratory tract
 Generalized lymphoid hyperplasia
Clinical Presentation
 Signs and Symptoms depend on

 Size of the adenoids
 Relative available space in the nasopharynx
 They are divided into 3 categories
 Nasal
 Aural
 General
Nasal
1. Nasal Obstruction
2. Nasal Discharge
3. Sinusitis
4. Epistaxis
5. Voice Change
Aural
1. Eustachian Tube Obstruction

2. Recurrent attacks of Acute Otitis Media
3. Chronic Suppurative Otitis Media
4. Serous Otitis Media
General
1. Adenoid facies
2. Pulmonary hypertension
3. Aprosexia
Diagnosis
 Detailed History.
 Examination of Nasopharynx with a posterior Rhinoscopy Mirror.
 Rigid or Flexible Nasopharyngoscopy
 Soft tissue Lateral Radiograph of Nasopharynx
 Detailed Nasal Examination to rule out other causes of nasal obstruction
Management
Adenoidectomy
 Indications
 Snoring, mouth breathing, sleep apnea syndrome and speech
abnormalities
 Recurrent rhinosinusitis
 Chronic serous otitis media
 Recurrent ear discharge in CSOM
 Dental malocclusion. Doesn’t correct dental abnormalities but will
prevent recurrence after orthodontic treatment
 Contraindications
 Submucous or cleft palate
 Hemorrhagic diathesis
Complications
 Hemorrhage
 Injury to opening of Eustachian tube
 Injury to pharyngeal musculature and vertebrae
 Grisel’s syndrome
 Nasopharyngeal stenosis
 Velopharyngeal insufficiency
 Recurrence
SEROUS OTITIS MEDIA
Middle Ear Anatomy
What is SOM?
 Otitis media separated into two broad categories
 Acute Otitis Media
 Serous Otitis Media.
 Also known as
 Otitis Media with Effusion (OME),
 Secretory Otitis Media,
 Mucoid Otitis Media,
 “Glue Ear”
 Characterized by inflammation of the Middle Ear, with accumulation of non-purulent
effusion.
 Effusion is usually thick and viscid, but sometimes may be thin and serous.
 Usually Sterile.
 Commonly seen in school-going children and it is the most common cause of hearing
impairment in children (between ages 5-8 years).
Pathogenesis
 Malfunctioning of Eustachian tube
 Failure to aerate the middle ear and is unable to drain the fluid.
 Increased secretory activity of Middle Ear Mucosa

 Biopsies of middle ear mucosa in these cases have confirmed increase in number of
mucus or serous secreting cells.
Etiology
1. Malfunctioning of Eustachian Tube:

i. Adenoid Hyperplasia
ii. Chronic Rhinitis and Sinusitis
iii. Chronic Tonsillitis
iv. Benign and Malignant Tumors of nasopharynx.
v. Palatal defects
2. Allergy
3. Unresolved Otitis Media
4. Viral Infections
Clinical Presentation
 Symptoms
1. Hearing loss (rarely exceeds 40 dB)
2. Delayed and defective speech
3. Feeling of fullness in ear
4. Mild Earaches
 Signs
1. Tympanic membrane:
i. Appears dull and opaque
ii. Loss of light Reflex.
iii. Yellow, grey or bluish in colour
2. Blood Vessels around handle of malleolus/periphery of TM
3. Retraction of tympanic membrane.
4. Appear full/ bulging in posterior part due to effusion.
5. Air Bubbles may be seen when fluid is thin and tympanic membrane is transparent.
6. Mobility of tympanic membrane is restricted.
Diagnosis
 Tuning fork tests:

1) Rinne's
2) Weber’s
 Audiometry
 Impedance Audiometry
 X-ray of mastoid (air cells clouding due to fluid)
Impedance Audiometry
 The impedance of an acoustic system reflects its ability to transmit a
sound wave.
 impedance audiometry is the evaluation of the integrity and correct
function of the ossicular chain.
A. Shows normal compliance of the

eardrum, ossicles and the middle ear.
B. Shows a break in the ossicular chain or
a flaccid eardrum.
C. Suggests reduced mobility caused by
the presence of fluid in the tympanic
cavity.
D. Represents negative pressure in the
tympanic cavity indicating eustachian
tube dysfunction, which can lead to
OME.
Complications
 Atrophic tympanic membrane and atelectasis of middle ear

 Ossicular necrosis ( >50 Db loss)
 Tympanosclerosis
 Retraction pockets and cholesteatoma
 Cholesterol Granuloma
 Facial Nerve Paresis
 Speech Delay
Treatment
 Aim of treatment is removal of fluid and prevention of its recurrence.

 Watchful waiting for 3 months if
 hearing loss < 20 dB
 no speech development problem
 Medical
 Surgical
Medical Treatment
1. Decongestants
2. Anti-allergics
3. Antibiotics
4. Middle Ear Aeration
 Valsalva Maneuver
 Politzerization
 Eustachian Tube catheterization
 Chewing gum
Surgical Treatment
1. Myringotomy and Aspiration of fluid:

 Mucolytics
 “Beer-can” Principle
2. Grommet insertion (persistent 40 dB loss)
3. Tympanotomy or Cortical Mastoidectomy
4. Surgical treatment of Causative factor
and prompt surgical treatment if structural damage present.
THANK YOU!
References
 https://www.uptodate.com/contents/adenoidectomy-in-children-postoperati
ve-care-and-complications#H1819841244
 https://www.uptodate.com/contents/clinical-presentation-diagnosis-and-tre
atment-of-nasal-obstruction
 https://www.sciencedirect.com/science/article/pii/S1878875015004933
 https://www.uptodate.com/contents/otitis-media-with-effusion-serous-otitis
-media-in-children-management#H377254982
 Current Diagnosis & Treatment in Otolaryngology – Head & Neck Surgery
 Diseases of Ear, Nose and Throat & Head and Neck Surgery

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ADENOID HYPERTROPHY

 Management and complications

 Serous otitis media

 Signs and symptoms

It is a circular structure of lymphoid tissue located in the

 Covered by 3 types of epithelium:

 Signs and Symptoms depend on

1. Eustachian Tube Obstruction

 Increased secretory activity of Middle Ear Mucosa

1. Malfunctioning of Eustachian Tube:

 Tuning fork tests:

A. Shows normal compliance of the

 Atrophic tympanic membrane and atelectasis of middle ear

 Aim of treatment is removal of fluid and prevention of its recurrence.

1. Myringotomy and Aspiration of fluid:

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