Signs and Symptoms of Adenoid Hypertrophy
Adenoid hypertrophy presents with a characteristic constellation of symptoms including nasal obstruction, mouth breathing, hyponasal speech, snoring, and sleep-disordered breathing. 1
Primary Clinical Manifestations
Nasal Symptoms
- Persistent nasal obstruction/congestion (most common symptom) 2
- Mouth breathing (especially noticeable during sleep)
- Rhinorrhea (runny nose)
- Hyponasal speech ("talking through the nose")
- Chronic nasal discharge
Sleep-Related Symptoms
- Snoring
- Sleep-disordered breathing
- Obstructive sleep apnea (in severe cases)
- Restless sleep
- Daytime sleepiness/fatigue 3
Ear-Related Manifestations
- Recurrent otitis media (ear infections)
- Otitis media with effusion (fluid in the middle ear)
- Hearing difficulties due to Eustachian tube dysfunction 3
- Delayed speech development (secondary to hearing impairment)
Other Associated Symptoms
- Chronic cough (especially at night)
- Halitosis (bad breath)
- Recurrent sinusitis or rhinosinusitis 3
- Difficulty swallowing
- Growth disturbances in severe cases
Physical Examination Findings
The definitive diagnosis of adenoid hypertrophy requires visualization of the adenoid tissue:
- Nasal endoscopy is the gold standard for diagnosis, allowing direct visualization of the adenoid tissue and assessment of its size 4
- Enlarged, pale, lobulated lymphoid tissue visible in the nasopharynx
- Possible associated findings:
- Turbinate hypertrophy
- Nasal mucosa inflammation
- Middle ear effusion on otoscopic examination
Age Considerations
- Most common in children between 3-7 years of age 2
- Adenoid tissue naturally grows until age 6, then gradually atrophies
- Typically disappears by age 16 5
- Adenoid hypertrophy in adults is rare but increasing in incidence (21% of adult nasal obstruction cases in some studies) 5
Complications and Comorbidities
Untreated adenoid hypertrophy can lead to:
- Obstructive sleep apnea with potential neurocognitive effects (behavioral problems, poor attention, learning difficulties) 1
- Cardiovascular complications in severe cases (right ventricular dysfunction, left ventricular hypertrophy) 1
- Craniofacial development abnormalities ("adenoid facies")
- Chronic sinusitis
- Persistent middle ear effusion with potential hearing loss 3
Risk Factors and Associations
- Allergic rhinitis (strong association) 3
- Chronic infections 5
- Environmental pollutants and tobacco smoke exposure 5
- Rarely associated with more serious conditions in adults (sinonasal malignancy, lymphoma, HIV) 5
Diagnostic Pitfalls
- Symptoms may overlap with allergic rhinitis, making differentiation challenging
- In children with recurrent respiratory infections, adenoid hypertrophy must be distinguished from primary immunodeficiency disorders 3
- In adults, persistent adenoid hypertrophy should prompt investigation for underlying causes including chronic infections, allergies, and rarely malignancy 5
When evaluating a patient with suspected adenoid hypertrophy, a thorough assessment of symptoms, physical examination with nasal endoscopy when possible, and consideration of comorbid conditions is essential for proper diagnosis and management.