What is the treatment for adenoid hypertrophy in adults?

Treatment of Adenoid Hypertrophy in Adults

Adenoidectomy is the definitive treatment for adenoid hypertrophy in adults, particularly when symptoms are significant or when medical management has failed. 1

Medical Management Options

First-Line Medical Therapy

• Intranasal corticosteroids are recommended as the initial treatment approach for mild to moderate adenoid hypertrophy in adults
  • Mechanism: Reduces inflammation and adenoid size
  • Duration: Trial of 4-6 weeks before reassessing
  • Evidence: Studies show modest but significant decrease in airway resistance and improvement in nasal obstruction symptoms 2
  • Caution: Less effective in adults compared to children, where significant improvements in AHI have been documented 2

Additional Medical Options

• Treatment of underlying allergic rhinitis if present:
  • Antihistamines
  • Leukotriene receptor antagonists
  • Allergen avoidance measures
• Management of chronic infection:
  • Appropriate antibiotics for bacterial infections
  • Nasal saline irrigation

Surgical Management

Indications for Adenoidectomy in Adults

• Persistent nasal obstruction despite medical therapy
• Sleep-disordered breathing/obstructive sleep apnea
• Chronic rhinosinusitis refractory to medical management
• Recurrent otitis media or chronic otitis media with effusion
• Eustachian tube dysfunction

Surgical Techniques

1. Endoscopic adenoidectomy - preferred approach in adults 1, 3

   • Better visualization
   • More precise removal
   • Lower recurrence rates (endoscopic follow-up shows minimal recurrence over 17 months) 1

2. Radiofrequency ablation (RFVTR)

   • Can be performed under local anesthesia
   • Creates submucosal necrosis and fibrosis
   • Preserves overlying mucosa and mucociliary clearance
   • Minimal bleeding and postoperative crusting 2

3. Other techniques:

   • Electrocautery (unipolar or bipolar)
   • Cryosurgery (limited long-term benefit)
   • Argon plasma coagulation 2

Treatment Algorithm Based on Severity

Mild Adenoid Hypertrophy (Grade 1)

1. Trial of intranasal corticosteroids for 4-6 weeks
2. Treat underlying allergic rhinitis or infection if present
3. Consider radiofrequency ablation if symptoms persist 3

Moderate Adenoid Hypertrophy (Grade 2)

1. Combined approach with medical therapy and minimally invasive procedures
2. Radiofrequency ablation or electrocautery under local anesthesia
3. Progress to adenoidectomy if symptoms persist 3

Severe Adenoid Hypertrophy (Grade 3)

1. Endoscopic adenoidectomy is recommended as first-line treatment
2. Complete surgical removal is required in 100% of cases with this severity 3

Special Considerations

Diagnostic Evaluation

• Nasal endoscopy is essential for proper diagnosis in adults, as posterior rhinoscopy is often inadequate 1
• Consider biopsy to rule out malignancy, particularly in cases with:
  • Unilateral presentation
  • Rapid growth
  • Associated cervical lymphadenopathy
  • History of HIV or immunosuppression 2, 4

Post-Treatment Follow-up

• Endoscopic evaluation at 1 month and 6-12 months post-treatment
• Assess for symptom improvement and recurrence
• Consider sleep study if OSA was present pre-treatment

Important Caveats

• Adenoid hypertrophy in adults is increasingly recognized and should not be overlooked as a cause of nasal obstruction (accounts for approximately 21% of adult nasal obstruction cases) 4
• Males are more commonly affected (70%), possibly due to increased exposure to environmental pollutants 4
• Underlying causes in adults include chronic infection (53.3%), allergic rhinitis (30%), and rarely malignancy or HIV infection (3.3% each) 4
• Any adult with adenoid hypertrophy should be evaluated thoroughly to exclude potentially serious underlying causes 4