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Adenoid and other infections

Adenoid and other infections. Dr Deekshith RM Senior resident 29/01/2019. Anatomy of nasopharnyx. Santorini described the nasopharyngeal lymphoid aggregate or ' Lushka's tonsil

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Adenoid and other infections

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  1. Adenoid and other infections Dr Deekshith RM Senior resident 29/01/2019

  2. Anatomy of nasopharnyx

  3. Santorini described the nasopharyngeal lymphoid aggregate or 'Lushka's tonsil • Lymphoid tissue of the adenoid may extend to the fossa of Rosenmiiller and to the Eustachian tube orifice as Gerlach's tonsil. • Functions: The adenoid produces B cells • Blood supply: branches of the facial and maxillary arteries and the thyrocervical trunk.

  4. Adenoiditis • “Adenoiditis” is pathological hypertrophy of the nasopharyngeal tonsil. • Under normal conditions the nasopharyngeal tonsil starts to diminish in size at the age of 7-8 years.

  5. Etiology: Predisposing factors: General • Environmental pollution. • 2) Allergy. • 3) Bad Hygiene • 4) Poor general health. Local • Recurrent upper respiratory infections. • 2) Chronic tonsillitis.

  6. Symptoms: • nasal obstruction • mouth breathing • nasal discharge • adenoid face: • elongated face, dull expression, nasal discharge, open mouth, hitched-up upper lip, prominent and overcrowded upper teeth, high-arched palate • pulmonary hypertension • Aprosexia, i.e. lack of concentration.

  7. Nocturia due to hypercapnea • Recurrent OME,CSOM • Feeding problems,irritant • hyponasality

  8. Diagnosis: • nasopharyngoscopy • X-ray nasopharynx lateral view

  9. Treatment: • When symptoms are not severe, decongestant nasal drops + antihistamines is the treatment of choice • Marked symptoms, treatment is adenoidectomy

  10. Adenoidectomy

  11. COMPLICATIONS OF ADENOIDECTOMY bleeding; dental trauma; airway obstruction, due to: - retained swab; - nasopharyngeal blood clot; infection; cervical spine injury (particularly in Down syndrome); velopharyngeal dysfunction; regrowth of the adenoid.

  12. Thornwalds disease • It is infection of the pharyngeal bursa which is a median recess representing attachment of notochord to endoderm of the primitive pharynx. • Pharyngeal bursa is located in the midline of posterior wall of the nasopharynx in the adenoid mass.

  13. CLINICAL FEATURES 1. Persistent postnasal discharge with crusting in the nasopharynx. 2. Nasal obstruction due to swelling in the nasopharynx. 3. Obstruction to eustachian tube and serous otitis media. 4. Dull type of occipital headache. 5. Recurrent sore throat. 6. Low-grade fever

  14. Examination would reveal a cystic and fluctuant swelling in the posterior wall of nasopharynx. • It may also show crusts in the nasopharynx due to dried up discharge.

  15. TREATMENT • Antibiotics are given to treat infection and marsupialization of the cystic swelling and adequate removal of its lining membrane

  16. Acute nasopharyngitis AETIOLOGY • Acute infection of the nasopharynx. • It may be caused by viruses (common cold, influenza, parainfluenza, rhino or adenovirus) or bacteria (especially streptococcus, pneumococcus or Haemophilusinfluenzae).

  17. CLINICAL FEATURES • Dryness and burning of the throat above the soft palate • pain and discomfort localized to the back of nose with some difficulty on swallowing. • In severe infections, there is pyrexia and enlarged cervical lymph nodes. • Examination of nasopharynx reveals congested and swollen mucosa often covered with whitish exudate. TREATMENT • Mild cases clear up spontaneously. Some analgesic may be required for relief of pain and discomfort. In severe cases with antibiotics and nasal decongestents

  18. Chronic Nasopharyngitis • AETIOLOGY • It is often associated with chronic infections of nose, paranasal sinuses and pharynx. • It is commonly seen in heavy smokers, drinkers and those exposed to dust and fumes.

  19. CLINICAL FEATURES • Postnasal discharge and crusting with irritation at the back of the nose • hawking or inspiratory snorting (forcibly drawing nasal secretions back into the throat). • Examination of nasopharynx reveals congested mucosa and mucopus or dry crusts. In children, adenoids are often enlarged and infected (chronic adenoiditis). • TREATMENT • Excessive smoking and drinking should be corrected Alkaline nasal douche helps to remove crusts and mucopus. Steam inhalations are soothing.

  20. Thank you

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