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130                  THE PHARYNX AND NASOPHARYNX


The name adenoids is given to the pharyngeal tonsil, but it has come to be
loosely applied to enlargement of that tissue. More correctly 'adenoid
hypertrophy' should be used. Adenoid tissue arises from the junction of the
roof and posterior wall of the nasopharynx, and is composed of vertical
ridges of lymphoid tissue separated by deep clefts (Fig. 50). It differs from
tonsillar tissue in that it contains no crypts, is bounded by no capsule and is
covered by ciliated epithelium. Adenoids are present at birth, continue

Fig. 50. Mass of adenoids removed from a child aged 3.

throughout childhood and atrophy at puberty, although persistence into
adult life is not uncommon. It is probable that they are subject to the same
physiological and pathological enlargement and retrogression as tonsils, but,
being more difficult to examine, these are not recognized clinically. Adenoids
probably form part of the body defence mechanism against infection.

Adenoids are liable to inflammatory changes. Acute adenoiditis may occur
alone or in association with rhinitis or tonsillitis. It produces pain behind
the nose and postnasal catarrh, lack of resonance of the voice, nasal
obstruction and feeding difficulties in babies and it is often accompanied by
cervical adenitis. Treatment is that of acute rhinitis. Chronic adenoiditis may
result from repeated acute attacks or from infection in small adenoid remnants.
The main symptom is postnasal catarrh which is got rid of by hawking or by
snorting in young children, and the secretion is seen to hang down behind the
soft palate as tenacious mucopus. Treatment consists of removal of the
infected adenoids or adenoid remnants.

Adenoid hypertrophy. The enlargement may be simple or inflammatory, and
the symptoms may be referable to hypertrophy, to infection or to both.

SYMPTOMS. Symptoms due to hypertrophy are produced, not from the actual
size of the lymphoid mass, but from the relative disproportion in size between
the adenoids and the cavity of the nasopharynx. This leads to nasal obstruction,
which manifests itself in the following ways:

1. In infants enlarged adenoids may interfere with feeding because the baby
has to stop sucking intermittently in order to take a breath. This makes
feeding a wearisome process for both mother and child. The infant tires easily,
takes insufficient food and fails to thrive. It may also have noisy respirations
and a wet bubbly nose. Removal of even a small mass of adenoid tissue in such
a case is often sufficient to result in an immediate improvement.