Year : 2021 Month : September Volume : 10 Issue : 36 Page : 3199-3201

Adenoid Hypertrophy with Deviated Nasal Septum in Young Adults

 

Shweta Anand1, Mahesh Virupakshi Kattimani2

1, 2 Department of ENT, NIMS Medical College, Jaipur, Rajasthan, India.

CORRESPONDING AUTHOR

Dr. Mahesh Virupakshi Kattimani, # 252, F-1, Metroprime -3, Apartments, Manyawas, Jaipur, Rajasthan, India.
Email : magz0705@gmail.com

INTRODUCTION

Adenoid hypertrophy is a common cause of nasal obstruction in children but relatively uncommon in adults, however adenoid hypertrophy in young adults is thought to be a persistence of untreated adenoid hypertrophy of childhood. This case series also notes that adenoid hypertrophy can be associated with deviated nasal septum. Coblation assisted endoscopic adenoidectomy usually has good result in adenoid clearance. Hence, routine endoscopic examination of nasopharynx helps in early diagnosis of adenoid hypertrophy and subsequent better management in young adults with complaints of nasal blockage.

Nasopharyngeal vegetations were earlier described by Wilhelm Meyer in 1870 as forming part of Waldeyer’s ring of lymphoid tissue and he coined the term ‘adenoid’ to describe the same. In younger children, it has been thought that the adenoids may have an important role in development of an immunological memory.Physiologically it has been considered that hypertrophy of adenoid tissue occurs during 6 - 10 years and tend to regress and atrophy at 16 years.

Grading of adenoid hypertrophy as described by Clemens et al. is as follows.1

  • Grade I: adenoid tissue filling 1/3rd. of the vertical height of choana.

  • Grade II: adenoid tissue filling up to 2/3rd of the vertical height of choana.

  • Grade III: from 2/3rd to nearly all but not completely filling the choana.

  • Grade IV: complete choanal obstruction

We present three cases of adenoid hypertrophy with deviated nasal septums in adults who visited ENT outpatient department (OPD) at National Institute of Medical Sciences, Jaipur during COVID era of January 2021 to April 2021.

PRESENTATION OF CASE

Case 1

A 20 year female presented with complaints of bilateral nasal obstruction, left nasal obstruction worse than right, mouth breathing and snoring since childhood. There was no history of fever, nasal discharge and nasal bleeding.

A diagnostic nasal endoscopic examination revealed left sided septal spur and septal deviation with right sided inferior turbinate hypertrophy and a grade 3 adenoid hypertrophy.

Other findings on clinical examination were high arched palate, grade 1 tonsillar hypertrophy and retracted tympanic membrane. Reverse transcriptase polymerase chain reaction (RT PCR) of COVID-19 and other routine investigations were done and patient underwent coblation adenoidectomy with endoscopic septoplasty under general anaesthesia.

 

Case 2

A 17 year old male presented with bilateral nasal obstruction, worse on the right side and mouth breathing since childhood. There was history of bilateral aural fullness for 2 years on and off. There was no history of nasal discharge or ear discharge.

On endoscopic examination, right sided nasal septal deviation was noted with grade 3 adenoid hypertrophy. Ear examination revealed bilateral retracted tympanic membrane. RT PCR of COVID 19 was negative and other routine preoperative investigations were within normal limits. Patient underwent coblation adenoidectomy and endoscopic septoplasty.

 

 

Case 3

An 18 year old male presented with history of bilateral nasal obstruction however nasal obstruction was more on left side than the right side. A nasal endoscopic examination revealed. Grade 4 adenoid hypertrophy and a sharp left sided septal spur. Oral cavity examination revealed high arched palate.

The patient tested negative for COVID 19 and was fit for surgery as per pre-operative investigations. Coblation adenoidectomy with endoscopic septoplasty completely relieved the nasal obstruction symptom