Endoscopy in Nasopharyngeal Adenoid Surgery

Adenoid diseases include acute adenoiditis, recurrent acute adenoiditis, chronic adenoiditis, and obstructive adenoid hyperplasia. The latter, that constitutes a triad of symptoms including chronic nasal obstruction (with snoring and obligate oral breathing), nasal discharge, and nasal intonation of voice, is the most common cause necessitating surgical intervention. Differentiating adenoid infection from that of the sinuses may be challenging due to similarity of signs and symptoms, and the high incidence of coexistence of both diseases adds to the dilemma, as one may even lead to the other. An additional factor that has been recently recognized is the effect of extraesophageal reflux disease and its role in inducing both adenoid and sinus infection, when this is identified and treated, and treatment fails, surgery should intervene, usually adenoidectomy, putting in mind that the associated sinus affection may take a few weeks to months to clear out. The diagnosis of adenoid hyperplasia and hypertrophy needing surgery is best achieved by both history and physical examination, the aforementioned triad of symptoms is quite nonspecific, as it may be present in other conditions, as allergic rhinitis, non allergic rhinitis, sinusitis, and reflux esophagitis. The physical examination should guide to the possible disease, and indicate if further investigations are needed. The classic “adenoid facies” appearance, luckily enough, is rarely seen now, as both the parents and physicians diagnose and treat such conditions early enough to avoid such drastic affection of prolonged nasal obstruction. One of the important investigations that are frequently needed is a sleep study, and a variety of tests are used according to need and facilities, starting from simple overnight oximetry, to a full sleep laboratory test, but these are used only in cases where more severe conditions are suspected, such as in cases of resistant nocturnal enuresis without definite history or physical findings of obstructive condition. When the condition is also not clear cut, a CT scan of the nasopharynx and sinuses may be done. It is the authors personal experience that for symptoms of nasal obstruction to occur in the very young child (below one year of age), to be attributed to simple adenoid hypertrophy, and to be severe enough to need surgery, a lateral radiograph of the nasopharynx would not suffice, but a CT scan should be done to exclude other more serious conditions that can cause nasal obstruction, as –and not restricted tomeningeocles, encephaloceles, dermoid cysts, and