Conventional curettage adenoidectomy versus endoscopic assisted adenoidectomy.

An adenoidectomy is the surgical treat ment that consists in the removal of hypertrophied lymphatic tissue (Lushka’s pharyngeal tonsil), which blocks the rhinopharynx, behind the nose. Hypertrophy is the result of an abnormal development of the lymphatic follicles either from birth or as a result of repeated infections of the upper respiratory tract. Hypertrophy, in its turn, favors recurrent infections, blocked nose, rhinitis, rhinosinusitis, tonsillitis, recurrent otitis, laryngitis and bronchitis. Subjective manifestations are dominated by chronic nasal obstruction, which make the child breathe with an open mouth, snore during sleep, and sometimes eat with difficulty. A characteristic is also the alteration of the voice, which may become “nasal” and the decrease of the auditory function due to recurrent otitis A positive diagnosis entails a correlation between symptomatology and an endoscopic exam of the nose and behind the nose (showing a significant growth in volume of the lymphatic tissue in the rhinopharynx); an oto-microscopic exam and an audiogram are always necessary to evaluate the morphology of the tympanum and the auditory function. The hypertrophic adenoid tissue blocking the Eustachian tube opening in the rhinopharynx may affect the latter. Correct nasal breathing and proper Eustachian tube ventilation influence the growth and development of the child in a decisive manner. A differential diagnosis must be performed with all other causes of a nasal and rhinopharyngeal obstruction: Choanal atresia (newborn and infant) Chronic hypertrophic rhinitis, septal deviation, nasal polyposis (older children) Juvenile angiofibroma (during puberty-for boys) Tornwald’s Cyst , chordoma, malignant lymphoma, lymphoepitelial carcinoma, and the hypertrophy of the pharyngeal tonsil during HIV infection (in adults). Sometimes, a tissue sample under endoscopic control is necessary in order to establish a positive diagnosis.