Adenoiditis

Adenoiditis is an acute or chronic inflammation of the pharyngeal tonsil (adenoids). Unlike hypertrophy, adenoiditis is an active infectious-inflammatory process that is a focus of chronic infection in the nasopharynx.

The acute form of the disease is often called “retronasal tonsillitis.” Chronic adenoiditis, in turn, causes prolonged coughing, runny nose, and frequent respiratory diseases in children, acting as a reservoir for pathogenic flora.

Aetiology and pathophysiology

Acute adenoiditis is caused by viruses (adenoviruses, rhinoviruses) and bacteria, most commonly Streptococcus pneumoniae and Haemophilus influenzae. In chronic form, bacterial biofilms form on the surface of the tonsils, which maintain persistent inflammation and are resistant to standard antibiotic therapy.

Clinical Significance

Acute adenoiditis manifests itself as fever, purulent rhinorrhoea and persistent nighttime coughing due to secretions flowing down the back of the throat. The chronic form is characterised by low-grade fever, constant mucous purulent discharge and frequent complications in the form of otitis and sinusitis.

The diagnosis is confirmed by nasopharyngeal endoscopy, which reveals hyperaemia, swelling and pus on the surface of the adenoids. Treatment of the acute process includes antibiotics (in cases of bacterial aetiology) and local therapy. In cases of chronic adenoiditis that does not respond to conservative treatment, adenotomy is indicated to eliminate the source of infection.

Differential Diagnosis

The key point is differential diagnosis with adenoid hypertrophy without signs of inflammation. In hypertrophy, the main symptom is obstruction, whereas in adenoiditis, signs of an active inflammatory process (purulent secretion, hyperaemia, intoxication) are under the spotlight.