Enlarged adenoids - How to diagnose?

So, you have noticed one or more signs in your child. How can you confirm or rule out the diagnosis? You might ask, 'Is an X-ray of the nasopharynx in the lateral projection the best option?' Not really! Today, this method is recognized as obsolete and should only be used when endoscopy is impossible.

In X-rays, bone structures are clearly visible, but the nasopharyngeal tonsil is a soft tissue. What we observe on the X-ray is essentially a shadow of the adenoids. Furthermore, since lymphoid tissue is often concealed by mucopurulent discharge, this can lead to a misleading interpretation of the X-ray image. Additionally, when performing radiography in the naso-chin projection, a child's mouth is kept wide open, whereas the anatomical lumen of the nasopharynx narrows. As a result, the adenoids may appear larger in relation to this narrowed space.

The gold standard for the diagnosis of adenoid hypertrophy is an endoscopic investigation of the nasal cavity and nasopharynx.

For children, endoscopy is performed using a flexible endoscope with a diameter of up to 1 cm. The procedure is painless and typically takes less than 1 minute. However, it's important to consider that children may feel frightened and uncomfortable when undergoing endoscopy, leading some of them to cry or resist the procedure. In such cases, it's reassuring for the child to have the loving support of their parents, who may need to hold them briefly.

To provide a better understanding of the value of endoscopic examination, let me explain its benefits:

1. We can accurately assess the true size of the adenoids

2. We can identify the presence or absence of discharge, including its colour, consistency, and its source.

3. We are able to visualize the openings of the auditory tubes, assess the adenoid-to-auditory tube ratio, and detect the presence of discharge. This is particularly valuable when determining the cause of recurrent otitis media in children.

4. We can analyse the structure of the adenoid tissue, including its density and smoothness. This information allows us to make informed predictions about the potential effectiveness of conservative treatment. In other words, it helps us determine whether therapeutic treatment is advisable or if adenoid removal is necessary.