Adenoid Hypertrophy Flashcards
A case of adenoid hypertrophy
Case: Abba is a 5 year old boy who presented with excessive snoring during sleep, difficulty sleeping at night and mouth breathing. He was diagnosed with adenoid hypertrophy. Counsel his mother on his condition.
- GREET + Quick biodata + LCCC
GRIP (greet, create rapport, introduce, seek permission)
Greet: Good morning Sir/ma, Rapport: How are you today?
Introduce: My name is ***** and for the purpose of this exam I will like to talk to you about your child’s condition
Permission: May I go ahead?
Quick biodata: Just to confirm, What is your name? How old are you? What’s your highest level of education? What is your relationship with child?
Name of the child
Age
Class
LCCC
Tell
Definition, epidemiology, causes and clinical features
Adenoids hypertrophy means enlargement of the adenoids. The adenoids are small patches of tissue located at the back of the nasal cavity, above the roof of the mouth.
Adenoids are present at birth, they grow until a child is between the age of 3 and 5 and begin to shrink. Around age 7, as other organs take up the function of the immunity in the child, it disappears at about 16.
Functions: they are part of the immune system. Made of lymphoid tissue that fight infection during early years of a child . They protect infants from infection by trapping germs ( bacteria and viruses) that enter the body through the nose or mouth
Epidemiology: it occurs in 10 to 30% of children. Occurs mostly in children under 5 yrs of age. Not age or gender specific.
Causes:
It becomes enlarged when upper respiratory tract infection occurs eg tonsility,sore throat, ear infection etc , they return to their normal size when infection is gone, in some patients it remains enlarged even when infection is gone. Allergy can cause it to enlarge too.
Clinical features
Mouth breathing
Pause in breathing during sleep (sleep apnea)
Swollen gland in neck
Difficulty swallowing
Ear problem
Snoring
Sore throat
Complications, diagnosis and treatment
Complications
Recurrent infection
Enlarged heart due to recurrent infection
Increase sleep during the day as the child finds it difficult to sleep at night
Weakness and fatigue
Poor growth cus all energy is spent on fighting infections instead of growth
However I am glad you are here, we will manage your child adequately to prevent these complications
Diagnosis
Clinical Diagnosis
Diagnostic nasa endoscopy ( flexible camera that can view adenoids through the nose)
Posterior rhinoscopyy
CT scan of the nasopharynx
X ray , lateral view of the nasopharyngx
Treatment
Watch waiting to see if it will shrink
Medication: nasal decongestant, antihistamine, nasal spray to help alleviate symptoms associated with nasal congestion
Mometaaone can also be used
Surgery: adenoidectomy
Recommended if medical treatment fails.
Benefits and complications of surgery
Surgery is the definitive treatment, when surgery is done , airway is open for the child to breath properly, sleep and grow well.
Complications
After surgery child might experience sore throat, minor bleeding, blocked nose. However, this will resolve in few days .
Empathy and Help
Fortunately the adenoids are not an essential part of the immune system, thus their removal poses no threat to the child immune system function
Prognosis is excellent, no risk for regrowth
Retell
Do you understand all that I have said
Do you have any questions for me
Can you retell what you understand in your own words
Can you proceed with the surgery. If yes
Kindly sign this consent form that u agree to the surgery
We will see you in one week for a follow up visit
Thank you ma
Thank examiner
A 6 years old child was admitted into the ward with a history of;
-Recurrent mouth breathing.
-Excessive sleepiness in school.
-Poor growth.
Past medical history revealed patient has severally been in and out of the hospital on account of what mother described as “serious cough and difficulty in breathing”.
Physical examination reveals: Cardiomegaly with apex beat at 6th LICS mid axillary line. Liver size is normal.
Counsel this family on the clinical condition and definitive treatment.
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