DISEASES OF NASOPHARYNX

DR.AARYA SERIN

ADENOIDS Adenoids are also called as

nasopharyngeal tonsil Situated at junction of the roof and

posterior wall of the nasopharynx Composed of vertical ridges of lymphoid

tissue separated by deep clefts and covered by ciliated columnar epithelium

Adenoids have no crypts and no capsule unlike palatine tonsil

consists of B and T-lymphocytes

DEVELOPMENT Development starts at 16th week of intra-

uterine life Clinically not present at 1st month after

birth Adenoids are identifiable by 4th month-2

yrs Hypertrophy/hyperplasia starts at 3-5

years of age Involutes at puberty and almost

completely disappears by the age of 20.

CLINICAL IMPORTANCE 1ST month after birth any mass in

nasopharynx – Encephalocoele should be suspected

Absence or decrease in size of adenoids at 4months-2years hypogammaglobenemia / wiskot-aldrich syndrome should be suspected

Ectopic hypophysis-remnant rathke’s pouchchronophil adenoma in females after 50 years

BLOOD SUPPLY

Ascending palatine branch of facial. Ascending pharyngeal branch of external

carotid. Pharyngeal branch of the third part of

maxillary artery. Ascending cervical branch of inferior thyroid

artery of thyrocervical trunk.

Lymphatics from the adenoid drain into upper jugular nodes directly or indirectly via retropharyngeal and parapharyngeal nodes

ADENOID HYPERPLASIA / ADENOIDITIS - ETIOLOGY

Physiological enlargement 3-5 years of age (some children develop generalized lymphoid hyperplasia)

Recurrent attacks of rhinitis, sinusitis, tonsillitis Allergy of upper respiratory tract

CLINICAL FEATURES

NASAL SYMPTOMS Nasal obstruction Nasal discharge Sinusitis (commonly chronic maxillary

sinusitis) Epistaxis Voice change

CLINICAL FEATURES

EAR COMPLAINTS

Tubal obstruction Recurrent attacks of acute otitis media Chronic suppurative otitis media and

serous otitis media

CLINICAL FEATURES

Adenoid facies: elongated face with dull expression, open mouth, prominent and crowded teeth, hitched up upper lip, pinched in appearance of nose, high arched palate

Pulmonary hypertension / cor-pulmonaleAprosexia, i.e. lack of concentration

DIAGNOSIS Posterior rhinoscopic examination difficult

to perform in children Rigid or flexible nasopharyngoscopy X-ray lateral view of the nasopharynx Detailed nasal examination to be

conducted to rule out other causes of nasal obstruction

TREATMENT When symptoms are not marked

breathing exercises, decongestant nasal drops, antihistaminics, antibiotics can be used

When symptoms are marked adenoidectomy is done

ACUTE NASOPHARYNGITIS Etiology: may be due to isolated infection

or secondary to generalized upper respiratory tract infection

Viruses: influenza, para-influenza, rhino virus, adeno virus

Bacteria: streptococci, pneumococcus, haemophilus influenzae

CLINICAL FEATURES

Dryness and burning sensation of the throat above soft palate

Pain and discomfort localized to the back of nose with some difficulty in swallowing

In severe infections there is fever and enlarged cervical lymph nodes

Examination reveals congested and swollen mucosa often covered with whitish exudate

TREATMENT

Mild cases: spontaneous recovery seen. Analgesics may be used to relieve pain

Severe cases require systemic antibiotics

If associated with adenoids topical decongestant drops can be used

CHRONIC NASOPHARYNGITIS

Etiology : associated with chronic infections of nose, paranasal sinuses and pharynx

Commonly seen in heavy smokers, drinkers and those exposed to dust and fumes

CLINICAL FEATURES

postnasal discharge with irritation at the back of the nose is most common complaint

Patient will have consistent desire to clear throat by hawking or inspiratory snorting

Examination of nasopharynx reveals congested mucosa and mucopus or dry crusts

In children adenoids are often enlarged and infected

TREATMENT chronic infections of the nose,

paranasal sinuses and oropharynx should be treated

Smoking and drinking should be stopped

Avoid dust and fumes Alkaline nasal douche to remove crusts

and mucopus Steam inhalation

THORNWALDT’S DISEASE(PHARYNGEAL BURSITIS)

It is infection of pharyngeal bursa which is a median recess representing attachment of notochord to endoderm of primitive pharynx

It is located in the posterior wall of nasopharynx in the adenoid mass

CLINICAL FEATURES Persistent post nasal discharge with

crusting in nasopharynx Nasal obstruction Tubal obstruction and resulting serous

otitis media Dull type of occipital headache Recurrent sore throat Low grade fever

Examination reveals a cystic and fluctuant swelling in posterior wall of nasopharynx

TREATMENT

Antibiotics Marsupialisation of cystic swelling and

adequate removal of its lining membrane