Managing Adenoid Hypertrophy: A Homoeopathic Approach

Abstract

Upper respiratory tract infections in children are a constant menace worldwide. Adenoid enlargement and its subsequent complications particularly affect the paediatric population and its prevalence is significantly high. Adenoids are enlarged due to infectious or non-infectious causes, but surely cause feeding difficulties, nasal discharge, mild to severe nasal obstruction and its related facial features that one can recognise without much difficulty. Treating the severe cases of adenoid hypertrophy is almost always surgical, but when the scenario is not much severe, homoeopathy has enough to offer to manage and alleviate the difficulties caused due to the hypertrophy. This article explores the role of homoeopathy in managing adenoid hypertrophy, focusing on its holistic principles and individualised treatment strategies.

Keywords Adenoid Hypertrophy; Homoeopathy; Paediatrics; Rubrics; 

Introduction 

Adenoids are small lumps of tissue located at the back of the nose, above the roof of the mouth. They are part of the immune system and protect us from infections caused by bacteria and viruses. Adenoids are present only in children, growing from birth and reaching their largest size around 3-5 years of age. By the age of 7-8, they begin to shrink, and by late adolescence, they are usually no longer visible, having disappeared completely by adulthood.

Anatomy and Physiology Of Adenoids

The adenoids are lymphoid tissues beneath the mucous membrane at the junction of the roof and posterior wall of the nasopharynx and it plays a vital role in the immune system, particularly in early life. They develop during the 12th to 14th week of gestation and are characterized by a quadrilateral shape with rounded edges. The adenoids have a surface area expanded by folds, which are lined with pseudostratified ciliated columnar epithelium. This surface epithelium is essential for immune responses, and the adenoids contain lymphoid follicles composed of B cells, T cells, and dendritic cells.

These lymphoid follicles are embedded in mucosal folds and include crypts lined by stratified squamous and reticulated epithelium. The adenoids are involved in the first line of immune defence against inhaled and ingested antigens by housing lymphocytes, plasma cells, macrophages, and dendritic cells.

Key immune cells include B cells, which produce antibodies; T cells, which are divided into cytotoxic and helper types; and natural killer (NK) cells, which target abnormal cells. The adenoids, along with other lymphoid tissues in the nasopharynx, are part of the nasal-associated lymphoid tissue (NALT) system. 

Etiology

It is broadly categorized into infectious and non-infectious causes

Infectious causes:

• Viral pathogens: Adenoid hypertrophy can result from infections by viruses such as Adenovirus, Coronavirus, Coxsackievirus, Cytomegalovirus (CMV), Epstein-Barr virus (EBV), Herpes simplex virus (HSV), Parainfluenza virus, and Rhinovirus.
• Bacterial pathogens: Both aerobic bacteria (e.g., alpha-, beta-, and gamma-hemolytic Streptococcus species, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, Corynebacterium diphtheria, Mycoplasma pneumoniae) and anaerobic bacteria (e.g., Fusobacterium, Peptostreptococcus, Prevotella species) can contribute to adenoid hypertrophy.

Non-infectious causes

• Gastroesophageal reflux: Acid reflux can irritate the adenoid tissue.
• Allergies: Allergic reactions can lead to inflammation and hypertrophy.
• Exposure to cigarette smoke: Smoke exposure can cause chronic irritation and enlargement of the adenoids. 
• In adults, adenoid hypertrophy may be associated with more serious conditions such as HIV infection, lymphoma, or sino-nasal malignancy. [3]

Epidemiology

Adenoid hypertrophy is more prevalent in children than in adults, primarily because the adenoids naturally shrink and regress during adolescence. According to a recent meta-analysis, the prevalence of adenoid hypertrophy among children and adolescents is approximately 34.46%. [3] A prevalence of 83.87% and 79.03% was seen based on the clinical and radiological findings respectively. 4

Clinical Features

The clinical features and symptoms of hypertrophied adenoids can be categorized into those due to hypertrophy and those due to infection:

Symptoms due to Hypertrophy 

• In Infants:

• Difficulty feeding due to intermittent pauses for breathing.
• Increased fatigue, insufficient food intake, and failure to thrive
• Noisy respiration and a wet, bubbly nasal sound.

1. In Older Children:

• Nasal obstruction leading to mouth breathing.[5]
• Obstructive sleep apnea exists in 1–4% of children and can occur in children of all ages, from neonates to adolescents, with a peak prevalence around 2–8 years.[6]
• Voice changes to a nasal tone.
• Nasal discharge caused by mechanical obstruction and secondary chronic rhinitis.

1. Adenoid Facies

• Elongated face with a dull expression.
• Open mouth and prominent, crowded upper teeth.
• Pinched nose appearance due to atrophy of the alae nasi.
• Highly arched hard palate due to loss of tongue molding action.

1. Aprosexia: Difficulty concentrating.

Symptoms due to Infection

1. Nasal Discharge – Purulent discharge from rhinitis and sinusitis. 
2. Epistaxis– Nosebleeds due to infection.
3. Throat Issues: Recurrent upper respiratory tract infections, including post-nasal discharge, pharyngitis, tonsillitis, and cough.[5]
4. Ear Problems: Recurrent Eustachian tube inflammation, acute otitis media, and chronic otitis media. Proximity of the adenoids in the nasopharynx with the middle ear and the eustachian tube predisposes the child to otitis media as a result of mechanical obstruction. Local inflammation and mucosal edema as a result of regional spread of a bacterial biofilm leading to eustachian tube dysfunction and development of otitis media.[5]
5. Lymphadenitis: Infection of upper deep cervical lymph nodes.
6. Respiratory Issues: Aggravation of bronchial asthma and bronchitis.
7. General Symptoms: Nocturnal enuresis (bedwetting) and night terrors due to suffocation.

Diagnosis

This diagnosis of adenoid hypertrophy is based on clinical features more than examination findings as the adenoid tissue is situated at a place where visualization is difficult. Children majorly present with a stuffy nose, mucopurulent posterior nasal drip, chronic cough and halitosis. They develop a nasal intonation of speech and occasionally snorting occurs as hyperplastic adenoids encroach on the posterior nasal choanae resulting in collection of secretions in the nose.

• X-ray imaging – The simple plain lateral X-ray of the neck is still an excellent tool for screening and identification of the adenoids and based on the percentage of air column available in front of the adenoids, a 25%, 50% or 75% reduction is classified as mild, moderate or severe adenoid hypertrophy respectively. .[6]
• CT Scan– A CT scan not only provides a clearer view of the nasopharynx and adenoids but also defines the type and character of lesions with potential bone destruction, suggesting the presence of a malignant tumour. Additionally, a CT scan proves valuable in diagnosing chronic sinusitis. [7]
• Nasopharyngoscopy– Nasopharyngoscopy examination of the adenoids gives a better estimation of the degree of adenoid hypertrophy. It is graded from adenoids not in contact with adjacent structures (Grade 1) to the most severe where the adenoid tissue is in direct contact with the palate at rest (Grade 4). [6]
• Currently, the mainstream diagnostic methods for detecting adenoid hypertrophy include flexible fibre-optic nasal endoscopy and nasopharyngeal radiological examination (such as lateral cephalography). Nasal endoscopy provides strong evidence for preoperative diagnosis and evaluation of postoperative outcomes. But, nasal endoscopy is a little on the difficult side to perform due to poor child coordination with the physician. This makes lateral cephalography the most commonly used tool for detecting hypertrophied adenoids.
• The most reliable is based on calculating the adenoid-to-nasopharyngeal (AN) ratio. It is the ratio between the measurement of the adenoid tissue (defined by the distance between the basiocciput region and the most convex part of the adenoid pad) and the nasopharyngeal aperture (defined by the distance between the spheno basiocciput and the posterior edge of the hard palate). [8]

Differential Diagnosis 

1. Palatine Tonsil Hyperplasia: Characterized by enlarged tonsils that can obstruct the airway, often leading to difficulty breathing, especially during sleep.
2. Incomplete Choanal Atresia: A congenital condition where the choanae (the passageway at the back of the nose) are obstructed, leading to respiratory distress in infants and possible nasal congestion in older children.
3. Endonasal Foreign Bodies: These can cause nasal obstruction, discharge, and sometimes infection, especially in younger children who are more prone to inserting objects into their noses.
4. Nasal Concha Hyperplasia: Enlargement of the nasal conchae (turbinates) can obstruct airflow and cause nasal congestion and breathing difficulties.
5. Infectious or Allergic Rhinitis: These conditions cause nasal congestion, discharge, and sneezing due to inflammation and irritation of the nasal mucosa.
6. Neoplasms: Both benign and malignant tumors should be considered, particularly in patients with persistent symptoms despite treatment
7. Carcinoma and Lymphoma: In adults, malignancies may present with symptoms such as nasal obstruction, bleeding, ulceration, and conductive hearing loss. Carcinomas and lymphomas can also be associated with abnormal growths and slimy coatings.

Repertory

• BOERICKE- EARS- DEAFNESS hardness of hearing; Cause: Adenoids and Hypertrophied tonsils 

Agra Aur Bar-c Calc-p Merc Nit-ac Staph

1. BOERICKE- THROAT- ADEONOID VEGETATIONS

Agra Bar-c Calc Calc-f Calc-I Calc-p Chr-ac Iod Kali-s Lob-s Mez

Psor Sang-n Sulph Thuj

1. PHATAK- ADENOIDS 

Agra Calc Calc-I Calc-p Iod Merc Tub

1. PHATAK- ADENOIDS- Post nasal

Mez

• SYNTHESIS- NOSE ADENOIDS [11]

Agra Bac Bar-c Bar-I Bar-m Calc Calc-f Calc-I Calc-p Carc Chr-ac

Gonotox Iod Kali-s Lob-s Merc Mez Mucor Nat-m Osm Phos

Psor Sang-n Spig Staph Sulph Syc Thuj Tub

• SYNTHESIS- NOSE ADENOIDS Children in

Carc Syc Tub

• SYNTHESIS- NOSE ADENOIDS Swelling

Calc-f

• SYNTHESIS- NOSE ADENOIDS Posterior nares 

Mez 

• SYNTHESIS- HEARING-IMPAIRED Adenoids from

Staph

• SYNTHESIS- RESPIRATION SNORING children in

Chin Dros Dulc Mez Op

• SYNTHESIS- RESPIRATION SNORING sleep during children in

Chin

Homoeopathic Management

• Agraphis Nutans

Catarrhal conditions; obstruction of nostrils. Adenoids throat deafness. Enlarged tonsils; Throat and ear troubles with tendency to free discharges from mucous membranes. 

• Bacillinum

Constant disposition to take cold; Indicated in children with consumptive family history; Glands of the neck are enlarged and tender; Useful as an intercurrent remedy [13]

• Baryta Carb

Chronic enlargement and suppuration of tonsils < after slight cold or following suppressed foot sweat. Especially suitable for old people dwarfs scrofulous children especially those who have swelling and inflammations acute or chronic from least cold.[14] The inflammation is more likely to turn into an increased infiltration. [15]

• Calcarea Carb

Swelling of tonsils, difficulty in swallowing. Stoppage of nose in morning, on rising; Offensive odour of the nose as from eggs; Takes cold at every change of weather; [12]

1. Calcarea Phosphoricum

Swollen tonsils cannot open mouth without pain; Adenoid growths; Numbness and crawling are characteristic sensations and tendency to perspiration and glandular enlargement are symptoms it shares with Calcarea carb [12]

• Thuja 

Swelling of throat and tonsils. Painful swallowing, especially empty swallowing, or that of saliva; Accumulation of mucus in posterior nares; Chronic catarrh after measles; Smell in nose as from brine of fish or of fermenting beer. [16]

• Tuberculinum

Tuberculinum can be given in 10M, 50M and 100M potencies, two doses of each potency at long intervals, all children and young pupils who have inherited tuberculosis may be immuned from their inheritance and their resiliency will be restored. It cures most cases of adenoids and tuberculous glands of the neck. [15]

References

1. Huse M, Padale P. Homeopatic Approach for Enlarged Adenoids in Children: A Review. Journal of Medical and Pharmaceutical Innovation. 2019 Nov 16;6(32
2. Niedzielski A, Chmielik LP, Mielnik-Niedzielska G, Kasprzyk A, Bogusławska J. Adenoid hypertrophy in children: a narrative review of pathogenesis and clinical relevance. BMJ Paediatr Open. 2023 Apr;7(1):e001710. doi: 10.1136/bmjpo-2022-001710. PMID: 37045541; PMCID: PMC10106074
3. Geiger Z, Gupta N. Adenoid Hypertrophy. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536984/
4. Kondekar S, Phatale S, Arickatt T,SoniA, Proposed clinical and radiological grading system in pediatric adenoid hypertrophy. Journal of the Pediatric Association of India [Internet].2020 Jan 1;9(4):146. Available from: https:// doi.org/10.4103/jpai.jpai_19_21
5. Dr. V Rekha. Homeopathic management of adenoids: A review. Int J Hom Sci 2021;5(3):05-08. DOI: 10.33545/26164485.2021.v5.i3a.394
6. Gupta Piyush, Menon PSN, Ramji Siddarth and Lodha Rakesh, PG Textbook of Pediatrics, Volume 2, 1st edition, ISBN: 978-93-5152-955-2, New Delhi: Jaypee Brothers Medical Publishers (p) Ltd. 2015Ghai O.P., Essentials Pediatrics, 6th Edition, 16  A, Narainall, New Delhi
7. Tonpe S, Warbhe H, Banode P, Gandham S, Nagendra V. The Diagnostic Value of CT Scan in Identifying Adenoid Hypertrophy in Adults: A Case Report. Cureus. 2024 Jun 20;16(6):e62793. doi: 10.7759/cureus.62793. PMID: 39040788; PMCID: PMC11260661. 
8. Z. He, Y. Xiao, X. Wu, Y. Liang, Y. Zhou and G. An, “An Automatic Assessment Model of Adenoid Hypertrophy in MRI Images Based on Deep Convolutional Neural Networks,” in IEEE Access, vol. 11, pp. 106516-106527, 2023, doi: 10.1109/ACCESS.2023.3316689 
9. Ahmad Z, Krüger K, Lautermann J, Lippert B, Tenenbaum T, Tigges M, Tisch M. Adenoid hypertrophy-​diagnosis and treatment: the new S2k guideline. HNO. 2023 Aug;71(Suppl 1):67-72. doi: 10.1007/s00106-023-01299-6. Epub 2023 Jul 25. PMID: 37491540; PMCID: PMC10409824
10. HOMPATH FIREFLY 
11. SYNTHESIS REPERTORY
12. Boericke, W. Pocket Manual of Homoeopathic Materia Medica & Repertory (Second Revised and Reaugmented edition). B Jain Publishers 2000.
13. Phatak SR. Materia Medica of Homoeopathic Medicines: Revised and Enlarged Edition. New Delhi, India: B Jain; 2003. p. 87-88, 467, 471, 601, 605, 639-640, 644, 675-676, 681-682.
14. Nash EB, Leaders in Homoeopathic Therapeutics with grouping and classification, 5th edition, B Jain Publishers, 2002
15. Kent JT, Lectures on Homoeopathic Materia Medica, B Jain Publishers, 2016.
16. John Henry Clarke, A Dictionary of Practical Materia Medica, 22nd edition, B Jain Publishers, 2015

Author 
Dr Bhuresingh Patel

MD Scholar, Department of Paediatrics, Government Homoeopathic Medical College and Hospital, Bhopal, Madhya Pradesh

Guide – Dr J P Tripathi

Associate Professor, Department of Forensic Medicine and Toxicology, Government Homoeopathic Medical College and Hospital, Bhopal, Madhya Pradesh

Head of the Department – Dr Ajay Singh Parihar

Professor and HOD, Department of Paediatrics, Government Homoeopathic Medical College and Hospital, Bhopal, Madhya Pradesh