Relative Etiological Importance of Adenoid Hypertrophy Versus Sinusitis in Children with Persistent Rhinorrhoea

Abstract

Persistent rhinorrhoea is a common, yet often neglected, problem among Indian children. This study was designed to evaluate the relative etiological importance of adenoid hypertrophy versus sinusitis in children with persistent rhinorrhea. Additionally, the association between S. pneumoniae colonization and adenoid hypertrophy was studied. Children aged 1-14 years with persistent rhinorrhea underwent clinical evaluation, rigid nasal endoscopy and xrays of the nasopharynx and paranasal sinuses to ascertain the presence of adenoid hypertrophy and sinusitis using standard criteria. Nasopharyngeal swabbing to ascertain the presence of nasopharyngeal colonization with S. pneumoniae was also performed. Adenoid hypertrophy was more consistently associated with persistent rhinorrhea than sinusitis (p \ 0.0001). Coincident adenoid hypertrophy and sinusitis occurred in 57 %. S. pneumoniae was cultured in only 29 % of children. Up to 47 % of patients had features of nasal allergy. There was no association between S. pneumoniae colonization and adenoid hypertrophy (p = 0.1). Adenoid hypertrophy is an important cause of persistent rhinorrhea in children. Measures to evaluate for and treat adenoid hypertrophy should be instituted early to alleviate the problem of persistent rhinorrhoea in children. S. pneumoniae colonization of the nasopharynx is not a major etiological factor for persistent rhinorrhoea in these children. Nasal allergy may be a cause of adenoid hypertrophy in roughly half the children.

Adenoidectomy May Not Be Effective to Reduce the Number of Hospital Visits for Sinusitis

“… 8 14 Additionally, the effect of adenoid for sinusitis may be secondary to mechanical obstruction of the nasopharynx. 4 Therefore, some authors suggested that adenoidectomy should be performed to remove mechanical obstruction of the nasopharynx or infection focus in chronic or recurrent sinusitis patients. 13 14 19 However, they had some limitations due to small participant size, 13 19 significant follow up loss, 19 and lack of investigation about subjective sinusitis symptoms.…”

“… 3 The adenoids are known to cause either mechanical obstruction or stasis of secretions or may be a nidus causing repeated episodes of upper respiratory infection. 4 Additionally, the adenoid can serve as a reservoir of pathogenic bacteria and recurrent or persistent adenoiditis is associated with common diseases of neighboring structures including sinusitis. 5 In many children, adenoid hypertrophy and sinusitis are known to coexist.…”