Adenoid Hypertrophy and Eustachian Tube Dysfunction: Implications in Middle Ear Surgery

Pathologic hyperplasia of the pharyngeal tonsils, known as adenoid hypertrophy, is linked to mechanical obstruction and/or chronic inflammatory processes in the nasopharynx. Considering that adenoids naturally decrease in size during adolescence, adenoid diseases and related pathological conditions most frequently affect children between one and six years of age. Adenoid hypertrophy may result in several local and systemic conditions, and for this reason, it should be diagnosed when symptoms of mechanical obstruction and/or chronic inflammation in the nasopharynx are clear. Adenoid hypertrophy can involve the Eustachian tube, resulting in its dysfunction. Persistent dysfunction of the Eustachian tube may contribute to a range of middle ear conditions, including conductive hearing loss, tympanic retraction, cholesteatoma, and recurrent episodes of acute otitis media. Conservative management (watchful waiting, topical steroids, anti-allergic treatment etc.) is an option for patients with adenoid hyperplasia without other signs and symptoms. When conservative management is not successful, The American Academy of Otolaryngology–Head and Neck Surgery recommends surgery. The purpose of this chapter is to explore the implications of adenoid hypertrophy and Eustachian tube dysfunction in middle ear surgery.