Understanding and Managing Adenotonsillar Hypertrophy in Pediatric Otolaryngology

Authors

  • Ivry Zagury-Orly, MD, MMSc Division of Otolaryngology—Head and Neck Surgery, McMaster University, Hamilton, ON
  • Jonathan MacLean, MD Division of Otolaryngology—Head and Neck Surgery, McMaster University, Hamilton, ON

DOI:

https://doi.org/10.58931/cait.2024.4267

Abstract

Adenotonsillar hypertrophy (ATH) is a common pediatric condition marked by the growth of lymphoid tissues within the Waldeyer’s ring, which includes adenoids, palatine tonsils, and lingual tonsils. These tissues surround the upper airway and food passage, and play an immunological role, enlarging until about age 12, before gradually reducing during adolescence and adulthood.

Untreated or poorly managed ATH can severely impact multiple health aspects of children. It is the primary cause of upper airway obstruction and obstructive sleep apnea (OSA) syndrome in children, which disrupts sleep and can severely impair cognitive development, school performance and behaviour. Chronic mouth breathing from ATH can alter dental arches and facial growth, known as adenoid facies. More severe outcomes include increased pulmonary pressures and the potential development of pulmonary hypertension and cor pulmonale due to chronic hypoxia and CO2 retention.

As a result, tonsillectomy, with or without adenoidectomy (T&A), has become one of the most frequently performed surgeries in North America, with over 530,000 operations performed annually on children under age 15. This paper discusses the significant impact of ATH on pediatric health and the frequent need for surgical intervention. It covers the immunophysiology, influence of atopy, community-based assessments prior to specialist referrals, and an overview of available medical and surgical treatment options. Additionally, it outlines general indications for referring patients to otolaryngology.

Author Biographies

Ivry Zagury-Orly, MD, MMSc, Division of Otolaryngology—Head and Neck Surgery, McMaster University, Hamilton, ON

Dr. Ivry Zagury-Orly is a resident, Division of Otolaryngology—Head and Neck Surgery, McMaster University, Hamilton, Ontario. He completed his medical degree from Université de Montréal, Montreal, Quebec, and obtained a Master’s of Medical Sciences in Medical Education from Harvard University, Boston, Massachusetts. His research interests include medical education, pediatric otolaryngology, and otology.

Jonathan MacLean, MD, Division of Otolaryngology—Head and Neck Surgery, McMaster University, Hamilton, ON

Dr. Jonathan MacLean, is a pediatric otolaryngologist and associate professor, Division of Otolaryngology—Head and Neck Surgery, McMaster University, Hamilton, Ontario. He obtained his medical degree at Dalhousie University, Halifax, Nova Scotia. He then completed his Otolaryngology Head and Neck Surgery residency training at McMaster University in Hamilton, Ontario. He went on to complete a pediatric otolaryngology fellowship at Emory University in Atlanta, Georgia before returning to McMaster. His clinical interests are in pediatric head and neck surgery and pediatric airway disorders.

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Published

2024-09-23

How to Cite

1.
Zagury-Orly I, MacLean J. Understanding and Managing Adenotonsillar Hypertrophy in Pediatric Otolaryngology. Can Allergy Immunol Today [Internet]. 2024 Sep. 23 [cited 2024 Nov. 21];4(2):11–15. Available from: https://canadianallergyandimmunologytoday.com/article/view/4-2-Zagury-Orly_et_al

Issue

Volume 4, Issue 2, Summer 2024

Section

Articles