This lateral pharyngeal X ray was done for a 5 year old child who was brought to a pediatrician with the complaints of snoring, recurrent respiratory infections and chronic suppurative otitis media and peculiar facies.
What Is the most likely Diagnosis?
Lateral pharyngeal X-ray reveals obliteration of nasopharyngeal air column and adenoidal hypertrophy. All these features along with this X-ray are very much suggestive of enlarged adenoids in this child. Digital palpation or indirect visualization by pharyngeal mirror in older children helps in the diagnosis of this condition.
Case Discussion:
Clinical Features: Enlarged Adenoids in children is characterized by
- mouth breathing (especially in the supine position),
- snoring,
- persistent rhinitis,
- chronic suppurative otitis media,
- nasal speech,
- halitosis,
- night cough,
- impaired hearing and
- adenoid facies.
Enlargement of adenoids can block the nasal passages causing snoring, breathing through mouth and nasal voice due to blocking of the secretions in the nose.
It can result in nasal infections (rhinitis) which can traverse to middle ear too.
They may present with features of sleep apnea. If the apnea is more than 10 seconds despite the respiratory effort, it is regarded to be significant.
Sleep apnea syndrome is diagnosed when 30 or more apneic episodes occur during seven hours sleep period. It would ultimately lead to somnolence, physical and behavioral problems and Cor pulmonale lastly.
Diagnosis of sleep apnea syndrome is confirmed by Polysomnography.
Management: Adenotonsillectomy cures the condition in many children.
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