Adenoiditis classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

Adenoiditis may be classified according to duration of symptoms into 3 subtypes: acute adenoiditis, recurrent acute adenoiditis, and chronic/persistant adenoiditis.^[1] Adenoiditis may also be classified according to the responsible pathogen/mechanism of disease into 4 subtypes: viral adenoiditis, bacterial adenoiditis, parasitic adenoiditis, and non-infectious adenoiditis.

Classification

Adenoiditis may be classified according to duration of symptoms into 3 subtypes: acute adenoiditis, recurrent acute adenoiditis, and chronic/persistant adenoiditis.^[1] Adenoiditis may also be classified according to the responsible pathogen/mechanism of disease into 4 subtypes: viral adenoiditis, bacterial adenoiditis, parasitic adenoiditis, and non-infectious adenoiditis.

Adenoiditis classification based on durtion of symptoms

Subtypes	Duration of symptoms
Acute adenoiditis	Acute onset of symptoms^[2]
Recurrent acute adenoiditis	At least 4 or more episodes of acute adenoiditis within a 6 months period^[3]
Chronic/persistent adenoiditis	Persistent adenoiditis for more than 6 months Presence of complications

Adenoiditis classification based on the responsible pathogen and coexisting conditions

		Pathogen	Clinical features (other than adenoiditis)	Treatment
Viral adenoiditis^[4]^[5]^[6]		Epstein-barr virus (EBV)	Asymptomatic In small children, the course of the disease is frequently asymptomatic. Majority of adults infected with mono also remain asymptomatic with serological evidence of past infection. Initial Prodrome Common symptoms include: low-grade fever without chills, Sore throat, white patches on the tonsils and back of the throat, Muscle weakness, fatigue, tender lymphadenopathy, involvement of posterior cervical lymph nodes	Treating symptoms and complications of the infection
		Human adenovirus	Common cold syndrome, Pneumonia, Croup, Bronchitis	Treating symptoms and complications of the infection
		Enterovirus	Mild respiratory illness (common cold), hand-and-foot-and-mouth disease, acute hemorrhagic conjunctivitis, Aseptic meningitis, myocarditis, severe neonatal sepsis-like disease, acute flaccid paralysis^[2]	Treating symptoms and complications of the infection
		Rhinovirus	Sore throat, runny nose, nasal congestion, sneezing and cough, sometimes accompanied by muscle aches, fatigue, malaise, headache, muscle weakness, or loss of appetite	Interferon-alpha Pleconaril
		Respiratory syncytial virus	Bronchiolitis, and pneumonia in children under 1 year of age Recurrent wheezing and asthma	Treating symptoms and complications of the infection Ribavirin
		Cytomegalovirus	Unable to swallow due to enlarged tonsils, dry cough, Loss of appetite, Anorexia, Nausea without vomiting, Abdominal pain-a possible symptom of a potentially fatal rupture of the spleen^[1] and diarrhea	Treating symptoms and complications of the infection Ganciclovir Foscarnet Cidofovir
		Herpes virus	Watery blisters in the skin or mucous membranes (such as the mouth or lips) or on the genitals^[1]	Acyclovir Valacyclovir Famcyclovir
Bacterial adenoiditis	Acute ^[7]^[8]^[9]^[10]	Haemophilus influenzae	Bacteremia, and acute bacterial meningitis, epiglottitis, Otitis media,conjunctivitis, Sinusitis, Pneumonia	Beta lactamase inhibitor antibiotics
		Group A β-hemolytic streptococcus	Strep throat, acute rheumatic fever, scarlet fever, acute glomerulonephritis and necrotizing fasciitis
		Staphylococcus aureus	Toxic shock syndrome
		Moraxella catarrhalis	Otitis media, sinusitis, tracheobronchitis, pneumonia
		Streptococcus pneumoniae	Pneumonia, sinusitis, otitis media, endocarditis
	Recurrent^[4]^[9]	Usually due to normal flora pathogens: Staphylococcus aureus Group A β-hemolytic streptococcus	Nasal airway obstruction, Snoring, sleep apnea, oral breathing, sore or dry throat from breathing through the mouth, purulent rhinorrhea, nasal obstruction, fever, ear pain, Headache, Sore throat	Antihistamines Cosrticosteroids Decongestants
	Chronic ^[11]^[9]			Antihistamines Cosrticosteroids Decongestants
Parasitic adenoiditis		Toxoplasma gondii	Cervical lymphadenopathy, sore throat, muscle aches and pains that last for a month or more, fever, malaise, night sweats	Pyrimethamine Sulfadiazine Leucovorin (Folinic acid)
Non-infectious adenoiditis^[4]^[11]^[5]		Allergies	Allergic sinusitis Redness and itching of the conjunctiva (allergic conjunctivitis) Sneezing, coughing, broncho-constriction, wheezing and dyspnea, sometimes outright attacks of asthma, in severe cases the airway constricts due to swelling known as angioedema	Antihistamines
		Asthma	Cough with or without sputum (phlegm) production, pulling in of the skin between the ribs when breathing (intercostal retractions), Shortness of breath that gets worse with exercise or activity, wheezing	Fast-acting bronchodilators (LABA) Short-acting selective beta₂-adrenoceptor agonists Anticholinergic medications
		GERD	Heartburn, esophagitis, strictures, dysphagia, vomiting, effortless spitting up, coughing, and other respiratory problems	Lifestyle Modifications Proton pump inhibitors Antacids Alginic acid(Gaviscon)

References

↑ ^1.0 ^1.1 “Head & Neck Surgery–otolaryngology – Google Books”.
↑ Havas T, Lowinger D (2002). “Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy”. Arch. Otolaryngol. Head Neck Surg. 128 (7): 789–91. PMID 12117336.
↑ Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A (2014). “Peripheral lymphadenopathy: approach and diagnostic tools”. Iran J Med Sci. 39 (2 Suppl): 158–70. PMC 3993046. PMID 24753638.
↑ ^4.0 ^4.1 ^4.2 Sadeghi-Shabestari M, Jabbari Moghaddam Y, Ghaharri H (2011). “Is there any correlation between allergy and adenotonsillar tissue hypertrophy?”. Int J Pediatr Otorhinolaryngol. 75 (4): 589–91. doi:10.1016/j.ijporl.2011.01.026. PMID 21377220.
↑ ^5.0 ^5.1 Proenca-Modena JL, Pereira Valera FC, Jacob MG, Buzatto GP, Saturno TH, Lopes L; et al. (2012). “High rates of detection of respiratory viruses in tonsillar tissues from children with chronic adenotonsillar disease”. PLoS One. 7 (8): e42136. doi:10.1371/journal.pone.0042136. PMC 3411673. PMID 22870291.
↑ Endo LH, Ferreira D, Montenegro MC, Pinto GA, Altemani A, Bortoleto AE, Vassallo J (2001). “Detection of Epstein-Barr virus in tonsillar tissue of children and the relationship with recurrent tonsillitis”. Int. J. Pediatr. Otorhinolaryngol. 58 (1): 9–15. PMID 11249975.
↑ Lilja M, Räisänen S, Stenfors LE (1998). “Initial events in the pathogenesis of acute tonsillitis caused by Streptococcus pyogenes”. Int. J. Pediatr. Otorhinolaryngol. 45 (1): 15–20. PMID 9804015.
↑ Wessels MR, Bronze MS (1994). “Critical role of the group A streptococcal capsule in pharyngeal colonization and infection in mice”. Proc. Natl. Acad. Sci. U.S.A. 91 (25): 12238–42. PMC 45412. PMID 7991612.
↑ ^9.0 ^9.1 ^9.2 Cunningham, M. W. (2000). “Pathogenesis of Group A Streptococcal Infections”. Clinical Microbiology Reviews. 13 (3): 470–511. doi:10.1128/CMR.13.3.470-511.2000. ISSN 0893-8512.
↑ Ellen RP, Gibbons RJ (1972). “M protein-associated adherence of Streptococcus pyogenes to epithelial surfaces: prerequisite for virulence”. Infect. Immun. 5 (5): 826–30. PMC 422446. PMID 4564883.
↑ ^11.0 ^11.1 Akcay A, Tamay Z, Dağdeviren E, Guler N, Ones U, Kara CO; et al. (2006). “Childhood asthma and its relationship with tonsillar tissue”. Asian Pac J Allergy Immunol. 24 (2–3): 129–34. PMID 17136878.

[urlHead_&_Neck_Surgery--otolaryngology_-_Google_Books-1] 1.0 ^1.1 “Head & Neck Surgery–otolaryngology – Google Books”.

[pmid12117336-2] Havas T, Lowinger D (2002). “Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy”. Arch. Otolaryngol. Head Neck Surg. 128 (7): 789–91. PMID 12117336.

[pmid24753638-3] Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A (2014). “Peripheral lymphadenopathy: approach and diagnostic tools”. Iran J Med Sci. 39 (2 Suppl): 158–70. PMC 3993046. PMID 24753638.

[pmid21377220-4] 4.0 ^4.1 ^4.2 Sadeghi-Shabestari M, Jabbari Moghaddam Y, Ghaharri H (2011). “Is there any correlation between allergy and adenotonsillar tissue hypertrophy?”. Int J Pediatr Otorhinolaryngol. 75 (4): 589–91. doi:10.1016/j.ijporl.2011.01.026. PMID 21377220.

[pmid22870291-5] 5.0 ^5.1 Proenca-Modena JL, Pereira Valera FC, Jacob MG, Buzatto GP, Saturno TH, Lopes L; et al. (2012). “High rates of detection of respiratory viruses in tonsillar tissues from children with chronic adenotonsillar disease”. PLoS One. 7 (8): e42136. doi:10.1371/journal.pone.0042136. PMC 3411673. PMID 22870291.

[pmid11249975-6] Endo LH, Ferreira D, Montenegro MC, Pinto GA, Altemani A, Bortoleto AE, Vassallo J (2001). “Detection of Epstein-Barr virus in tonsillar tissue of children and the relationship with recurrent tonsillitis”. Int. J. Pediatr. Otorhinolaryngol. 58 (1): 9–15. PMID 11249975.

[pmid9804015-7] Lilja M, Räisänen S, Stenfors LE (1998). “Initial events in the pathogenesis of acute tonsillitis caused by Streptococcus pyogenes”. Int. J. Pediatr. Otorhinolaryngol. 45 (1): 15–20. PMID 9804015.

[pmid7991612-8] Wessels MR, Bronze MS (1994). “Critical role of the group A streptococcal capsule in pharyngeal colonization and infection in mice”. Proc. Natl. Acad. Sci. U.S.A. 91 (25): 12238–42. PMC 45412. PMID 7991612.

[Cunningham2000-9] 9.0 ^9.1 ^9.2 Cunningham, M. W. (2000). “Pathogenesis of Group A Streptococcal Infections”. Clinical Microbiology Reviews. 13 (3): 470–511. doi:10.1128/CMR.13.3.470-511.2000. ISSN 0893-8512.

[pmid4564883-10] Ellen RP, Gibbons RJ (1972). “M protein-associated adherence of Streptococcus pyogenes to epithelial surfaces: prerequisite for virulence”. Infect. Immun. 5 (5): 826–30. PMC 422446. PMID 4564883.

[pmid17136878-11] 11.0 ^11.1 Akcay A, Tamay Z, Dağdeviren E, Guler N, Ones U, Kara CO; et al. (2006). “Childhood asthma and its relationship with tonsillar tissue”. Asian Pac J Allergy Immunol. 24 (2–3): 129–34. PMID 17136878.

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