الفهرس 
EmbrologyOnly 14 pages are availabe for public view
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Abstract
Adenoids, which are nasopharyngeal lymphoid tissue forming part of the Waldeyer’s ring, were initially described in 1868 by Meyer. Present from early gestation, adenoid growth continues until about 6 years of age, after which atrophy occurs, adenoidal hypertrophy during childhood may both fill the nasopharynx and extend through the posterior choanae into the nose, resulting in nasal airway stenosis, impeding airflow. There is a significant relationship between the endoscopically determined size of obstructive adenoid tissue and symptomatic nasal obstruction in children.
Adenoid hypertrophy is a common cause of nasal obstruction in children. It can present as chronic or recurrent nasal discharge, OM, up to obstructive symptoms as snoring, OSA, hyponasal speech and adenoid facies. This nasal obstruction may also affect the concentration of the child and the mental growth.
Evaluation of adenoid size clinically can be done by posterior rhinoscopy, nasal endoscopy, plain radiography, video fluoroscopy but Nasal endoscopy remains the gold standard in assessment of hypertrophied adenoid while the plain radiograph is non invasive, reliable tool but falls short in determining the grade of hypertrophy of adenoid.
Adenoidectomy is one of the most common procedure performed in children but it may be contraindicated in bleeding disorders, cleft palate, URTI. Recurrent adenoids are most probably due to regrowth of residual lymphoid tissues left as a result of blind removal.
Cysteinyl leukotrienes are major mediators of inflammation and act as potent neutrophil chemoattractants and activators. The cysteinyl leukotriene receptors 1 and 2 are expressed on several tissues including the nasal mucosa and the lungs. A considerable overlap and interdependency between asthma and OSA as well as compelling evidence of the favorable effect of CYS
LT1-R antagonists in reducing inflammation in children with inflammatory conditions such as asthma and allergic rhinitis suggested a potential role for leukotriene modifiers in the management of pediatric OSA.
Assessment of the LT1-R and LT2-R expression in tonsils and adenoids of children with OSA compared to children with recurrent infectious tonsillitis without OSA revealed higher protein expression levels.
The leukotrienes and their receptors are highly expressed in the adenoids and tonsils of OSA patients was confirmed by Kaditis and colleagues who showed that tonsils of children with OSA display an enhanced expression of cysteinyl leukotriene receptors in T lymphocytes without an associated increase in serum hsCRP concentrations
A prospective study conducted on 60 patients of adenoid hypertrophy divided in two groups cases were divided into two groups; the first group 30 patients is the control group who did not receive the treatment and the second group 30 patients which included patients who received antileukotrienes therapy for 3 months to evaluate the effect of antileukotrienes on adenoid size and CD64 by comparing the adenoid size endoscopically and radiologically also CD64 level at the start of the study and after 3 months for case and control.
There was a significant difference between the case pretreatment and posttreatment regarding adenoid size and CD64 level. While there is no significant difference between the control at the start of the study and after 3 months, And by comparing the case posttreatment and control after 3 months from the start of the study regarding the decrease in adenoid size and CD64 level there was significant difference for favor of case posttreatment.
This study concludes that Antileukotrienes can decrease level of CD64 and subsequently adenoid size in children with adenoid hypertrophy if used daily for 3 months.
So Antileukotrienes can be used as effective medical treatment in adenoid hypertrophy.