Tubal tonsil hypertrophy: a cause of recurrent symptoms after adenoidectomy.
OBJECTIVES: To assess the incidence of symptomatic tubal tonsil hypertrophy (TTH) after adenoidectomy and to attempt to differentiate the clinicoradiographic presentation of TTH from that of recurrent or residual adenoid. DESIGN: Retrospective case series review. SETTING: Pediatric otolaryngology practice in a tertiary care hospital. PATIENTS: The charts of all patients scheduled to undergo revision adenoidectomy or nasopharyngeal examination under anesthesia over a 5-year period in 1 pediatric otolaryngologist's practice were reviewed. MAIN OUTCOME MEASURE: Presence of TTH in patients with recurrent symptoms after previous adenoidectomy. RESULTS: Forty-two patients were identified, 24 of whom satisfied the established criteria of recurrent symptoms after previous adenoidectomy. Ten (42%) of these patients were identified as having TTH. The average age at presentation was 7 years 2 months, at an average time interval of 4 years 2 months after adenoidectomy. The comparative incidence of recurrent or residual adenoid was 54%. The symptomatic manifestations of TTH included nasal obstruction, obstructive sleep disorder, rhinosinusitis, recurrent otitis media, and otitis media with effusion. Preoperative radiographic evaluation was not useful in distinguishing TTH from recurrent or residual adenoid; nasopharyngoscopy appears to have better diagnostic potential. Thermal ablation with suction cautery was therapeutically effective. CONCLUSIONS: Tubal tonsil hypertrophy is a significant clinical entity as a cause of recurrent symptoms after adenoidectomy. The study patients demonstrated the entire spectrum of signs and symptoms seen in patients with adenoid hypertrophy. Operative nasopharyngeal examination is required to definitively distinguish TTH from recurrent or residual adenoid.