ADENOID

Arif Kusuma Wardhana

Michael Aaron Romulo
Mohammad Galih Pratama
 IDENTITAS PASIEN

Nama : An. AKW

Tanggal Lahir : 23/03/2006
Umur : 13 tahun
No.RM :
Jenis Kelamin : Laki-laki
Tempat Tinggal : Tirtomartani, Kalasan
Agama : Islam
Pekerjaan : Siswa SMP
KELUHAN UTAMA

Sesak saat tidur

 RIWAYAT PENYAKIT

Riwayat Penyakit Sekarang

• Sejak 3 minggu yang lalu, orang tua pasien mengeluhkan anaknya
saat tidur malam sering mendengkur, bernafas melalui mulut, dan
sering terbangun karena sesak. Pasien sering merasa hidungnya
mampet dan tidak nyaman. Pasien sering pilek dengan ingus berwarna
bening. Riw alergi belum pernah diperiksa lebih lanjut.
• Mimisan (-), batuk (-), nyeri telan (-), sakit kepala (-), demam (-),
keluhan pada telinga (-)
• Pasien dirujuk dari RS lain dengan pembesaran adenoid dan tonsil
untuk dilakukan tonsil adenoidectomy
Riwayat Penyakit Keluarga
 PEMERIKSAAN FISIK

• Deskripsi Umum
• Kondisi Umum: tenang
• Gizi:
• Berat Badan : 60
• Tinggi Badan : 155
• IMT : 25

• Vital Sign
 PEMERIKSAAN KEPALA LEHER

• Mata : CA (-/-), SI (-/-)

• Hidung : mucosa normal, pembesaran concha nasi dextra,
septum nasi sedikit deviasi ke dextra, sekret mucus bening
• Telinga : Auricula pada telinga kiri tidak berkembang dengan
baik
• Mulut : mucosa normal, hipertrofi tonsil (T4 – T3), kripta (-)
• Leher : pembesaran limfonodi (-), massa (-)
 PEMERIKSAAN THORAX

DADA
KANAN KIRI
ANTERIOR

Simetris, jejas (-), retraksi dinding dada (-), penggunaan otot

Inspeksi
bantu napas (-/-)

Palpasi Ekspansi paru simetris, nyeri tekan (-), fremitus taktil (+/+)

Perkusi Sonor Sonor

Vesikular (+), wheezing (-), Vesikular (+), wheezing (-),

Auskultasi
krepitasi (-), rbb (-), rbk (-) krepitasi (-), rbb (-), rbk (-)
 PEMERIKSAAN JANTUNG

• Inspeksi : ictus cordis tidak tampak

• Palpasi : ictus cordis teraba di SIC 5 Linea Midaxillaris Sinistra
• Perkusi : Batas jantung normal
• Auskultasi : S1 S2 normal, split (-), mengeras (-). Bising (-).
Gallop (-) S4 (-). Suara tambahan (-)
 PEMERIKSAAN ABDOMEN

• Inspeksi : Distensi (-), kulit normal

• Auskultasi : Bising usus (+) normal 10 kpm
• Perkusi : timpani 13 titik
• Palpasi : supel, nyeri tekan (-), hepatosplenomegaly (-)
 DIAGNOSIS KERJA

Hipertrofi adenoid dan tonsil

 PEMERIKSAAN PENUNJANG (RO
CRANIUM AP/LAT)

• Hipertrofi concha nasalis dextra dd polyp nasi

• Gambaran pembesaran adenoid yang menyempitkan lumen
nasopharynx
• Sinus paranasalis normolusen
• Septum nasalis relative di tengaah, os nasalis tampak intak
 MANAJEMEN

• Tonsil adenoidectomy
PEMBAHASAN
ANATOMY
 HYPERTROPHY ADENOID

• Adenoid hypertrophy is an obstructive condition

related to an increased size of the adenoids
• Adenoid hypertrophy is more common in
children than in adults; the adenoids naturally
atrophy and regress during adolescence,
usually reaching maximal size by age 6 or 7
before regressing by adolescence
 ETIOLOGY

• Adenoid hypertrophy can occur because of infectious and non-infectious

etiologies
• Viral pathogens associated with adenoid hypertrophy include adenovirus,
coronavirus, coxsackievirus, cytomegalovirus (CMV), Epstein-Barr virus
(EBV), herpes simplex virus, human bocavirus parainfluenza virus, and
rhinovirus
• Many bacterial species have been implicated including alpha-, beta-, and
gamma-hemolytic Streptococcus species, Haemophilus influenzae,
Moraxella catarrhalis, Staphylococcus aureus, Neisseria gonorrhoeae,
Corynebacterium diphtheriae, Chlamydophila pneumoniae,
and Mycoplasma pneumoniae, Fusobacterium, Peptostreptococcus,
and Prevotella species
 SIGN AND SYMPTOMS

• Adenoid hypertrophy is an obstructive condition, with its

symptomatology depending on the obstructed structure
• Nasal obstruction by hypertrophic adenoid tissue can cause the
patient to complain of rhinorrhea, difficulty breathing through
the nose, chronic cough, post-nasal drip, snoring, and/or sleep
disordered breathing in children
• Obstruction of the Eustachian tube can lead to symptoms
consistent with Eustachian tube dysfunction such as muffled
hearing, otalgia, crackling or popping sounds in the ear, and/or
recurrent middle ear infections
• The patient with adenoid hypertrophy will often breathe
through the mouth, have a hypo nasal character to their voice,
and may have the facial characteristics known as adenoid
facies which include a high arched hard palate, increased facial
 DIAGNOSIS

• Lateral head and neck radiography have been

used for assessment of the adenoids
• Videofluoroscopy has also been described as a
method for determining the degree of adenoid
hypertrophy
• Direct visualization of the adenoids by fiberoptic
nasopharyngoscopy is another option for
assessing the adenoids in the clinical setting
 TERAPI

• No good evidence supports any curative medical

therapy for chronic infection of the adenoids. Systemic
antibiotics have been used long-term (ie, 6 wk) for
lymphoid tissue infection, but eradication of the bacteria
failed. In fact, with the current trend of resistant
bacteria, the use of prophylactic or long-term antibiotics
has been decreased to prevent the formation of resistant
bacteria.
• Some studies indicate a benefit with using topical nasal
steroids in children with adenoid hypertrophy. Studies
indicate that while using the medication, the adenoid
may shrink slightly (ie, up to 10%), which may help
relieve some nasal obstruction. However, once the
 SURGERY

• Adenoidectomy is considered for patients with

recurrent or persistent obstructive or infectious
symptoms related to adenoid hypertrophy
• Breathing problems
• Difficulty in sleeping
• Persistent problems with the ears 
• Recurrent or persistent sinusitis 
 DIFFERENTIAL DIAGNOSIS

• Choanal atresia
• Pyriform aperture stenosis
• Rhinitis Allergica
• Sinusitis
• Nasal polyp
• Intranasal encephalocele
• Nasal dermoid
• Neoplasma nasopharyng
• OMA
• OMSK
 REFFERENCE

• Zachary Geiger; Nagendra Gupta. Adenoid Hypertrophy.

Treasure Island (FL): StatPearls Publishing; 2019 Jan