The role of adenoids in pediatric rhinosinusitis

The adenoids are an immunologically active collection of lymphoid tissue situated in the posterior nasopharynx. Because of their immunologic role, they are apt to become enlarged as a result of pathologic processes such as infection and/or allergies. In addition, they can also become an active bacterial reservoir, serving as the primary source of bacteria in cases of acute otitis media and sinusitis because of their anatomic proximity. Since the adenoids have a greater immunologic role in children, they also play a key role in the development of sinusitis in this patient population in particular when compared to adults. Medical treatment options specifically directed at the adenoid tissue are limited, thus surgical removal of the adenoid pad via adenoidectomy remains the mainstay for surgical treatment of adenoidal disease, including pediatric rhinosinusitis.