Association Between Adenoid Hypertrophy and Chronic Rhinosinusitis in Children: A Systematic Review

Introduction. Adenoid hypertrophy (AH) and chronic rhinosinusitis (CRS) are common pediatric conditions, with a prevalence of approximately 34% and 2–4%, respectively. The anatomical proximity of the pharyngeal tonsil to the nasal cavity and the similarity in clinical presentations raise questions regarding a potential association between these pathologies. Establishing correlations between adenoid hypertrophy and chronic rhinosinusitis may assist clinicians in early diagnosis and the implementation of individualized treatment approaches. Aim. To conduct a comprehensive evaluation and critical systematic analysis of existing scientific literature to determine the association between adenoid hypertrophy and chronic rhinosinusitis in children. Materials and methods. A systematic search was conducted in the PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, and Google Scholar databases covering the period from 1975 to December 2023. The search included the Keywords: “adenoid hypertrophy,” “adenoid vegetation,” “chronic rhinosinusitis,” “chronic sinusitis.” Study quality was assessed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool. The review followed PRISMA guidelines. Results. A total of 41 studies were analyzed, with sample sizes ranging from 16 to 12,965 children (mean age 3.3–12.62 years). Shared etiological pathogens were identified, including Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. Biofilms were detected in 94.9% of CRS cases with AH compared to 1.9% in cases of obstructive sleep apnea syndrome (OSAS). Elevated levels of pro-inflammatory mediators (TGF-β1, sIL-2R, MMP-2, MMP-9, TIMP-1) and decreased levels of protective factors (IgA, BLIMP-1, SP-D) were reported. Impaired mucociliary clearance was demonstrated by reduced ciliary beat frequency (5.35 ± 1.06 Hz vs. 6.37 ± 0.71 Hz in controls). Adenoidectomy showed efficacy in 47–88.3% of cases in reducing CRS symptoms. Conclusions. Most studies confirm a strong association between adenoid vegetations and chronic rhinosinusitis in children, driven by common etiopathogenetic mechanisms. Adenoidectomy may be considered a first-line treatment for uncomplicated pediatric CRS. It is proposed to classify adenoid vegetations as a distinct phenotypic subtype within pediatric CRS classification.