Iranian Journal of Otorhinolaryngology

Iranian Journal of Otorhinolaryngology

Mechanistic Insights into the Role of Adenoid Hypertrophy and Chronic Adenoiditis in the Pathogenesis of Pediatric Chronic Rhinosinusitis: A Systematic Review

Articles in Press

Document Type : Systematic Review

Authors
Gagat Ragil Andaru Pratomo 1
Feri Trihandoko 2
1 Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
2 Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; Gadjah Mada University Academic Hospital, Yogyakarta 55291, Indonesia
10.22038/ijorl.2026.97252.4200
Abstract
Objective:
To synthesize available evidence on the mechanistic role of adenoid hypertrophy and chronic adenoiditis in the pathogenesis of pediatric chronic rhinosinusitis (CRS), given that the mechanistic relationship between adenoid disease and pediatric CRS remains incompletely synthesized.
Data Sources:
PubMed/MEDLINE, Embase, Scopus, Web of Science Core Collection, and Cochrane Library were systematically searched in accordance with PRISMA 2020 guidelines.
Methods of Review:
Eligible studies included children with CRS and evaluated adenoid-related mechanisms, including mechanical obstruction, impaired drainage, microbial reservoir function, biofilm formation, immune dysregulation, epithelial dysfunction, mucociliary impairment, or clinical outcomes after adenoidectomy. Study quality was appraised using the JBI Critical Appraisal Tools. Due to heterogeneity in study design, diagnostic criteria, and reported outcomes, a narrative synthesis was performed.
Results:
Nine studies involving 927 pediatric participants were included. Evidence for mechanical obstruction was mixed, as adenoid size did not consistently correlate with CRS severity. Stronger evidence supported the role of the adenoid as a microbial reservoir and biofilm-bearing tissue, with studies reporting pathogenic bacterial colonization and extensive adenoidal biofilm in children with CRS. Limited molecular evidence suggested reduced surfactant protein-D expression, while epithelial barrier dysfunction and mucociliary impairment were supported mainly by indirect findings. Adenoidectomy improved symptoms and quality of life in selected children with medically refractory CRS.
Conclusion:
Adenoid hypertrophy and chronic adenoiditis appear to be associated with pediatric CRS through combined obstructive, microbial, biofilm-related, inflammatory, and immunological pathways, although causal relationships cannot be established from the available evidence. Adenoidectomy appears beneficial in selected refractory cases, although further prospective mechanistic studies are needed.
Keywords
Adenoid Hypertrophy
Chronic Adenoiditis
Pediatric Chronic Rhinosinusitis
Biofilm
Microbial Reservoir
Adenoidectomy
Subjects
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Iranian Journal of Otorhinolaryngology

Articles in Press, Corrected Proof
Available Online from 26 August 2026