Nasal Mucociliary Dysfunction in Children with Adenoid Hypertrophy Mechanisms and Postoperative Recovery

Adenoid hypertrophy is associated with impaired nasal mucociliary transport, but the mechanisms and meaning of postoperative improvement remain incompletely resolved. This critical narrative review examines pediatric studies of transport time, ciliary activity, adenoidal morphology and bacterial biofilms. The findings suggest contributions from nasopharyngeal obstruction, epithelial dysfunction and the local microbial environment; their interactions remain incompletely established. Several studies report faster transport after adenoidectomy, and one prospective investigation found improved nasal ciliary beat frequency at six months. These functional findings do not demonstrate epithelial regeneration, which requires structural assessment. Adenoid size does not consistently correlate with mucociliary impairment, and biofilm findings differ between clinical phenotypes. Early shortening of transport time may reflect changes in drainage or secretions, but the mechanism cannot be inferred from timing alone. Existing studies are limited by heterogeneous populations, combined operations, variable follow-up and incomplete assessment of reproducibility. An interpretive framework distinguishes transport improvement, cellular recovery, symptom benefit and prognostic usefulness. Nasal transport testing can contribute to research on adenoid disease, but current evidence does not establish it as an independent indication for surgery or a validated predictor of postoperative benefit.