Adenoids

ADENOIDES (adenoidal deformations, adenoid vegetations) -pathological dilatation (hyperplasia, hypertrophy) of pharyngeal (nasopharyngeal) tonsils. They may occur in isolation or in combination with enlarged palatine tonsils. The pharyngeal tonsil is well developed in childhood; About 12 years of age, it becomes less, and in adults it is often completely atrophied. Adenoids are most often observed in children 3-10 years old, but can be in the first years of life, and after the period of puberty. The development of adenoids is promoted by children's infectious diseases (measles, scarlet fever, diphtheria), often recurring viral and microbial inflammatory diseases of the upper respiratory tract, immunodeficiency states, a tendency to allergy, the role of the hereditary factor is also not excluded.

Symptoms, course. Disturbance of nasal breathing, copious secretion of mucous secretion, filling nasal passages and flowing into the nasopharynx, chronic swelling and inflammation of the nasal mucosa. Because of the difficult nasal breathing, children sleep with their mouth open, sleep is often restless and accompanied by loud snoring; Children stand up sluggish, apathetic. Schoolchildren often lose academic performance due to a weakening of memory and attention. Adenoids, closing the pharyngeal openings of the eustachian (auditory) tubes and disrupting the normal ventilation of the middle ear, can cause a decrease in hearing, sometimes significant. The speech is distorted, the voice loses its sonority and takes on a nasal tinge. Young children hardly master speech. Frequent complaints of persistent headache as a result of a complicated outflow of blood and lymph from the brain, caused by congestion in the nasal cavity. Constant secretions of mucous secretions from the nose cause maceration and swelling of the skin of the upper lip, and sometimes eczema. The mouth is constantly open, the lower jaw is hanging, the nasolabial folds are smoothed, the facial expression in the late stages is not meaningful, saliva follows from the corners of the mouth, which gives the child's face a special expression called "adenoid face" or "external adenoidism." Continuous breathing through the mouth leads to deformation of the facial skull. Such children may have an incorrect bite, a high, so-called Gothic sky. As a result of prolonged obstructed nasal breathing, the thorax deforms, becoming flattened and sunken. The ventilation of the lungs is impaired, the oxygenation of the blood decreases, the number of red blood cells and the hemoglobin content decreases. Adenoids disrupt the activity of the gastrointestinal tract, develop anemia, bedwetting, choreopodobnye movements of the face, laryngospasm, asthmatic attacks, coughing attacks.

Mostly in childhood, acute adenoiditis (a throat of the pharyngeal tonsil) can occur independently or more often in combination with acute inflammation of the palatine tonsils, in which the body temperature can rise to 39 g. With and above, there is a feeling of dryness, sadness, burning in the nasopharynx.

Along with a runny nose, nasal congestion in patients noted pawning, and sometimes pain in the ears, paroxysmal cough at night. Regional lymph nodes (submandibular, cervical and occipital) are enlarged and painful on palpation. In young children, there may be signs of general intoxication, dyspepsia. The disease lasts 3-5 days. A common complication of acute adenoiditis is eustachiitis, otitis media.

Due to frequent respiratory diseases, acute adenoiditis, especially with severe allergies, chronic adenoiditis occurs. At the same time, the general condition of the patient is disturbed, the child becomes sluggish, loses appetite, often during vomiting, vomiting occurs. The leakage from the nasopharynx into the underlying respiratory tract of the mucopurulent separable causes a persistent reflex cough, especially at night. Body temperature is often subfebrile, regional lymph nodes are enlarged. Inflammatory process from the nasopharynx easily spreads to the paranasal sinuses, pharynx, larynx, underlying airways, as a result of which children often suffer from bronchopulmonary diseases.

For recognition, use the back rhinoscopy, finger examination of the nasopharynx and X-ray examination. The adenoids are divided by three degrees: I degree-adenoids of small size cover the upper third of the opener; II degree-adenoid of medium size, close two-thirds of the opener; III degree - adenoids of large size, cover all or almost the whole opener. The size of adenoids does not always correspond to the pathological changes caused by them in the body. Sometimes adenoids I - II degree cause severe difficulty breathing through the nose, hearing loss and other pathological changes. Adenoids differentiate from juvenile fibroids of the nasopharynx and other tumors of this area. Difficulty breathing through the nose happens not only with adenoids, but also with curvature of the nasal septum, hypertrophic rhinitis, and neoplasm of the nasal cavity.

Treatment is surgical. Indications for surgery are not so much the magnitude of adenoids, how many disorders in the body. In children with allergic diathesis, prone to allergies, adenoids after surgery often recur. In such cases, the operation is performed against the background of desensitizing therapy. With adenoides of the 1st degree without pronounced breathing disorders, conservative treatment can be recommended - instillation of 2% protargol in the nose. Of fortifying agents prescribed fish oil, calcium preparations inside, vitamins C and D, climatic treatment.