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Adenoids

Adenoids (adenoid growths, adenoid vegetation) - pathological growth (hyperplasia, hypertrophy) of the pharyngeal (nasopharyngeal) tonsil. May occur in isolation or in combination with enlarged palatine tonsils. The pharyngeal tonsil is well developed in childhood; from about 12 years old, it becomes smaller, and in adults it often completely atrophies. Adenoids are most often observed in children 3-10 years old, but can be in the first years of life, and after puberty. The development of adenoids is facilitated by childhood infectious diseases (measles, scarlet fever, diphtheria), often recurring viral and microbial inflammatory diseases of the upper respiratory tract, immunodeficiency states, a tendency to allergies, and the role of a hereditary factor is not excluded.

Symptoms, course. Violation of nasal breathing, copious secretion of mucous secretions that fill the nasal passages and flow into the nasopharynx, chronic swelling and inflammation of the nasal mucosa. Due to difficulty in nasal breathing, children sleep with their mouths open, sleep is often restless and is accompanied by loud snoring; children get lethargic, lethargic. Students often have poor performance due to weakened memory and attention. Adenoids, closing the pharyngeal openings of the Eustachian (auditory) tubes and disrupting the normal ventilation of the middle ear, can cause hearing loss, sometimes significant. Speech is distorted, the voice loses its sonority and takes a nasal tone. Young children have difficulty mastering speech. Complaints of persistent headache as a result of obstructed outflow of blood and lymph from the brain due to congestion in the nasal cavity are frequent. Constant secretions of the mucous secretion 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 sags, the nasolabial folds are smoothed out, the expression on the face in later stages is not meaningful, saliva flows from the corners of the mouth, which gives the child’s face a special expression called “adenoid face” or “external adenoidism”. Constant breathing through the mouth leads to deformation of the facial skull. Such children may experience malocclusion, a high, so-called Gothic sky. As a result of prolonged labored nasal breathing, the chest is deformed, becoming flattened and hollow. Lung ventilation is impaired, blood oxygenation decreases, the number of red blood cells and the hemoglobin content decrease. With adenoids, the activity of the gastrointestinal tract is disturbed, anemia, bedwetting, chore-like movements of the muscles of the face, laryngospasm, asthmatic attacks, coughing attacks develop.

Mostly in childhood, it can occur independently or more often in combination with acute inflammation of the palatine tonsils, acute adenoiditis (tonsillitis), in which body temperature can rise to 39 grams. C and above, there is a feeling of dryness, soreness, burning in the nasopharynx.

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

Due to frequent respiratory diseases, acute adenoiditis, especially with severe allergies, chronic adenoiditis occurs. In this case, a violation of the general condition of the patient is characteristic, the child becomes lethargic, loses appetite, and vomiting often occurs during meals. Flowing from the nasopharynx into the underlying airways of the mucopurulent discharge causes a persistent reflex cough, especially at night. Body temperature is often subfebrile, regional lymph nodes are enlarged. The inflammatory process from the nasopharynx easily spreads to the sinuses, pharynx, larynx, underlying respiratory tract, as a result of which children often suffer from bronchopulmonary diseases.

For recognition, posterior rhinoscopy, digital examination of the nasopharynx and x-ray examination are used. Largest adenoids are divided into three degrees: I degree — adenoids of small size cover the upper third of the opener; II degree adenoids of medium size, cover two thirds of the opener; III degree - large adenoids, cover the entire or almost the entire opener. The sizes of adenoids do not always correspond to the pathological changes caused by them in the body. Sometimes adenoids of I - II degree cause a sharp difficulty in breathing through the nose, hearing loss and other pathological changes. Adenoids differentiate from juvenile nasopharyngeal fibroma and other tumors in this area. Difficulty breathing through the nose happens not only with adenoids, but also with a curvature of the nasal septum, hypertrophic rhinitis, and neoplasms of the nasal cavity.

Surgical treatment. Indications for the operation are not so much the magnitude of the adenoids, as the resulting disorders in the body. In children with allergic diathesis, prone to allergies, adenoids often recur after surgical treatment. In such cases, the operation is carried out against the background of desensitizing therapy. With grade 1 adenoids without severe respiratory failure, conservative treatment can be recommended - instillation of a 2% protargol solution in the nose. Of the general strengthening agents, fish oil, calcium preparations inside, vitamins C and D, and climatic treatment are prescribed.