Adenoids( enlarged tonsils) - Causes, symptoms and treatment. MF.
Adenoids( adenoid vegetations, adenoidal deformations) are pathological growths of the nasopharyngeal tonsil, which is located deep in the nasopharynx, they consist of lymphoid tissue. Normally, this amygdala is well developed in childhood, and after twelve years it begins to decrease, so in adulthood adults are rare.
Normally, the tonsils are a small accumulation of lymphoid tissue in the thickness of the mucous membrane around the holes that lead to the nasal cavity, mouth and pharynx. There are paired tonsils: two tubal, two palatine;and unpaired - three lingual and pharyngeal( nasopharyngeal) tonsils. The tonsils are, so-called, the lymphoepithelial ring of Pirogov-Valdeier, which is an integral part of the body's immunity - it protects it from external pathogenic influences. So, the main function of the tonsils is protective. They are a barrier to inhaling airborne foreign bacteria and viruses, "catching" them and destroying them.
Adenoids - these are not those tonsils that you see on the sides of the throat, looking into the child's mouth. Adenoides without appropriate adaptations you can not see at all, because they are located above the pharynx, approximately opposite the nose almost in the center of the skull.
Location of adenoids
Adenoids are a common disease among children. It is common in the age of 1 to 15 years, but is more common in children 3-7 years.
Adenoids and adenoiditis are often confused. Adenoiditis is a disease of the inflammatory nature of of the pathologically enlarged nasopharyngeal tonsil( adenoids).It occurs both in isolated form and in combination with the inflammation of of the enlarged palatine tonsils. Adenoiditis is accompanied by an increase in body temperature and a sharp violation of nasal breathing.
Some reasons for the formation of adenoids:
1. Various children's infections( measles, scarlet fever), in which the mucous membrane of the nasal cavity and tonsils is affected;
2. Frequent inflammatory diseases of the upper respiratory tract;
3. Viral diseases;
4. Immunodeficiency;
5. Allergization of the child.
Symptoms on which the child can suspect adenoids:
• Difficult nasal breathing and discharge from the nose;
• Frequent colds;
• Snoring in a dream;
• Bad sleep;
• The child's mouth is often open;
• Appearance of nasal and indistinct speech.
• Rapid fatigue, lethargy, apathy;
• Headache;
• Hearing loss. The child often asks.
If you find several or even one of the symptoms in a child, you should immediately visit an ENT doctor to diagnose and conduct adequate treatment.
Complications to which adenoids can lead:
1. Disturbance of normal functioning of the middle ear.
When the nasopharyngeal tonsil is enlarged, it closes the mouth of the auditory tube. This anatomical formation( Eustachian tube) serves to regulate the pressure difference between the internal( in the nasal cavity and the nasopharynx) and the external( atmospheric) pressure. Normally, the auditory tube air comes from the nasal cavity in the middle ear. When the mouth is blocked, air enters the middle ear. As a result, the eardrum becomes less mobile and it affects the hearing. In advanced cases, such a decrease in hearing( hearing loss) can not be cured completely.
2. Inflammatory diseases of the middle ear. If passage of air into the middle ear is difficult, then excellent conditions are created for the penetration and development of infection there( otitis media of the middle ear).
3. Deformation of the facial skeleton and thorax, incorrect bite. Such complications are caused by constant breathing with the mouth.
4. Disturbance of ventilation of lungs and decrease in working capacity. This leads to a decrease in the oxygen saturation of the blood, as a result of which the brain does not receive it and this affects its normal functioning. Therefore, children who have adenoids often learn poorly, are less efficient and attentive.
5. Constant presence of a hotbed of chronic infection in the body. Since the nasopharyngeal tonsil is constantly inflamed, it contains many viruses and bacteria, which has a bad effect on the children's body as a whole.
6. Inflammatory respiratory disease. Slime, which is constantly produced in the chronically inflamed tonsil, descends below and causes pharyngitis( inflammation of the mucous membrane of the pharynx), laryngitis( inflammation of the larynx), tracheitis( inflammation of the trachea) and bronchitis( inflammation of the bronchi).
7. Violation of the gastrointestinal tract.
8. Violation of blood composition.
9. Enuresis( bedwetting).10. Spasm of the larynx.11. Coughing attacks.
Degrees of adenoid enlargement:
First degree of - adenoids close the top of the opener. At the first degree, a child may experience discomfort and difficulty breathing only when sleeping.
Second degree - adenoids close the upper two-third of the opener. At the second degree the child snores regularly at night, and often breathes with the mouth during the day, because of the difficult nasal breathing.
Third degree - adenoids cover all or almost the whole opener. At the third degree, air access through the nose is blocked by adenoids completely, and the child can breathe only with the mouth.
Adenoid enlargement degrees
Adenoids 1 degree, photos through the endoscope
Adenoids 3 degrees, photos through the endoscope
The clinical picture( severity of pathological changes) does not always correspond to the degree of adenoids. It happens that adenoids of the first and second degree can cause severe obstruction of nasal breathing, a sharp decrease in hearing, and adenoids of the third degree do not cause visible disturbances. Therefore, only by size one can not say exactly what to do-treat conservatively or radically( remove adenoids).
Diagnosis of adenoids.
Diagnosis of diseases with the help of basic( survey, examination) and additional research methods. The latter include:
- Pharyngoscopy - a method of visual examination of the oropharynx.
It is carried out under artificial lighting, with a spatula and a nasopharyngeal, guttural mirror. With pharyngoscopy, assess the condition of the oropharynx( the color of the mucous membrane, the surface of the posterior pharyngeal wall), reveal the pathological formations of this section of the pharynx. You can see adenoids, assess the extent of their increase.
- Anterior rhinoscopy is a method of examining the nasal cavity. It is carried out with a nasal dilator. In doing so, examine and assess the front nasal passages( the presence of edema that is separated from the nose), its septum. If you sip the vasoconstrictor, you can consider the posterior wall of the nasal pharynx, adenoids.
Nasal dilator
- Rear Rhinoscopy - a method for examining the posterior parts of the nose.
It can be carried out using a nasal mirror, a fibroscope. With the back of the rhinoscopy, you can examine the opener, the back surface of the soft palate, the pharyngeal arch, the choana, the posterior sections of the nasal concha. It is informative and harmless, but in childhood it is difficult to conduct.
- Radiographic study. It allows you to diagnose adenoids in a child and determine their degree of growth.
- Endoscopic examination of the nasopharynx. It consists in a detailed examination of the nasal cavity and nasopharynx, evaluating their functionality with the help of special endoscopes. This is an informative and harmless method. It allows you to record the results of the research on photos and videos.
Treatment of adenoids.
There are two methods of treatment - conservative and surgical.
1. Conservative treatment( without surgery) of adenoids in children
is carried out with the help of medicinal and physiotherapeutic methods of treatment. Conservative methods are usually used with a small degree of nasopharyngeal tonsillitis or if there are contraindications to their removal.
Conservative treatment should be local and general. With local treatment, anti-inflammatory and antimicrobial drugs are used. For local effects( instillation into the nose), vasoconstrictive drops are used. Drops are applied from five to seven days. In the nose, a 0.05% solution of naphthyzine or a 1-2% solution of ephedrine, galazoline, sanorin and others is instilled. Then, the nasal cavity is washed.
Rinsing of the nose is prescribed against adenoids, all kinds of colds, as well as for the prevention of diseases of ENT organs and their complications. However, most solutions for the treatment of runny nose in the form of ready-made aerosols imply a procedure for nasal irrigation, rather than for immediate rinsing. Irrigation, unlike washing, can only reduce the thick consistency of nasal secretions, but will not solve the problems with their removal along with harmful bacteria. After irrigation the mucous membrane quickly dries up, which further aggravates the rhinitis, provokes swelling.
Flushing promotes the reduction of inflammation, improving the mucous membrane of the nose and reducing the risk of sinusitis and sinusitis. Modern methods involve the washing of the nasal passages with special antiseptic agents. For example, the components of the drug "Dolphin" get to the sinuses of the nose, diluting the clots of mucus and naturally leading them out.
Along with local effects, general treatment is also used. To general means of influence carry tonic( vitamins with microelements, immunostimulants( tincture of Echinacea)), antihistamines( fenkarol, suprastin).
To improve the effectiveness of conservative treatment, physiotherapy methods are additionally used:
1. UFO.You can use endonasal( inside the nose) up to 10 procedures.
2. Helium - neon laser. Also endonasal up to 10 times.
3. Electrophoresis with solutions of potassium iodide, dimedrol - endonasal.
4. UHF on the nose area up to 10 procedures.
Climatotherapy often gives positive results on the condition of the child. Especially for this, the resorts of the Crimea and the Black Sea coast of the Caucasus are good.
The final decision on the choice of a method of treatment is made by the attending physician, based on the condition of the child
2. Surgical treatment of adenoids( adenotomy).
This operation should be performed as soon as possible after the diagnosis and diagnosis of adenoids, but only if there are indications. This is the most effective method of treatment. After all, adenoids are an anatomical formation and it will not go anywhere, and no drugs can dissolve it.
The operation is indicated for:
- failure of conservative treatment of adenoids;
- persistent obstruction of breathing through the nose, which leads to permanent colds and infectious diseases of the child( tonsillitis, pneumonia, chronic tonsillitis);
- frequent otitis media;
- the appearance of complications from the paranasal sinuses( sinusitis);
- snoring and delayed breathing during sleep.
Some contraindications for surgery:
1. Blood diseases
2. Acute period of infectious and skin diseases or with newly transferred diseases.
Most often, the adentomy surgery is performed at the age of up to three years, from five to six years, from 9 to 10 years and after 14 years. The choice of such age for the operation is associated with the growth periods of the child's body.
Before operation it is necessary to sanitize the oral cavity and cure inflamed adenoids. If this is not done, the surgeon may not be able to remove the entire focus of the infection and after the operation, various complications are possible.
Surgical removal of the adenoid( adenotomy) can be performed on an outpatient basis( in a polyclinic) or in a hospital under local anesthesia or under general anesthesia. There are conventional methods of removal and using modern medical equipment( endoscopes).Under local anesthesia, the procedure is quick and painless. Under general anesthesia, the operation is performed with increased excitability of the child or when the adenoids are close to the mouths of the auditory tubes in the nasopharynx.
The operation is short in time, lasts 15-20 minutes, the "cutting off" of the grown up tissue takes only 2-3 minutes. Adenotom Beckman( knife in the form of a ring) is captured adenoid tissue and cut off in one motion( the usual technique).
Becken's Adenotom
When the operation is carried out, the child sits with his head tilted slightly. The nostrils of the nose are clogged with cotton. The head is held by the assistant( nurse), slightly pressing from above, so you can not go up.
Operation stages:
1. Conduct anesthesia. First anesthetize the nasal cavity, special attention is paid to the posterior end of the opener, and then - the posterior wall of the nasopharynx and the nasopharyngeal surface of the soft palate. Sometimes you can do without anesthesia.
2. The tongue is squashed with a spatula, for a better view.
3. Adenotom is held by the right hand, like a stick, and is inserted into the throat behind the soft palate.
4. The ring knife is pulled forward until it touches the opener and advances up to failure.
5. A sharp movement of the adenotomy posteriorly and simultaneous turning downwards cuts the adenoid tissue, after which the knife is removed outward.
Stages of adenotomy
After removal of adenoids from the nose, fleece is removed. The person being operated should blow his nose and then breathe through his nose, closing his mouth. Usually there is bleeding, which stops quickly. Conduct several repeated examinations for a couple of hours. If there are no complications, the bleeding stopped, then usually go home( this is if the operation was performed under local anesthesia).
In the first day after the operation at home, the child is shown a strict bed rest. It is necessary to exclude physical activity( for at least two weeks), hot and rough food. It is necessary to limit exposure to the sun, do not wash in hot water and steam. It is useful to carry out breathing exercises, which should advise ENT doctor. Further, a gradual transition to an ordinary way of life.
Endoscopic adenoidectomy
In addition to the usual method of adenoid removal, there is a more modern operation - endoscopic adenoidectomy. This operation is carried out using a special technique( endoscope).With its help, penetration into the nasopharynx takes place, where you can not only well consider the size and condition of the adenoid tissue in the child, take a photo of this tissue and remove it.
Endoscopic adenoidectomy
The effect of the operation is usually good: in most cases, nasal breathing is restored immediately after surgery, the child becomes mobile, begins to develop better. Unfortunately, relapses are possible, adenoids can again grow. In such cases, a second operation is necessary.
Relapses may result from:
1. Incomplete removal of adenoids( even if a millimeter of tissue is left, it can again proliferate). When using an endoscope this usually does not occur ;
2. Early age of the operation( up to three years).But if there are absolute indications for the operation, then it is carried out at any age;
3. Child's addiction to allergy;
4. Individual features of rapid proliferation of adenoid tissue in a child.
It is not necessary to be afraid of a repeat operation, as it will take about five minutes to complete and will bring relief to the child. If a repeat operation is needed, but not carried out, the child will have the complications described above.