Adenoiditis in children is a chronic inflammatory process that develops in the hypertrophied pharyngeal amygdala (adenoids). It is manifested by symptoms of adenoids: difficulty in nasal breathing, nasal voice, snoring in a dream. There are also signs of inflammation in the form of a runny nose and fever. Adenoiditis in children has a chronic course and further leads to a delay in physical and mental development. The disease is diagnosed clinically, confirmed by the results of rhinoscopy, rhinocytological examination and radiography. Treatment is aimed at eliminating the focus of infection and restoring nasal breathing.
J35 Chronic diseases of the tonsils and adenoids
Adenoiditis in children is a common reason for contacting a pediatrician and a pediatric otorhinolaryngologist. The incidence is approximately 15:1,000, taking into account the available adenoids without inflammation. It is more often detected in children from 2-3 to 7 years old, since it is at this age that the maximum physiological dimensions of the pharyngeal tonsil are noted. Among schoolchildren, pathology is diagnosed several times less often. The relevance of the disease in pediatrics is extremely high. Currently, adenoiditis in children is more common in comparison with the incidence rate at the end of the XX century. This is due to an increase in the number of pathologies of pregnancy and childbirth, leading to a weakening of immunity in the population, as well as the spread of antibiotic-resistant forms of microorganisms.
The inflammatory process in the overgrown lymphoid tissue of the pharyngeal tonsil is most often caused by hemolytic streptococcus, respiratory viruses, less often by fungi and opportunistic flora, mycobacterium tuberculosis, etc. The risk of adenoiditis in children increases if the child is often and for a long time ill, and also has a burdened allergic history. Narrow nasal passages (for example, with a curvature of the nasal septum) contribute to a decrease in the natural sanitation of the nasal cavity and the long-term persistence of pathogenic microorganisms on the pharyngeal tonsil.
Since adenoiditis in children develops on the hypertrophied pharyngeal tonsil, it is worth mentioning separately the causes of the proliferation of lymphoid tissue. Many children have adenoids to varying degrees, represented by an enlarged pharyngeal tonsil. They usually appear at the age of 2-7 years and are gradually reduced after puberty. This is due to the fact that it is the pharyngeal amygdala that plays the role of the first immune barrier for respiratory infections in early childhood. Adenoiditis in children occurs when adenoids go unnoticed for a long time, the child often gets sick as a result of immunodeficiency or conservative therapy is ineffective.
Manifestations of adenoiditis in children are always layered on the overall picture of adenoids. Signs of an increase in the palatine tonsil include difficulty breathing through the nose, which is why the baby breathes through his mouth and snores in his sleep, as well as closed nasal, in which the sounds “m” and “n” actually disappear from speech. In addition, the child has a characteristic appearance: the mouth is open, the face is hypomimic, the nasolabial folds are smoothed. With a long course of adenoids and adenoiditis in children lead to a delay in physical development, a decrease in memory and attention.
The child quickly gets tired and irritated due to chronic hypoxia and lack of a healthy night’s sleep. In addition to the above symptoms, adenoiditis in children is accompanied by an increase in temperature (more often to subfebrile values), even more pronounced difficulty in nasal breathing up to its complete absence, as well as a runny nose. Nasal secretions are removed with difficulty, but even after that, breathing through the nose is facilitated only for a short time.
The disease is chronic and often leads to complications from the cardiovascular system. This is due to the fact that the most common pathogen is hemolytic streptococcus group A, which has a similar structure to heart cells, therefore endocarditis and myocarditis develop by an autoimmune mechanism. Adenoiditis in children is often accompanied by otitis media and conjunctivitis. The child often suffers from viral infections. This is due to a decrease in immunity, and the constant secretion of infected mucus in children with adenoiditis.
Mucus flows down the back wall of the pharynx, the inflammatory process spreads to the lower respiratory tract. Chronic hypoxia and constant stress of the immune system lead to a delay in physical and mental development. Oxygen deficiency is manifested not only by general hypoxemia, but also by underdevelopment of the facial skull, in particular, the upper jaw, as a result of which the child forms an incorrect bite. Possible deformation of the palate (“Gothic” sky) and the development of a “chicken” chest. Adenoiditis in children also leads to chronic anemia.
A pediatrician can suspect adenoids and adenoiditis in children during a physical examination. The child has an “adenoid” type of face, which is mentioned above. Difficulty in nasal breathing, nasal twang, frequent viral infections are indications for rhinoscopy for a child.
- Anterior rhinoscopy is performed by pulling the tip of the nose up. So you can assess the condition of the mucous membrane, the patency of the nasal passages and notice the adenoids themselves with significant hypertrophy of the pharyngeal tonsil.
- Posterior rhinoscopy is technically more complicated, especially taking into account the age of the patient, but it allows you to examine the back wall of the pharynx, determine the presence of adenoids and adenoiditis in children.
It is possible to conduct a finger examination. The procedure is simple and takes only a few seconds. The method is very informative, but extremely unpleasant for the child, so the study is usually performed at the end of the examination. Endonasal diagnosis of adenoiditis in children is also used. It allows you to visualize the adenoids, assess their condition and the degree of enlargement, but its implementation requires special preparation (anesthesia, mucosal anemia). The presence of anatomical deformities of the nasal cavity is a contraindication to this study, therefore, it is necessary to exclude possible curvatures, as well as nasal polyps and other formations, otherwise there is a great risk of bleeding.
Rhinocytological examination (nasal smear followed by microscopy) gives an idea of the cellular composition of mucus. Thus, the high content of eosinophils indicates the allergic nature of adenoids and adenoiditis in children. To confirm the allergic nature of the disease, skin tests are carried out, especially in the presence of allergies in parents and allergodermatoses in the anamnesis of the child. Consultation of an otorhinolaryngologist is mandatory. Otoscopy allows you to assess the condition of the eardrum and the involvement of the auditory tube and ear cavity in the inflammatory process. The examination also evaluates the child’s hearing.
Diagnosis of adenoiditis in children includes skull x-ray in a straight and lateral projection to exclude sinusitis and tumors of the nasal cavity and pharynx. CT and MRI are necessary if an anterior cerebral hernia is suspected, which leads to a violation of nasal breathing, however, with such pathology, deformities of the facial skull with a wider eye position and other signs are more often noted. Hoan atresia is manifested by the complete impossibility of nasal breathing on one or two sides, but this malformation is more often diagnosed immediately after birth. If hoan atresia is suspected, a test is carried out with instillation of colored drops into the nose.
Treatment of the disease includes the rehabilitation of the focus of inflammation and the provision of full nasal breathing. Rinsing with antiseptic solutions, as well as isotonic salt solutions, is prescribed. Aerosol antibiotics and steroid preparations are used, drops with antiseptic and vasoconstrictive effect (adrenomimetics are used only in short courses). Also, inhalations with antiseptics and mucolytics are effective in the treatment of adenoiditis in children. Any antibiotics are used only after confirming the nature of the disease, that is, isolating the pathogen and determining its sensitivity to drugs. Interferon inducers are shown to stimulate immunity.
Operations for adenoids and adenoiditis in children are carried out with the ineffectiveness of conservative methods, as well as with difficulty in nasal breathing. An important condition for surgical intervention is the absence of exacerbation of the inflammatory process. The duration of remission should be at least one month.
Usually, an adenotomy is performed using an adenotome, the lymphoid tissue is cut off with a special knife under local anesthesia or general anesthesia, depending on the patient’s age, the degree of adenoids, the presence of hearing disorders, etc. Endonasal removal of adenoids is also possible, but when using this technique, areas of lymphoid tissue remain more often, so there may be a need for repeated surgery. Hospitalization for an adenotomy is not required.
Prognosis and prevention
The prognosis of the disease is favorable with timely diagnosis and therapy. With repeated proliferation of adenoids, a recurrence of adenoiditis in children is possible, this happens rarely and is an indication for repeated adenotomy. A separate block of adaptation of the child is represented by the restoration of nasal breathing, as patients get used to breathing through the mouth. The baby is engaged in special exercises with his parents, if necessary – with a speech therapist. Prevention of adenoiditis in children is timely removal of adenoids or successful conservative therapy. A mandatory moment is to maintain the immunity of the child, which requires a full-fledged diet, staying in the fresh air and other hardening procedures.