Adenoids in children – excessive proliferation of lymphoid tissue of the pharyngeal (nasopharyngeal) amygdala, accompanied by a violation of its protective function. Adenoids in children are manifested by nasal breathing disorder, rhinophonia, hearing loss, snoring in sleep, recurrent otitis media and colds, asthenic syndrome. Diagnosis of adenoids in children includes consultation with a pediatric otolaryngologist with finger examination of the nasopharynx, posterior rhinoscopy, endoscopic rhinoscopy and epipharyngoscopy, radiography of the nasopharynx. Treatment of adenoids in children can be carried out by conservative methods (antibiotics, immune stimulants, physiotherapy treatment) or surgically (adenotomy, endoscopic removal, laser removal, cryodestruction).
J35 Chronic diseases of the tonsils and adenoids
Adenoids in children – excessive hypertrophy of the adenoid tissue forming the nasopharyngeal tonsil. Adenoids in children occupy the first place among all diseases of the upper respiratory tract in pediatric otolaryngology, accounting for about 30%. In 70-75%, adenoids are diagnosed in children aged 3-10 years; less often – in infancy and in children older than 10 years. From about the age of 12, adenoid vegetations of the pharyngeal tonsil undergo reverse development and by the age of 17-18 they practically atrophy. In rare cases (less than 1%) adenoids are detected in adults.
The nasopharyngeal or pharyngeal tonsil is located in the area of the arch of the pharynx, on the upper and back wall of its nasal part. Together with other lymphoid structures of the pharynx (palatine, tubal and lingual tonsils), the nasopharyngeal tonsil forms the so-called Waldeyer-Pirogov ring, which performs the function of a protective barrier against the penetration of infection into the body. Normally, the nasopharyngeal tonsil is small in size and is defined as a slight elevation under the pharyngeal mucosa. Adenoids in a child are a very overgrown pharyngeal tonsil, which partially overlaps the nasopharynx and pharyngeal openings of the Eustachian tubes, which is accompanied by a violation of free nasal breathing and hearing.
Adenoids in children can be caused by innate features of the child’s body – the so-called lymphatic-hypoplastic diathesis – an anomaly of the constitution, accompanied by a weakening of immunity, endocrine disorders. Children with lymphatic-hypoplastic diathesis often suffer from the proliferation of lymphoid tissue – adenoids, lymphadenopathy. Adenoids are often found in children with hypofunction of the thyroid gland – sluggish, pasty, apathetic, sedentary, with a hypersthenic physique.
An adverse effect on the formation of the child’s immune system is caused by intrauterine infections, the intake of medications by a pregnant woman, the effect on the fetus of physical factors and toxic substances (ionizing radiation, chemicals). The main causes of the development of adenoids in children are:
- Diseases of the upper respiratory tract. Frequent acute and chronic pharyngitis, tonsillitis, laryngitis.
- Acute respiratory infections. Influenza, SARS, measles, diphtheria, scarlet fever, whooping cough, rubella, etc.
- Specific infections. Syphilitic infection (congenital syphilis), tuberculosis can play a certain role in the proliferation of adenoids in children.
Adenoids in children can occur as an isolated pathology of lymphoid tissue, but they are much more often combined with angina. Among other reasons leading to the appearance of adenoids in children, there are increased allergization of the child’s body, hypovitaminosis, alimentary factors, fungal infestations, unfavorable social and living conditions, etc. The predominant occurrence of adenoids in preschool children, apparently, is explained by the formation of immunological reactivity observed during this period (4-6 years).
The nasopharyngeal or pharyngeal tonsil is located in the area of the arch of the pharynx, on the upper and back wall of its nasal part. Together with other lymphoid structures of the pharynx (palatine, tubal and lingual tonsils), the nasopharyngeal tonsil forms the so-called Waldeyer-Pirogov ring, which performs the function of a protective barrier against the penetration of infection into the body.
Normally, the nasopharyngeal tonsil is small in size and is defined as a slight elevation under the pharyngeal mucosa. Adenoids in a child are a very overgrown pharyngeal tonsil, which partially overlaps the nasopharynx and pharyngeal openings of the Eustachian tubes, which is accompanied by a violation of free nasal breathing and hearing.
The failure of the child’s immune system, along with constant and high bacterial contamination, leads to lymphocytic-lymphoblastic hyperplasia of the nasopharyngeal tonsil as a compensation mechanism for increased infectious load. A significant increase in the nasopharyngeal tonsil is accompanied by a disorder of free nasal breathing, a violation of mucociliary transport and the appearance of stagnation of mucus in the nasal cavity.
At the same time, allergens, bacteria, viruses, and foreign particles penetrating into the nasal cavity with the flow of air stick to the mucus, are fixed in the nasopharynx and become triggers of infectious inflammation. Thus, adenoids in children eventually become a focus of infection themselves, which spreads to both neighboring and distant organs. Secondary inflammation of the adenoid tissue (adenoiditis) leads to an even greater increase in the mass of the pharyngeal tonsil.
Depending on the severity of lymphoid vegetation, grade III adenoids are isolated in children.
- I – adenoid vegetations extend to the upper third of the nasopharynx and the upper third of the coulter. Discomfort and difficulty in nasal breathing in a child are noted only at night, during sleep.
- II – adenoid vegetations overlap half of the nasopharynx and half of the coulter. Characterized by pronounced difficulty of nasal breathing during the day, night snoring.
- III – adenoid vegetations fill the entire nasopharynx, completely cover the coulter, reach the level of the posterior edge of the lower nasal conch; sometimes adenoids in children can protrude into the lumen of the oropharynx. Nasal breathing becomes impossible, the child breathes exclusively through the mouth.
Clinical manifestations of adenoids in children are associated with a combination of three factors: a mechanical obstacle caused by an increase in the nasopharyngeal tonsil, a violation of reflex connections and the development of infection in the adenoid tissue.
Mechanical obturation of the nasopharynx and choan is accompanied by a violation of nasal breathing. Difficulties of nasal inhalation and exhalation can be moderate (with grade I adenoids in children) or pronounced, up to the complete impossibility of breathing through the nose (with grade II, III adenoids). The pressure of lymphoid tissue on the vessels of the mucous membrane leads to edema and the development of persistent rhinitis. In turn, this makes it even more difficult to breathe through the nose.
Adenoids in infants lead to difficulty sucking and, as a consequence, systematic malnutrition and hypotrophy. A decrease in blood oxygenation is accompanied by the development of anemia in children. Due to nasal breathing difficulties, children with adenoids sleep with their mouths open, snore in their sleep, and often wake up. The result of inadequate night sleep is apathy and lethargy in the daytime, rapid fatigue, memory loss, and a decrease in school performance.
The presence of adenoids forms a recognizable type of face, characterized by a constantly half-open mouth, smoothness of the nasolabial folds, sagging of the lower jaw, a slight exophthalmos. Adenoids can lead to a violation of the formation of the facial skeleton and the maxillary system: in this case, there is an elongation and narrowing of the alveolar process, high palate (hypsystaphilia – Gothic palate), abnormal development of the upper incisors, malocclusion, curvature of the nasal septum.
The voice of children with adenoids is nasalized, monotonous, quiet. Rhinophony is caused by the fact that the hypertrophied nasopharyngeal amygdala prevents the passage of air into the nasal cavity and sinuses, which are resonators and take part in phonation. In speech therapy, this condition is regarded as posterior closed organic rhinolalia.
Due to the overlap of the pharyngeal openings of the auditory tube by adenoids, the natural ventilation of air in the middle ear is hindered, which leads to conductive hearing loss. Enlarged adenoids in children are accompanied by impaired sense of smell and swallowing. Frequent shallow oral breathing in children with adenoids causes chest deformity (the so-called “chicken breast”).
A number of manifestations of adenoids in children are associated with the neuro-reflex mechanism of development. Children with adenoids may suffer from headaches, neuroses, epileptiform seizures, enuresis, compulsive paroxysmal cough, choreographic movements of facial muscles, laryngospasm, etc.
Permanent chronic inflammation of the nasopharyngeal tonsil is the background for the development of allergic and infectious diseases: chronic rhinitis, sinusitis, otitis media, tonsillitis. Inhalation of cold and uncleaned air through the mouth causes frequent respiratory diseases – laryngitis, tracheitis, bronchitis.
Suspicion of adenoids requires a pediatrician and specialized specialists to conduct an extended examination of the child. In the presence of adenoids in children, a consultation of a pediatric allergist-immunologist is conducted with the formulation and evaluation of skin allergy tests. Consultation of a pediatric neurologist is required for children with epileptiform seizures and headaches; consultation of a pediatric endocrinologist – with signs of thyroid hypofunction and thymomegaly.
Laboratory diagnostics for adenoids in children includes a general blood and urine test, a study of immunoglobulin E, nasopharyngeal bacposage for microflora and sensitivity to antibiotics, cytology of prints from the surface of adenoid tissue, ELISA and PCR diagnostics for the presence of infections.
The main role in the detection of adenoids and concomitant disorders belongs to the pediatric otolaryngologist. Finger examination of the nasopharynx, posterior rhinoscopy, endoscopic rhinoscopy and epipharyngoscopy are used to determine the size and consistency of adenoids in children, as well as the degree of adenoid vegetations. On examination, adenoids are defined as formations of a soft consistency and pink color, having an irregular shape and a wide base, located on the arch of the nasopharynx. The data of the instrumental study are clarified by performing lateral radiography of the nasopharynx and CT.
Depending on the degree of hypertrophy of the pharyngeal tonsil and the severity of clinical manifestations, treatment of adenoids in children can be conservative or surgical. Conservative therapy is carried out with grade I – II hypertrophy or the inability to surgically remove the tonsils. In case of repeated infections, antibiotic therapy, immunostimulants, vitamins are prescribed.
Symptomatic therapy includes instillation of vasoconstrictive drugs, washing of the nasal cavity with saline solutions, herbal decoctions, antiseptics, ozone-saturated solution. With adenoids in children, physiotherapy methods are widely used in pediatrics: laser therapy, UVI,UVGI, UHF for the nasal area, magnetotherapy, electrophoresis, EHF therapy, climatotherapy. If desired, parents can use the services of a children’s homeopath and undergo a course of homeopathic treatment.
Indications for surgical removal of adenoids in children are: ineffectiveness of conservative tactics for grade II hypertrophy; grade III adenoids; severe nasal breathing disorder; sleep apnea syndrome; chronic (recurrent) adenoiditis, sinusitis, otitis, pharyngitis, laryngitis, pneumonia, etc.; maxillofacial anomalies caused by overgrown adenoids.
Adenoid removal surgery in children (percrotal adenotomy / adenoidectomy) and can be performed under local anesthesia or general anesthesia. It is possible to perform endoscopic removal of adenoids in children under visual control. Alternative surgical interventions are: removal of adenoids using a laser (laser adenoidectomy, interstitial destruction, vaporization of adenoid tissue), cryodestruction of adenoids.
Prognosis and prevention
Timely diagnosis and adequate therapy leads to a stable recovery of nasal breathing and the elimination of concomitant infections, increased physical and mental activity, normalization of physical and intellectual development of the child.
Complications of surgical treatment and recurrence of adenoids often occur in children suffering from allergies (bronchial asthma, urticaria, Quincke’s edema, bronchitis, etc.). Children with developed concomitant disorders (malocclusion, speech disorders) in the future often need the help of a pediatric orthodontist and speech therapist.
Prevention of adenoids in children requires mandatory vaccination, hardening, early diagnosis and rational treatment of upper respiratory tract infections, increasing the immunological properties of the body.