Adenoids are a pathological overgrowth of the lymphoid tissue of the nasopharyngeal tonsil, more often in children 3-10 years old. It is accompanied by difficulty in free nasal breathing, snoring during sleep, nasal voice, runny nose. It leads to frequent colds and inflammation in the middle ear, hearing loss, voice changes, slurred speech, developmental delay, formation of malocclusion. The diagnosis is made by an otolaryngologist on the basis of pharyngoscopy, rhinoscopy, nasopharyngeal radiography, endoscopic examination of the nasopharynx. With surgical removal of adenoids (adenotomy, cryodestruction), a recurrence of their proliferation is not excluded.
J35 Chronic diseases of the tonsils and adenoids
Adenoids are pathological enlargement of the nasopharyngeal tonsil. The disease is detected in 5-8% of children aged 3 to 7 years, equally often affects boys and girls. In older children, the incidence rate decreases. In patients over the age of 15, hypertrophy of the nasopharyngeal tonsil is rarely detected, although in some cases adults may also be ill.
Together with food, water and air, a huge number of microbes enter the human body through the mouth. In the pharynx there are lymphoid formations (tonsils) that prevent the penetration of infection and protect the body from pathogens. The tonsils form a pharyngeal ring (the Valdeira-Pirogov ring). The nasopharyngeal tonsil is part of the pharyngeal ring and is located on the arch of the nasopharynx. The amygdala is well developed in children, decreases with age and often completely atrophies.
Causes of adenoids
There is a hereditary predisposition to the proliferation of the nasopharyngeal tonsil, due to a deviation in the structure of the endocrine and lymphatic system (lymphatic-hypoplastic diathesis). In children with this anomaly, along with adenoids, a decrease in thyroid function is often detected, which is manifested by apathy, lethargy, swelling and a tendency to fullness.
A predisposing factor in the development of adenoids may be a nutritional disorder (over-feeding) and the toxic effect of a number of viruses. Secondary inflammation and enlargement of adenoids can develop after childhood infectious diseases such as whooping cough, measles, scarlet fever and diphtheria.
There are three degrees of adenoid enlargement:
- 1 – adenoids cover a third of the choan and coulter. During the day, the child breathes freely. At night, due to the transition to a horizontal position and an increase in the volume of adenoids, breathing is difficult.
- 2 – adenoids cover half of the choan and the coulter. The child breathes mainly through his mouth day and night, often snores in his sleep.
- 3 – adenoids completely (or almost entirely) cover the coulter and choans. The symptoms are the same as with grade 2, but more pronounced.
Symptoms of adenoids
The child’s nose is constantly or periodically blocked, characterized by abundant serous discharge. The child sleeps with his mouth open. Due to breathing difficulties, the patient’s sleep becomes restless, accompanied by loud snoring. Children often have nightmares. During sleep, there may be attacks of suffocation caused by the sinking of the root of the tongue.
With large adenoids, phonation is disturbed, the patient’s voice becomes nasal. The openings of the auditory tubes are closed by overgrown adenoids, which causes hearing loss. Children become distracted and inattentive. Due to adenoids, stagnant hyperemia of the surrounding soft tissues develops (posterior palatine arches, soft palate, nasal mucosa). As a result, breathing problems worsen, rhinitis often develops, eventually turning into chronic catarrhal rhinitis.
The proliferation of adenoid tissue is often complicated by adenoiditis (inflammation of the adenoids). With an exacerbation of adenoiditis, signs of a general nonspecific infection appear (weakness, fever). Adenoids and especially adenoiditis are often accompanied by an increase in regional lymph nodes. The long course of the disease leads to a violation of the normal process of development of the facial skeleton. The lower jaw becomes narrow, elongates. Due to the violation of the formation of the hard palate, malocclusion occurs. The patient’s face acquires a peculiar “adenoid appearance”.
Adenoids can affect the mechanism of respiration. When a jet of air passes through the nasal cavity, the reflex formation of the character of inhalation and exhalation occurs. Therefore, a person always breathes through the nose deeper than through the mouth. Prolonged breathing through the mouth causes a slight, but uncompensated shortage of ventilation.
The child’s blood is less saturated with oxygen, chronic mild hypoxia of the brain occurs. Due to chronic oxygenation disorders, children with a long course of adenoids sometimes develop some mental retardation. Patients often complain of headaches, study poorly, and have difficulty memorizing educational material.
A decrease in the depth of inspiration for a long period of time causes a violation of the formation of the chest. The child develops such a deformity of the chest as a “chicken breast”. In a number of patients with adenoids, anemia, disruption of the gastrointestinal tract (loss of appetite, vomiting, constipation or diarrhea) is detected.
The diagnosis is made on the basis of a detailed examination, a carefully collected anamnesis and data from instrumental studies. The following instrumental techniques are used:
- Pharyngoscopy. The study evaluates the condition of the oropharynx and palatine tonsils. The presence of a detachable mucopurulent character on the back wall of the pharynx is determined. To inspect the adenoids, the soft palate is lifted with a spatula.
- Anterior rhinoscopy. The doctor examines the nasal passages. The study reveals edema and the presence of discharge in the nasal cavity. Vasoconstrictive drops are instilled into the child’s nose, after which the adenoids covering the choana become visible. The child is asked to swallow. The resulting contraction of the soft palate causes an oscillation of the adenoids, in which light glare is visible on the surface of the tonsils.
- Posterior rhinoscopy. The doctor examines the nasal passages through the oropharynx using a mirror. On examination, adenoids are visible, which are a hemispherical tumor with furrows on the surface or a group of hanging formations in various parts of the nasopharynx. The study is highly informative, but its implementation presents certain difficulties, especially in young children.
- Radiography of the nasopharynx. The radiograph is performed in a lateral projection. During the study, the child opens his mouth so that the adenoids are more clearly contrasted with the air. An X-ray allows you to reliably diagnose adenoids and accurately determine their degree.
- Nasopharyngeal endoscopy. A highly informative study that allows for a detailed examination of the nasopharynx. When examining young children, anesthesia is required.
Treatment of adenoids
Treatment tactics are determined not so much by the size of the adenoids as by concomitant disorders. Indications for surgery are determined by an otolaryngologist. In young children, operations with adenoids are performed under general anesthesia. In older children, they are often performed under local anesthesia. Cryodestruction of adenoids or their endoscopic removal is possible.
In allergy-prone patients, adenoids often recur, so surgical treatment should be combined with desensitizing therapy. With the proliferation of nasopharyngeal tonsils of the 1st degree and mild respiratory impairment, conservative therapy is recommended (instillation of a 2% solution of protargol). The patient is prescribed general tonic agents (vitamins, calcium preparations, fish oil).