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% of the adenoids are diagnosed in children aged 3-10 years; less often – in infancy and in children over 10 years old. From about 12 years of age, adenoid vegetations of the pharyngeal tonsil undergo a reverse development and are practically atrophied by the age of 17-18. In rare cases (less than 1%), adenoids are detected in adults.
The nasopharyngeal or pharyngeal tonsil is located in the region of the pharynx, on the upper and back wall of its nasal part. Together with other lymphoid structures of the pharynx (palatal, tubal and lingual tonsils), the nasopharyngeal tonsil forms the so-called Waldeyer-Pirogov ring, which serves as a protective barrier against the penetration of the infection into the body. Normally, the nasopharyngeal tonsil is small and is defined as a slight elevation under the pharyngeal mucosa.
Adenoids in a child are strongly overgrown pharyngeal tonsil, which partially covers the nasopharynx and pharyngeal openings of the Eustachian tubes, which is accompanied by a violation of free nasal breathing and hearing.
Causes of adenoids in children
Adenoids in children can be caused by congenital features of the children’s body – the so-called lymphatic-hypoplastic diathesis – an anomaly of the constitution, accompanied by a weakened immune system, endocrine disorders. Children with lymphatic-hypoplastic diathesis often suffer from overgrowth of lymphoid tissue – adenoids, lymphadenopathy. Often, adenoids are found in children with hypofunction of the thyroid gland – sluggish, pastous, apathetic, slow-moving, with hypersthenic body build.
Adverse effects on the formation of the child’s immune system are caused by intrauterine infections , the intake of pregnant drugs, and the influence of physical factors and toxic substances (ionizing radiation, chemicals) on the fetus.
The development of adenoids in children is promoted by frequent acute and chronic diseases of the upper respiratory tract: pharyngitis , tonsillitis , laryngitis . Triggering factor for the growth of the adenoids in children can appear infections – flu , SARS , measles , diphtheria , scarlet fever , whooping cough , rubella , etc. A role in the growth of the adenoids in children can play syphilitic infection (. Congenital syphilis ), tuberculosis . Adenoids in children can occur as an isolated pathology of lymphoid tissue, but much more often they are combined withtonsillitis .
Among other reasons leading to the occurrence of adenoids in children, an increased allergenization of the child’s body, vitamin deficiencies, nutritional factors, fungal invasions , unfavorable social conditions, etc. , are distinguished .
The predominant occurrence of adenoids in children of preschool age is likely due to the development of immunological reactivity observed during this period (4-6 years).
The failure of the child’s immune system, along with permanent and high bacterial contamination, leads to lymphocytic lymphoblastic hyperplasia of the nasopharyngeal tonsil as a mechanism for compensating for increased infectious load. A significant increase in the nasopharyngeal tonsil is accompanied by a disorder of free nasal breathing, impaired mucociliary transport and the occurrence of a stasis of mucus in the nasal cavity. At the same time, allergens, bacteria, viruses, and foreign particles that penetrate into the nasal cavity with air flow adhere to the mucus, are fixed in the nasopharynx and become triggers of infectious inflammation. Thus, adenoids in children themselves become, over time, a focal point of infection, which extends to both neighboring and distant organs.
Classification degrees of adenoids in children
Depending on the severity of lymphoid vegetation, III degree of adenoids is distinguished in children.
- I – adenoid vegetations extend to the upper third of the nasopharynx and the upper third of the vomer. The discomfort and difficulty of nasal breathing in a child is observed only at night, during sleep.
- II – adenoid vegetations overlap half of nasopharynx and half of vomer. The characteristic difficulty of nasal breathing during the daytime, night snoring.
- III – adenoid vegetations fill the entire nasopharynx, completely cover the vomer, reach the level of the posterior edge of the inferior nasal concha; sometimes adenoids in children can act in the lumen of the oropharynx. Nasal breathing becomes impossible, the child breathes exclusively through the mouth.
Symptoms of adenoids in children
The 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 disturbance of the reflex connections and the development of infection in the adenoid tissue.
Mechanical obturation of the nasopharynx and choanas is accompanied by a violation of nasal breathing. Difficulties of nasal inhalation and exhalation may be moderate (with I grade adenoids in children) or pronounced, up to the complete impossibility of breathing through the nose (with adenoids II, III degree). The pressure of the lymphoid tissue on the vessels of the mucous membrane leads to edema and the development of persistent rhinitis. In turn, this makes breathing through the nose even more difficult. Adenoids in infants lead to difficulty sucking and, as a consequence, systematic underfeeding and malnutrition. Reduced blood oxygenation is accompanied by the development of anemia in children .
Due to difficulty in nasal breathing, children with adenoids sleep with their mouths open, snore in their sleep, and often awaken. The result of an inferior night’s sleep is apathy and lethargy during the daytime hours, fatigue, memory loss, and a decline in schoolchildren’s performance.
The presence of adenoids in children forms a recognizable type of face, characterized by constantly half-open mouth, smooth nasolabial folds, sagging of the lower jaw, small exophthalmos . Adenoids in children can lead to impaired formation of the facial skeleton and dentition: in this case, the lengthening and narrowing of the alveolar process, high palate (hypsytaphilia – gothic palate), abnormal development of the upper incisors, occlusion anomalies , curvature of the nasal septum are noted .
The voice in children with adenoids is nasalized, monotonous, quiet. Rhinophony is due to the fact that the hypertrophied nasopharyngeal tonsil prevents the passage of air into the nasal cavity and nasal sinuses, which are resonators and take part in phonation. In speech therapy, this condition is regarded as a posterior closed organic rhinolalia . Owing to the overlap of the pharyngeal openings of the auditory tube with adenoids, natural ventilation of the middle ear becomes difficult, which leads to conductive hearing loss . Enlarged adenoids in children are accompanied by impaired sense of smell and swallowing. Frequent shallow mouth breathing in children with adenoids causes deformation of the chest (the so-called ” chicken breast “).
A number of manifestations of adenoids in children is associated with the neuro-reflex developmental mechanism. Children with adenoids may suffer from headaches , neurosis, epileptiform seizures, enuresis , intrusive paroxysmal cough, choreiform movements of facial muscles, laryngospasm, etc.
Persistent chronic inflammation of the nasopharyngeal tonsil is the background for the development of allergic and infectious diseases: chronic rhinitis , sinusitis , otitis media , tonsillitis. Inhalation through the mouth of cold and unclean air causes frequent respiratory diseases – laryngitis, tracheitis , bronchitis .
Diagnosis of adenoids in children
Suspicion of adenoids requires a pediatrician and narrow specialists to conduct an extended examination of the child. In the presence of adenoids in children, a consultation of a children’s allergist-immunologist is carried out with the formulation and evaluation of skin allergies. A pediatric neurologist’s consultation is required for children with epileptiform seizures and headaches; Pediatric endocrinologist consultation – for signs of thyroid hypofunction and timomegaly.
Laboratory diagnosis of adenoids in children includes a general blood and urine test, a study of immunoglobulin E, bacterial nasopharyngeal microorganisms and sensitivity to antibiotics, cytology of imprints from the surface of adenoid tissue, ELISA and PCR diagnostics for infections.
The main role in identifying adenoids in children and related disorders belongs to the pediatric otolaryngologist. To determine the size and consistency of adenoids in children, as well as the degree of adenoid vegetations, a digital examination of the nasopharynx, posterior rhinoscopy, endoscopic rhinoscopy and epipharyngoscopy are used . On examination, adenoids in children are defined as formations of a soft consistency and pink color, having an irregular shape and a broad base, located on the arch of the nasopharynx.
Data instrumental studies are refined by conducting a side X-ray of the nasopharynx and CT.
Treatment of adenoids in children
Depending on the degree of hypertrophy of the pharyngeal tonsil and the severity of clinical manifestations, the treatment of adenoids in children may be conservative or surgical.
Conservative therapy of adenoids in children is carried out with I – II degree of hypertrophy or the impossibility of their surgical removal. With repeated infections, antibiotic therapy, immunostimulants, and vitamins are prescribed. Symptomatic therapy includes instillation of vasoconstrictor preparations, washing the nasal cavity with saline solutions, decoction of herbs, antiseptics, and ozonated solution. When adenoids in children Pediatrics is widely physiotherapy techniques: laser , UFO , OKUF therapy , UHF on the nose, magnetic therapy , electrophoresis , EHF-therapy , climatotherapy. If desired, parents can use the services of a children’s homeopath and undergo a course of homeopathic treatment.
The indications for surgical removal of adenoids in children are: the ineffectiveness of conservative tactics in grade II hypertrophy; III degree adenoids; severe nasal breathing; sleep apnea syndrome ; chronic (recurrent) adenoiditis, sinusitis, otitis , pharyngitis, laryngitis, pneumonia , etc.; maxillofacial anomalies caused by overgrown adenoids.
Surgery to remove adenoids in children ( perineal adenotomy / adenoidectomy) and can be performed under local anesthesia or general anesthesia. Possible endoscopic removal of adenoids in children under visual control.
Alternative surgical interventions for adenoids in children are: removal of the adenoids using a laser (laser adenoidectomy, interstitial destruction, vaporization of the adenoid tissue), cryodestruction of the adenoids .
Prognosis and prevention of adenoids in children
Timely diagnosis and adequate therapy of adenoids in children leads to a steady recovery of nasal breathing and the elimination of associated infections, increased physical and mental activity, normalization of the physical and intellectual development of the child.
Complications of surgical treatment and recurrence of adenoids often occur in children with allergies ( asthma , urticaria , angioedema , bronchitis, etc.). Children with concomitant disorders (occlusion anomalies, speech disorders) in the future often require the help of a children’s orthodontist and a speech therapist .
Prevention of adenoids in children requires mandatory vaccination , hardening, early diagnosis and rational treatment of infections of the upper respiratory tract, improving the immunological properties of the body.
Adenoids in children – excessive proliferation of lymphoid tissue of the pharyngeal (nasopharyngeal) tonsil, accompanied by a violation of its protective function. Adenoids in children are manifested by nasal breathing disorder, rhinophony, hearing loss, snoring during sleep, recurrent otitis media and catarrhal infections, asthenic syndrome. Diagnosis of adenoids in children includes consulting a pediatric otolaryngologist with a digital examination of the nasopharynx, posterior rhinoscopy, endoscopic rhinoscopy and epipharingoscopy, nasopharyngeal radiography. Treatment of adenoids in children can be carried out by conservative methods (antibiotics, immunity stimulators, PTL) or surgically (adenotomy, endoscopic removal, laser removal, cryodestruction).