Adenoiditis in children is a common cause of appeal to a pediatrician and pediatric otorhinolaryngologist . The incidence is approximately 15: 1 000, taking into account the existing adenoids without inflammation. Most often detected in children from 2-3 to 7 years, since it is at this age marked the maximum physiological dimensions of the pharyngeal tonsil. Among schoolchildren, pathology is diagnosed several times less. The relevance of the disease in pediatricsextremely high.
Currently, adenoiditis in children is more common in comparison with the incidence rate at the end of the 20th century. This is associated with an increase in the number of pathologies of pregnancy and childbirth, leading to a weakening of the immunity in the population, as well as the spread of antibiotic-resistant forms of microorganisms.
Causes of adenoiditis in children
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 conditionally pathogenic flora, mycobacteria of tuberculosis, and so on. burdened with allergic history. Narrow nasal passages (for example, when the nasal septum is curved) contribute to the reduction of the natural reorganization of the nasal cavity and the long persistence of pathogenic microorganisms on the pharyngeal tonsil.
Since adenoiditis in children develops in a hypertrophied pharyngeal tonsil, it is worth mentioning separately the reasons for the growth of lymphoid tissue. Many children in a different degree have adenoids, represented by enlarged pharyngeal tonsil. They usually appear at the age of 2-7 years and gradually decrease after puberty. This is due to the fact that it is the pharyngeal tonsil in early childhood that plays the role of the first immune barrier to respiratory infections. Adenoiditis in children occurs when the adenoids go unnoticed for a long time, the child often suffers from immunodeficiency or conservative therapy is ineffective.
Symptoms of adenoiditis in children
Manifestations of adenoiditis in children always layered on the overall picture of the adenoids. The signs of an increase in palatine tonsil include difficulty breathing through the nose, because of which the baby breathes through his mouth and snores in his sleep, as well as the closed nasal, in which the sounds of “m” and “n” actually disappear from speech. In addition, the child has a distinctive 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, loss of memory and attention. The child quickly gets tired and irritated due to chronic hypoxia and the lack of a good night’s sleep.
In addition to the above symptoms, adenoiditis in children is accompanied by an increase in temperature (more often to subfebrile values), an even more pronounced difficulty in nasal breathing up to its complete absence, as well as a runny nose . Nasal secretion is 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 cardiovascular complications. This is due to the fact that the most frequent causative agent is group A hemolytic streptococcus, which has a similar structure to the heart cells, therefore endocarditis and myocarditis develop by an autoimmune mechanism. Adenoiditis in children is often accompanied by otitis andconjunctivitis .
The child often suffers from viral infections. This is due to a decrease in immunity and constant secretion of infected mucus in children with adenoiditis. The mucus flows down the back of the pharynx, the inflammatory process spreads to the lower parts of the respiratory tract. Chronic hypoxia and constant tension of the immune system lead to a delay in physical and mental development. The lack of oxygen is manifested not only by general hypoxemia, but also by the 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” palate) and the development of “chicken” chest. Adenoiditis in children also leads to chronic anemia.
Diagnosis of adenoiditis in children
Pediatrician may suspect adenoids and adenoiditis in children during physical examination. The child has a “adenoid” type of face, which is described above. Obstruction of nasal breathing, nasal, frequent viral infections are indications for the rhinoscopy of the child . Anterior rhinoscopy is carried out with the tip of the nose up. So you can assess the condition of the mucous membrane, the nasal passages and notice the adenoids themselves with significant hypertrophy of the pharyngeal tonsil. Back rhinoscopy is technically more difficult, especially considering the patient’s age, but it is this one that allows you to inspect the back wall of the pharynx, to determine the presence of adenoids and adenoiditis in children.
It is possible to conduct a finger study. The procedure is simple and takes only a few seconds. The method is very informative, but extremely unpleasant for the child, so research is usually performed at the end of the examination. Endonasal diagnosis of adenoiditis in children is also used. It allows visualization of adenoids, assessment of their condition and degree of magnification, but its implementation requires special training (anesthesia, anemization of the mucous membrane). The presence of anatomical deformities of the nasal cavity is a contraindication to this study, therefore it is necessary to first exclude possible curvatures, as well as nasal polyps and other structures, otherwise there is a great risk of bleeding.
Rhinocytological examination (smear from the nose, followed by microscopy) gives an idea of the cellular composition of the 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 if there is an allergy to the parents and a history of allergic dermatosis in the child. Mandatory consultation otorhinolaryngologist . Otoscopy allows you to assess the state of the eardrum and the involvement of the auditory tube and ear cavity in the inflammatory process. On examination, the child’s hearing is also evaluated.
Diagnosis of adenoiditis in children includes radiography of the skull in frontal and lateral projection to exclude sinusitis and tumors of the nasal cavity and pharynx. CT and MRI are necessary for suspected anterior cerebral hernia, which leads to a violation of nasal breathing, but with this pathology, deformities of the facial skull with wider eye position and other signs are more common. Atresia of Choan is manifested by the complete impossibility of nasal breathing from one or two sides, but this malformation is more often diagnosed immediately after birth. If atresia is suspected, choanas are tested with instillation of colored drops in the nose.
Treatment of adenoiditis in children
Conservative treatment of the disease includes the rehabilitation of the center of inflammation and ensuring full nasal breathing. Appointed by washing with antiseptic solutions, as well as isotonic salt solutions. Aerosol antibiotics and steroid preparations, drops with antiseptic and vasoconstrictive effect are used (adrenomimetics are used only for short courses). Also in the treatment of adenoiditis in children, inhalations with antiseptics and mucolytics are effective . Any antibiotics are used only after confirming the nature of the disease, that is, isolating the pathogen and determining its susceptibility to drugs. To stimulate the immune system shown interferon inductors.
Surgical treatment of adenoids and adenoiditis in children is carried out with the ineffectiveness of conservative methods, as well as with difficulty in nasal breathing. An important condition for the operation 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 adenotomy, the lymphoid tissue is cut with a special knife under local anesthesia or general anesthesia depending on the patient’s age, degree of adenoids, presence of hearing impairments, etc. Endonasal removal of adenoids is also possible, but more often lymphoid areas remain when using this technique tissue, so you may need to re-operation. Hospitalization for adenotomy is not required.
Prognosis and prevention of adenoiditis in children
The prognosis of the disease is favorable with timely diagnosis and therapy. With the re-growth of the adenoids, adenoiditis may recur in children, this rarely happens and is an indication for repeated adenotomy. A separate adaptation unit of the child is represented by the restoration of nasal breathing, as patients become accustomed to breathe through the mouth. The kid does special exercises with his parents, if necessary with a speech therapist . Prevention of adenoiditis in children is the timely removal of adenoids or successful conservative therapy. An obligatory moment is the maintenance of the child’s immunity, which requires a full-fledged diet, exposure to fresh air and other tempering procedures.
Adenoiditis in children is a chronic inflammatory process that develops in a hypertrophied pharyngeal tonsil (adenoids). Manifested by symptoms of adenoids: difficulty in nasal breathing, nasal voices, snoring in sleep. 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 studies and X-ray. The treatment is aimed at eliminating the source of infection and restoring nasal breathing.