Adenoidit at children – the chronic inflammatory process developing in a hypertrophied pharyngeal almond (adenoides). It is shown by symptoms of adenoides: difficulty of nasal breath, twang of a voice, snore in a dream. Also inflammation signs in the form of cold and temperature increase are noted. Adenoidit at children has a chronic current and further leads to a delay of physical and intellectual development. The disease is diagnosed clinically, is confirmed by results of a rinoskopiya, a rinotsitologichesky research and a X-ray analysis. Treatment is directed to elimination of the center of an infection and restoration of nasal breath.
Adenoidit at children
Adenoidit at children – the frequent reason of the address to the pediatrician and the children's otorhinolaryngologist. Incidence makes about 15:1 000 taking into account the available adenoides without inflammation. Comes to light more often at children from 2-3 to 7 years as at this age the maximum physiological sizes of a pharyngeal almond are noted. Among school students pathology is diagnosed several times less often. Relevance of a disease in pediatrics is extremely high. Now adenoidit at children meets more often in comparison with incidence at the end of the 20th century. It is connected with increase in number of pathologies of pregnancy and the childbirth leading to easing of immunity in population and also with distribution of antibiotikorezistentny forms of microorganisms.
The reasons of an adenoidit at children
Inflammatory process in the expanded lymphoid fabric of a pharyngeal almond most often is caused by a hemolytic streptococcus, respiratory viruses, is more rare – mushrooms and opportunistic flora, tuberculosis mikobakteriya etc. The risk of emergence of an adenoidit at children increases if the child often and long is ill, and also has the burdened allergologichesky anamnesis. The narrow nasal courses (for example, at a curvature of a nasal partition) promote decrease in natural sanitation of a cavity of a nose and a long persistention of pathogenic microorganisms on a pharyngeal almond.
As adenoidit at children develops on a hypertrophied pharyngeal almond, It is necessary to tell about the reasons of growth of lymphoid fabric separately. Many children in that other degree have the adenoides presented by the increased pharyngeal almond. They usually appear at the age of 2-7 years and are gradually reduced after a puberty. It is caused by the fact that pharyngeal almond in the early childhood plays a role of the first immune barrier to respiratory infections. Adenoidit occurs at children when adenoides long remain unnoticed, the child often is ill as a result of an immunodeficiency or conservative therapy is inefficient.
Symptoms of an adenoidit at children
Manifestations of an adenoidit at children always accumulate on an overall picture of adenoides. Treat the complicated breath through a nose because of what the kid breathes through the mouth signs of increase in a palatal almond and snores in a dream, and also the closed twang at which sounds of "m" and "N" actually vanish from the speech. Besides, the child has characteristic appearance: the mouth is open, the person gipomimichny, nasolabial folds are maleficiated. At a long current also adenoidit adenoides at children lead to a delay of physical development, decrease in memory and attention. The child gets quickly tired and irritated owing to a chronic hypoxia and lack of a healthy night sleep.
Besides above-mentioned symptomatology adenoidit at children is followed by the temperature increase (more often to subfebrilny values) which was even more expressed by difficulty of nasal breath up to its total absence and also cold. The nasal secret is removed hardly, but even after that breath through a nose is facilitated only for a short time. The disease has chronic character and often leads to complications from cardiovascular system. It is connected with the fact that the most frequent activator is the hemolytic streptococcus of group A having a similar structure with cells of heart therefore endocarditises and myocardites develop on the autoimmune mechanism. Adenoidit at children quite often is followed by otitises and conjunctivitis.
The child often has viral infections. It is caused by both decrease in immunity, and continuous secretion of the infected slime at an adenoidita at children. Slime flows down on a back wall of a throat, inflammatory process extends in the lower departments of a respiratory path. The chronic hypoxia and constant tension of immune system lead to a delay of physical and intellectual development. Deficiency of oxygen is shown not only the general gipoksemiya, but also an underdevelopment of a facial skull, in particular, of the top jaw owing to what at the child the wrong bite is formed. Deformation of the sky (the "Gothic" sky) and development of a "chicken" thorax is possible. Adenoidit at children also leads to chronic anemia.
Diagnostics of an adenoidit at children
To suspect adenoides and adenoidit at children the pediatrician can at fizikalny survey. At the child the "adenoidny" face type about which it is told above is formed. Difficulty of nasal breath, twang, frequent viral infections are indications to carrying out a rinoskopiya to the child. The forward rinoskopiya is carried out at assignment of a tip of a nose up. It is so possible to estimate a condition mucous, passability of the nasal courses and to notice adenoides at a considerable hypertrophy of a pharyngeal almond. The back rinoskopiya is technically more difficult, especially taking into account age of the patient, but she allows to examine a back wall of a throat, to define presence of adenoides and an adenoidit at children.
Carrying out a manual research is possible. The procedure is simple and takes only several seconds. The method is very informative, but is extremely unpleasant for the child therefore the research is usually carried out at the end of survey. Also endonasal diagnostics of an adenoidit at children is applied. It allows to visualize adenoides, to estimate their condition and extent of increase, but its carrying out demands special preparation (anesthesia, an anemization of mucous). Existence of anatomic deformations of a nasal cavity is a contraindication to this research therefore it is necessary to exclude previously possible curvatures, and also polyps of a nose and other educations, otherwise danger of bleeding is big.
The Rinotsitologichesky research (dab from a nose with the subsequent microscopy) gives an idea of cellular composition of slime. So, the high content of eosinophils indicates the allergic nature of adenoides and an adenoidit at children. For confirmation of the allergic nature of a disease skin tests, especially in the presence of an allergy at parents and allergodermatoz in the anamnesis at the child are carried out. Consultation of the otorhinolaryngologist is obligatory. Otoskopiya allows to estimate a condition of an eardrum and involvement of an acoustical pipe and a cavity of an ear at inflammatory process. At survey hearing of the child is also estimated.
Diagnostics of an adenoidit at children includes a skull X-ray analysis in a direct and side projection for an exception of sinusitis and tumors of a cavity of a nose and a throat. KT and MRT are necessary at suspicion of forward brain hernia which leads to violation of nasal breath, however at such pathology deformations of a facial skull with wider position of eyes and other signs are more often noted. The atresia Joán is shown by utter impossibility of nasal breath from one or two parties, but this malformation is more often diagnosed right after the birth. At suspicion on an atresia Joán carry out test with an instillation of color drops to a nose.
Treatment of an adenoidit at children
Conservative therapy of a disease includes sanitation of the center of an inflammation and ensuring full nasal breath. Washing by solutions of anti-septic tanks, and also isotonic salt solutions is appointed. Aerosol antibiotics and steroid medicines, drops with antiseptic and vasoconstrictive effect are applied (adrenomimetik are used only by short courses). Also in treatment of an adenoidit at children inhalations with antiseptics and mucolytics are effective. Any antibiotics are used only after confirmation of the nature of a disease, that is allocation of the activator and definition of its sensitivity to medicines. For stimulation of immunity interferon inductors are shown.
Surgical treatment of adenoides and adenoidit at children is carried out at inefficiency of conservative methods, and also at difficulty of nasal breath. An important condition for carrying out operation is lack of an aggravation of inflammatory process. Duration of remission has to make not less than one month. Usually the adenotomiya is carried out by means of an adenotom, lymphoid fabric is cut off by a special knife under local anesthesia or the general anesthesia depending on age of the patient, degree of adenoides, existence of a hearing disorder etc. Also perhaps endonasal removal of adenoides, but when using of the given technique more often there are sites of lymphoid fabric therefore there can be a need for repeated operation. Hospitalization for an adenotomiya is not required.
The forecast and prevention of an adenoidit at children
The forecast of a disease favorable at timely diagnostics and therapy. At repeated growth of adenoides the recurrence of an adenoidit at children is possible, it happens seldom and is the indication to a repeated adenotomiya. The separate block of adaptation of the child is presented by restoration of nasal breath as patients get used to breathe through the mouth. The kid is engaged in special exercises together with parents, if necessary – with the logopedist. Prevention of an adenoidit at children is timely removal of adenoides or successful conservative therapy. The obligatory moment – maintenance of immunity of the child what the full-fledged diet, stay in the fresh air and other tempering procedures is necessary for.