Adenoidit - it is an acute or chronic inflammation of a pharyngeal almond of a limfoglotochny ring. Night snore, lack of nasal breath, mucous or purulent allocations, the closed twang, dry pristupoobrazny cough, a syndrome of intoxication, a sleep disorder belong to the main symptoms feeling of discomfort in a nose. Diagnostics is based on data of poll of the patient, a mezofaringoskopiya, back rinoskopiya, laboratory tests, a X-ray analysis or a computer tomography of area of a nasopharynx. In treatment of an adenoidit local and system medicamentous means, physical therapy are used, the adenoidektomiya is less often carried out.
Adenoidit (retronasal quinsy, or epifaringit) – the most widespread disease in children's otolaryngology. Most often it is observed at children of preschool and younger school age – from 3 to 9 years. Occurs at adults seldom that is connected with age involution of lymphoid fabric of a nasopharyngeal almond. According to statistical data, this pathology arises at 5-28% of representatives of the general children's population and at 70% of often ill children and teenagers. The indicator of primary incidence of a chronic adenoidit makes 1,8-2,7 on 1 000 children. Pathology is equally widespread among representatives men's and female, in 35-45% of cases is followed by recurrent or chronic diseases of bronchopulmonary system.
Reasons of an adenoidit
Retronasal quinsy – a polietiologichesky disease. The inflammation of adenoides is provoked by viruses or pathogenic bacteria. The group of viruses includes adenoviruses and herpes viruses, including a herpes virus 4 types – Epstein - Barrel. In bacterial associations crucial importance has deficiency of constant (indigenny) flora of a throat and increase in quantity of tranzitorny microflora of the sorts Moraxella (M.catarrhalis), Bacillus, Micrococcus, Pseudomonas, enterobakteriya (K.pneumoniae, K.oxytoca, E.coli), stafilokokk (S.aureus), streptococci (Str.pneumoniae, Str.pyogenes). The following factors can promote development of an adenoidit also:
- Frequent SARS. Constant high anti-gene loading owing to contact with a large number of viruses in combination with immaturity of immune system of children leads to violation of normal immunological processes in a pharyngeal almond, to formation of an adenoidit.
- Associated diseases. Include the recurrent or chronic diseases of the top airways which are the infection centers – rhinitises, nazofaringita, tubootita, sinusitis, tonsillitis, stomatitises. Separately allocate GERB at which hydrochloric acid supports a chronic inflammation of adenoides.
- Immunopathological states. The list includes diabetes, a hypothyroidism, HIV infection, genetically caused immunodeficiencies, allergic pathologies. At children of younger age lack of breastfeeding, insufficiency of vitamin D and the rickets developing on this background matters.
- Congenital features. Include hereditary tendency to growth of adenoidny vegetations and their inflammation, anomaly of the constitution as ekssudativno-catarrhal diathesis. An important role is played by the malformations breaking nasal breath – a curvature of a nasal partition, deformation of nasal sinks, etc.
- External influence. The ecological situation matters: excessively dry or polluted by production emissions air, the strengthened radiation background. Refer overcooling, steam burns of a nasopharynx, steam inhalation of chemicals and flying poisons to the promoting factors.
The damage of the resnitchaty epithelium which is on a surface of a pharyngeal almond, provoked by physical, thermal, chemical or biological factors is the cornerstone of pathogenesis of an adenoidit. On this soil so-called sites of "baldness", vulnerable to penetration of pathogenic bacteria and viruses are formed, the compensatory giperplaziya of lymphoid fabric develops. At excessive anti-gene loading processes of regeneration in an almond are broken, alteration of its cages amplifies. Atrophied and jet follicles result that in a combination with oppression of a fagotsitoz, deficiency of indigenny microflora and immaturity of immune system of the child leads to development of an inflammation.
Depending on duration of a current, expressiveness of symptoms and kliniko-morphological characteristics of an adenoidit distinguish several classifications of an inflammation of a nasopharyngeal almond. Such division of a disease into forms is caused by need of use of various therapeutic schemes at different situations. On the basis of duration of a current allocate the following options of an adenoidit:
- Sharp. Episodes of an inflammation of adenoides lasting up to 2 weeks and repeating no more than 3 times in a year concern to him. Average duration – from 5 to 10 days. Most often pathology develops sharply, against the background of ORZ or children's drop infections.
- Subsharp. As a rule, is a consequence of uncured sharp process. It is characteristic of children with a hypertrophied pharyngeal almond. The average duration of a disease does not exceed 20-25 days. The residual phenomena in the form of a subfebrilitet can be observed up to 30 days.
- Chronic. Here adenoidita which clinical symptoms remain more than 1 month enter or more than 4 times in a year repeat. As activators the combination of a bacterial and viral infection acts. Both initially chronic epifaringita, and consequences of inadequate therapy of a subsharp form meet.
Chronic adenoidit can be shown by various morphological changes in an almond parenchyma. Treat its main forms:
- Edematous and catarrhal. The exacerbation of a disease is followed by activation of inflammatory reactions in an almond, its expressed puffiness. In a clinical picture catarrhal symptoms prevail.
- Serous . It is characterized by a congestion of a large number of pathogenic microorganisms and purulent masses in deepenings of a parenchyma. As the result, an almond becomes edematous and hypertrophies.
- Mucopurulent. Inflammatory process is followed by continuous allocation of large volume of slime with impurity of purulent exudate. In parallel adenoidny fabric progressively increases in sizes.
On the basis of the general condition of the patient and expressiveness of the available clinical symptoms it is accepted to mark out 3 severity of an adenoidit:
- Compensated. Often is the physiological answer on infectious agents. The deterioration in the general state low-expressed or completely is absent. Incidentally there is a violation nasal breath, night snore.
- Subkompensirovany. Clinical manifestations gradually accrue, there is system intoxication answering to a sharp epifaringit. In the absence of due treatment the disease passes into a condition of a decompensation.
- Dekompensirovanny. In this case the pharyngeal almond loses the functions, turning into the center of a chronic infection. Local immunity at the same time completely is absent. Clinically it is followed by pronounced symptomatology.
Symptoms of an adenoidit
The disease has no patognomonichny symptoms or complaints. As primary manifestations feelings of tickling, a scratching in deep departments of a nose, noisy breath act during sleep. One more of early signs – night snore owing to which the dream of the child becomes uneasy, superficial. After a while join deterioration in nasal breath days, mucous allocation from a nose in the afternoon. Most of patients has a dry or unproductive cough of pristupoobrazny character which is becoming aggravated at night and at daybreak.
Further the intoksikatsionny syndrome – temperature increase of a body to 37,5-39 °C, a diffusion headache, the general weakness, drowsiness, deterioration or loss of appetite develops. Earlier arisen paresteziya gradually are transformed to the dull pressing aches without accurate localization which amplify when swallowing. The volume of mucous allocations from a nose increases, in them there is a purulent impurity. Drainage function of acoustical pipes is broken that leads to emergence of pain in ears, conductive relative deafness. Nasal breath becomes impossible, and the patient is forced to breathe through a mouth owing to what the last is constantly slightly opened. At the same time at the expense of an obturation Joán arises change of a voice as the closed twang.
At the long started current owing to a chronic hypoxia neurologic violations develop – the child becomes sluggish, apathetic, his ability to concentrate attention on something, memory, progress at school worsens. There is a distortion of a facial skull as "the adenoidny person": the hard palate becomes narrow and high, production of the saliva which subsequently is flowing down from a mouth corner amplifies. Also the top jaw is deformed – the top cutters are stuck out forward because of what nasolabial folds smooth out, the bite is distorted.
Complications of an adenoidit are connected with distribution of pathogenic microflora with a purulent masses in a nasal cavity, down a trakheobronkhialny tree. It becomes the reason of development of chronic rinosinusit, pharyngitises, laryngitis, trekheobronkhit, pneumonia. Aged up to 5 years there is a risk of formation of zaglotochny abscess. Long provokes eczema of a threshold of a nose and other dermatological defeats of this area. The accompanying inflammation of pipe almonds with obstruction of pharyngeal openings of acoustical pipes leads to evstakhiita, purulent average otitises and a heavy hearing disorder in the future. Long oxygen starvation of a brain is shown by a delay of mental development of the child, permanent neurologic frustration.
The diagnosis is exposed on the basis of anamnestichesky data, complaints of the child and parents, results of fizikalny and tool methods of a research. Laboratory tests play a role of the auxiliary methods allowing to specify an etiology of a disease and to decide on therapeutic tactics. The full diagnostic program consists from:
- Fizikalny inspection. At the general survey the otolaryngologist the attention to a voice and the speech of the patient, the nature of nasal breath is paid. At the same time twang of the closed type, difficulty or total absence of breath through a nose come to light. At a palpation of lymph nodes moderately increased, painless submandibular, occipital, forward and back cervical groups are defined.
- Mezofaringoskopiya. At survey of a pharynx a large number light yellow or flavovirent separated, flowing down on a hyperemic back wall of a throat is visualized. Also there is a reddening of palatal handles, increase in lymphoid follicles or lateral pharyngeal rollers.
- Back rinoskopiya. It gives the chance to reveal the increased, hyperemic, edematous nasopharyngeal almond covered with a fibrinozny raid. Visible lacunas are filled with purulent or mucous ekssudativny masses.
- Laboratory analyses. At a virus adenoidit in OAK the shift of a leykotsitarny formula to the right, increase in quantity of lymphocytes and SOE is displayed. Accession of bacterial flora is followed leykotsitozy, formula shift towards stab and young neutrophils. The microbiological research of nasal allocations is in addition conducted.
- Beam methods of diagnostics. The nasopharynx X-ray analysis in direct and side projections is used. It allows to reveal a hypertrophy of lymphoid fabric of the pharyngeal almond blocking openings Joán. At late stages the roentgenogram displays deformation of a hard palate, top jaw. For differentiation with tumors KT of a facial skeleton with contrast strengthening is used.
Treatment of an adenoidit
The treatment purpose – elimination of the center of an infection, prevention of synchronization of pathological process, its distribution to adjacent anatomical structures. Topichesky and system pharmacological means, physiotherapeutic procedures are for this purpose appointed. In hard cases, at the accompanying expressed growth of adenoidny vegetations or development of complications, expeditious treatment is shown. Thus, at an adenoidita it is carried out:
- Medicamentous therapy. It is presented by antibacterial or antiviral medicines, the hyposensibilizing means, dezintoksikatsionny actions, immunomodulators, vitamin complexes. As local therapy vasoconstrictive drops, topichesky corticosteroids, disinfectants in the form of sprays, inhalations of anti-septic tanks are appointed.
- Adenoidektomiya. Surgical treatment consists in excision of the hypertrophied lymphoid fabric blocking a gleam of the nasal courses and interfering normal nasal breath. Operation can be performed in the classical way by means of a scalpel or by means of the endoscopic equipment.
- Physical therapy. Are widely used: tubusny quartz, radiation of a nasal cavity and a back wall of a throat helium - the neon laser, an electrophoresis of medicamentous medicines on regional lymph nodes, respiratory gymnastics. Effectively sanatorium treatment which course includes cryooxygen and ozonoultrazvukovy therapy, mud procedures.
Forecast and prevention
At the full, correctly picked up treatment the forecast for life and health favorable. The risk of development of dangerous complications in such situations is extremely low – no more than 0,3-1%. Specific preventive actions for this pathology it is not developed. Sharp or aggravations of a chronic adenoidit early diagnostics and treatment of growths of adenoidny vegetations, infectious diseases and anomalies of development of a nasal cavity, strengthening of the general protective forces of an organism, avoiding of overcoolings, thermal and chemical burns of a nasopharynx, good and balanced nutrition, occupations active sports, regular control surveys of the otolaryngologist belong to nonspecific prevention.