Adenoides at children – the excess growth of lymphoid fabric of a pharyngeal (nasopharyngeal) almond which is followed by violation of its protective function. Adenoides at children are shown by disorder of nasal breath, a rinofoniya, decrease in hearing, snore in a dream, repeated otitises and catarrhal infections, an asthenic syndrome. Diagnosis of adenoides at children includes consultation of the children's otolaryngologist with carrying out a manual research of a nasopharynx, a back rinoskopiya, an endoscopic rinoskopiya and epifaringoskopiya, nasopharynx X-ray analysis. Treatment of adenoides at children can be carried out by conservative methods (antibiotics, stimulators of immunity, FTL) or a surgical way (an adenotomiya, endoscopic removal, laser removal, cryodestruction).
Adenoides at children
Adenoides at children – an excessive hypertrophy of the adenoidny fabric forming a nasopharyngeal almond. Adenoides at children win first place among all diseases of the top airways in children's otolaryngology, making about 30%. In 70-75% adenoides are diagnosed for children at the age of 3-10 years; more rare – at chest age and at children 10 years are more senior. Approximately from 12-year age, adenoidny vegetations of a pharyngeal almond undergo the return development and by 17-18 years practically atrophy. In rare instances (less than 1%) adenoides come to light at adults.
The nasopharyngeal or pharyngeal almond is located in the field of the throat arch, on the top and back wall of its nasal part. Together with other lymphoid structures of a throat (palatal, pipe and lingual almonds), the nasopharyngeal almond forms the so-called ring of Valdeyera-Pirogov performing function of a protective barrier on the way of penetration of an infection to an organism. Normal the nasopharyngeal almond has the small sizes and is defined as a small eminence under mucous drinks. Adenoides at the child represent strongly expanded pharyngeal almond which partially blocks a nasopharynx and pharyngeal openings of Eustachian tubes that is followed by violation of free nasal breath and hearing.
The reasons of adenoides at children
Adenoides at children can be caused by congenital features of a children's organism – so-called limfatiko-hypoplastic diathesis - anomaly of the constitution which is followed by immunity easing, endocrine violations. Children with limfatiko-hypoplastic diathesis often suffer from growth of lymphoid fabric - adenoides, a limfadenopatiya. Quite often adenoides are found in children with hypofunction of a thyroid gland – sluggish, pastose, apathetic, inactive, with a hyper sthenic constitution.
Adverse impact on formation of immune system of the child is exerted by pre-natal infections, reception of the pregnant woman of medicines, impact on a fruit of physical factors and toxic substances (ionizing radiation, chemicals).
Development of adenoides in children is promoted by frequent sharp and chronic diseases of the top airways: pharyngitises, tonsillitis, laryngitis. For growth of adenoides at children infections - flu, a SARS, measles, diphtheria, scarlet fever, whooping cough, a rubella, etc. can be a starting factor. In growth of adenoides at children the syphilitic infection (congenital syphilis), tuberculosis can play a part. Adenoides can occur at children as the isolated pathology of lymphoid fabric, however much more often they are combined with quinsies.
Among the other causes leading to developing of adenoides at children allocate the raised allergization of a children's organism, hypovitaminoses, alimentary factors, fungal invasions, adverse social conditions, etc.
Primary developing of adenoides at children of preschool age, most likely, is explained by the formation of immunological reactivity observed during this period (4-6 years).
Insolvency of immune system of the child, along with a constant and a high bacterial obsemenennost, leads to a lymphocytic limfoblastnoy of a giperplaziya of a nasopharyngeal almond as to the mechanism of compensation of the raised infectious loading. Significant increase in a nasopharyngeal almond is followed by disorder of free nasal breath, violation of mukotsiliarny transport and emergence of stagnation of slime in a nose cavity. At the same time the allergens getting into a nose cavity with an air stream, bacteria, viruses, alien particles stick to slime, are fixed in a nasopharynx and become triggers of an infectious inflammation. Thus, adenoides at children become over time the infection center which extends both on next, and to the remote bodies. The secondary inflammation of adenoidny fabric (adenoidit) leads to a bigger increase in mass of a pharyngeal almond.
Classification of degrees of adenoides at children
Depending on expressiveness of lymphoid vegetation allocate the III degrees of adenoides at children.
- I – adenoidny vegetations extend to the top third of a nasopharynx and the top third of a soshnik. The discomfort and difficulty of nasal breath at the child are noted only at night, during sleep.
- II – adenoidny vegetations block a half of a nasopharynx and a half of a soshnik. The expressed difficulty of nasal breath in the afternoon, night snore is characteristic.
- III - adenoidny vegetations fill all nasopharynx, completely cover a soshnik, reach the level of the rear edge of the lower nasal sink; adenoides at children can sometimes act in a gleam of a rotoglotka. Nasal breath becomes impossible, the child breathes only through the mouth.
Symptoms of adenoides at children
Clinical displays of adenoides at children are connected with a combination of three factors: the mechanical obstacle caused by increase in a nasopharyngeal almond, violation of reflex communications and development of an infection in adenoidny fabric.
The mechanical obturation of a nasopharynx and Joán is followed by violation of nasal breath. Difficulties of a nasal breath and an exhalation can carry moderated (at the I degree of adenoides at children) or the expressed character, up to utter impossibility of breath through a nose (at adenoides of II, III degrees). Pressure of lymphoid fabric upon vessels of a mucous membrane leads to hypostasis and development of persistent cold. In turn, it even more complicates breath through a nose. Adenoides at children of chest age lead to difficulty of sucking and, as a result, - to a systematic underfeeding and a hypotrophy. Decrease in oxygenation of blood is followed by development of anemia in children.
Owing to the complicated nasal breath children with adenoides sleep with an open mouth, snore in a dream, often waken. Apathy and slackness in the afternoon, bystry fatigue, memory easing, decrease in progress at school students become result of a defective night dream.
Presence of adenoides at children forms the recognizable face type which is characterized by constantly half-open mouth, a smoothness of nasolabial folds, an otvisaniye of the lower jaw, a small ekzoftalm. Adenoides at children can lead to violation of formation of a facial skeleton and zubochelyustny system: in this case lengthening and narrowing of an alveolar shoot, high standing of the sky (a gipsistafiliya – the Gothic sky), the wrong development of the top cutters, anomalies of a bite, a curvature of a nasal partition is noted.
Voice at children with adenoides nasalized, monotonous, silent. Rinofoniya is caused by the fact that the hypertrophied nasopharyngeal almond interferes with pass of air to a cavity of a nose and the nasal bosoms which are resonators and taking part in a fonation. In logopedics this state is regarded as the back closed organic rinolaliya. Owing to overlapping by adenoides of pharyngeal openings of an acoustical pipe natural ventilation of air on average to fish soup is at a loss that results in conductive relative deafness. The increased adenoides at children are followed by violation of sense of smell and swallowing. Frequent superficial oral breath at children with adenoides causes deformation of a thorax (a so-called "chicken breast").
A number of displays of adenoides at children is connected with the neuroreflex mechanism of development. Children with adenoides can have headaches, neurosises, epileptiformny attacks, enuresis, persuasive pristupoobrazny cough, the horeepodobny movements of face muscles, a laryngospasm etc.
The constant chronic inflammation of a nasopharyngeal almond is a background for development of allergic and infectious diseases: chronic rhinitis, sinusitis, average otitis, tonsillitis. Inhalation through a mouth of the cold and crude air causes frequent respiratory diseases - laryngitis, tracheitises, bronchitis.
Diagnosis of adenoides at children
Suspicion of adenoides demands from the pediatrician and narrow experts of carrying out expanded inspection of the child. In the presence of adenoides at children consultation of the children's allergist-immunologist with statement and assessment skin is held. Consultation of the children's neurologist is required to children with epileptiformny attacks and headaches; consultation of the children's endocrinologist – at signs of hypofunction of a thyroid gland and a timomegaliya.
Laboratory diagnostics at adenoides at children includes performing the general blood test and urine, an immunoglobulin E research, from a nasopharynx on microflora and sensitivity to antibiotics, cytology of prints from the surface of adenoidny fabric, IFA and PTsR-diagnostics on existence of infections.
The leading role in detection of adenoides at children and the accompanying violations belongs to the children's otolaryngologist. For determination of the sizes and a consistence of adenoides at children, and also extents of adenoidny vegetations use a manual research of a nasopharynx, a back rinoskopiya, an endoscopic rinoskopiya and an epifaringoskopiya. At survey adenoides at children are defined as the formations of a soft consistence and pink coloring having the irregular shape and the wide basis located on the nasopharynx arch.
Data of a tool research are specified by carrying out a side X-ray analysis of a nasopharynx and KT.
Treatment of adenoides at children
Depending on degree of a hypertrophy of a pharyngeal almond and expressiveness of clinical manifestations children can have a conservative treatment of adenoides or surgical.
Conservative therapy of adenoides at children is carried out at the I-II degree of a hypertrophy or impossibility of their expeditious removal. At repeated infections antibiotic treatment, immunostimulators, vitamins is appointed. Symptomatic therapy includes an instillation of vasoconstrictive medicines, washing of a cavity of a nose salt solutions, broths of herbs, antiseptics, ozononasyshchenny solution. At adenoides at children in pediatrics physical therapy methods are widely applied: laser therapy, Ural federal district, OKUF-therapy, UVCh on area of a nose, magnetotherapy, an electrophoresis, KVCh-therapy, a climatotherapy. At desire parents can use services of the children's homeopathist and complete a course of homeopathic treatment.
Serve as indications to surgical removal of adenoides at children: inefficiency of conservative tactics at a hypertrophy of the II degree; adenoides of the III degree; the expressed violation of nasal breath; syndrome sleepy ; chronic (recidivous) adenoidita, sinusitis, otitises, pharyngitises, laryngitis, pneumonia, etc.; the maxillofacial anomalies caused by the expanded adenoides.
Operation of removal of adenoides at children (a chrezrotovy adenotomiya/adenoidektomiya) can be also made under local anesthesia or the general anesthesia. Carrying out endoscopic removal of adenoides at children under visual control is possible.
Serve as alternative surgical interventions at adenoides at children: removal of adenoides by means of the laser (a laser adenoidektomiya, interstitial destruction, vaporization of adenoidny fabric), cryodestruction of adenoides.
The forecast and prevention of adenoides at children
Timely diagnosis and adequate therapy of adenoides at children carries out to permanent restoration of nasal breath and elimination of the accompanying infections, to increase in physical and intellectual activity, normalization of physical and intellectual development of the child.
Complications of expeditious treatment and a recurrence of adenoides often arise at the children having an allergy (bronchial asthma, a small tortoiseshell, Quincke's hypostasis, bronchitis, etc.). Children with the developed accompanying violations (anomalies of a bite, violations of the speech) quite often need further the help of the children's orthodontist and logopedist.
Prevention of adenoides demands from children performing obligatory vaccinal prevention, a hardening, early diagnostics and rational treatment of upper respiratory tract infections, increase in immunological properties of an organism.