Adenoiditis
The content of the article:
- Causes and risk factors
- Forms of the disease
- Disease stages
- Symptoms of adenoiditis
- Diagnostics
- Treatment of adenoiditis
- Possible complications and consequences
- Forecast
- Prevention
Adenoiditis is an inflammatory disease in the pathologically altered pharyngeal tonsil (adenoids). Adenoiditis is one of the most common otorhinolaryngological diseases in preschool and school children, which is caused by the proliferation of adenoid tissue at this age. In adult patients, the disease is rare.
Inflammatory diseases of the mucous membrane of the tonsils and nasal cavity - the main cause of the development of adenoiditis
The pharyngeal tonsil, together with the lingual, palatine and tubal tonsils, is part of the lymphadenoid pharyngeal ring. During a routine examination of the pharynx, the pharyngeal tonsil is not visible; instrumental examination methods are used to visualize it.
The development of adenoids is promoted by inflammatory diseases of the mucous membrane of the tonsils and the nasal cavity. Pathological proliferation of adenoid tissue is most often observed in children 3–10 years old.
Causes and risk factors
The main reason for the development of adenoiditis is the activation of the saprophytic microflora that lives in the nasopharynx, which is facilitated by hypothermia, as well as infectious diseases (including ARVI, scarlet fever, diphtheria, measles). In most cases, infectious agents in adenoiditis are hemolytic streptococcus, respiratory viruses, much less often - microscopic fungi, mycobacterium tuberculosis, etc.
Infectious processes, ARVI often become the reasons for the development of adenoiditis
Genetic predisposition is of great importance in the development of adenoiditis. It is noted that if one of the parents had this disease in childhood, the risk that adenoiditis will occur in the child also increases. In addition, the risk of developing the disease increases in children with a burdened allergic history, a long course of otorhinolaryngological diseases, and also with a curvature of the nasal septum.
Forms of the disease
By the nature of the course, adenoiditis can be acute, subacute and chronic. Chronic adenoiditis occurs with periods of exacerbations and remissions, as a rule, exacerbations occur in the autumn-winter period, that is, they have a pronounced seasonality.
Disease stages
There are three stages of the development of the disease, determined by the degree of hypertrophy of the pharyngeal tonsil:
- The overgrown adenoid tissue covers only the upper 1/3 of the vomer (unpaired bone plate located in the nasal cavity) or the height of the nasal passages.
- Adenoid tissue covers 2/3 of the opener or the height of the nasal passages.
- The adenoid tissue covers almost the entire opener.
Stages of adenoiditis
Symptoms of adenoiditis
Adenoiditis can occur both in isolation and in combination with an inflammatory process in the palatine tonsils (tonsillitis).
Acute adenoiditis usually debuts with an increase in body temperature to high numbers and general signs of intoxication. The symptoms of adenoiditis include difficulty in nasal breathing, patients have mucous or mucopurulent nasal discharge, nasal voices are noted, regional lymph nodes are enlarged. Due to difficulty in nasal breathing, the patient is forced to breathe through his mouth, the ingress of insufficiently warmed and purified air into the respiratory tract increases the risk of developing tonsillitis, pharyngitis, laryngotracheitis, pathologies of the bronchopulmonary system. The posterior wall of the oropharynx in patients with adenoiditis is sharply hyperemic, characteristic of this disease is a strip of mucopurulent discharge, which flows from the nasopharynx along the posterior wall of the oropharynx. Hyperemia of the posterior palatine arches is noted.
In acute adenoiditis, hyperemia of the posterior palatine irises is noted
The appearance of a cough indicates irritation of the larynx and trachea with discharge from the nasopharynx, which can lead to the development of tracheobronchitis. Often, inflammation of the mucous membrane of the Eustachian tube (eustachitis), inflammation of the middle ear (otitis media), as well as conjunctivitis join the pathological process. This happens especially often in children, due to the proximity of the location of the anatomical structures and the peculiarities of the functioning of the immune system.
Adenoiditis in children is often chronic. In chronic adenoiditis, there is usually a slight increase in body temperature (up to subfebrile numbers), patients get tired quickly, are irritable, night sleep is disturbed. Discharge from the nose is removed with difficulty, relief of nasal breathing after this does not last long. A typical appearance for patients with adenoiditis is a hypomimic face with smoothed nasolabial folds, as well as a mouth slightly open due to difficulty in nasal breathing. With the progression of the pathological process in children, complications from the cardiovascular system may occur.
With prolonged adenoiditis, the child develops a so-called adenoid face
Diagnostics
The primary diagnosis of adenoiditis is based on data obtained during the collection of anamnesis and during physical diagnosis. An examination of the nasal cavity is performed using special mirrors (rhinoscopy). With anterior rhinoscopy, edematous and hyperemic adenoid tissue covered with a mucopurulent film is visible. Anterior rhinoscopy makes it possible to assess the patency of the nasal passages and the condition of the mucous membrane. With posterior rhinoscopy, there is a pronounced swelling of the pharyngeal tonsil, hyperemia of the mucous membrane, the surface of the tonsil can be covered with a punctate or drainage purulent plaque. Posterior rhinoscopy is technically more difficult, especially in young children, but it allows to assess the condition of the posterior pharyngeal wall, to determine the degree of proliferation of adenoids and the inflammatory process in the pathologically altered pharyngeal tonsil.
Rhinoscopy allows you to identify adenoiditis and assess its degree
If necessary (as a rule, with chronic adenoiditis), a laboratory study of the discharge is performed in order to detect the pathogen and determine its sensitivity to antibacterial agents.
In order to clarify the diagnosis, sometimes there is a need for X-ray examination of the skull in frontal and lateral projections. Rhinocytological examination allows to assess the cellular composition of the nasopharyngeal discharge. If an allergic nature of the disease is suspected, skin tests are performed.
To determine the involvement of the Eustachian tube and ear cavity in the pathological process, they resort to otoscopy.
In diagnostically difficult cases, computed and / or magnetic resonance imaging can be used.
Differential diagnosis of adenoiditis is carried out with sinusitis, nasopharyngeal neoplasms, anterior cerebral hernia.
Treatment of adenoiditis
Treatment of adenoiditis can be both conservative and surgical, it depends on the stage of the disease, the general condition of the patient, the response to the therapy, and the presence of complications.
Conservative therapy for adenoiditis includes the use of anti-infective drugs, antihistamines and anti-inflammatory drugs. To restore nasal breathing, vasoconstrictor and antiseptic preparations for topical use, secretolytic agents in the form of an aerosol are used.
In the treatment of chronic adenoiditis, in some cases, they resort to washing the nasopharyngeal tonsil with antiseptics and isotonic saline solutions. Patients are prescribed anti-inflammatory drugs, immunomodulators and vitamin complexes. Physiotherapy procedures, inhalations with mucolytics and antiseptics are effective. In addition, breathing exercises are indicated for patients with adenoiditis.
Nasal lavage is an important step in the treatment of chronic adenoiditis
Since the lymphoid tissue of the pharynx plays an important role in the general immune defense of the body, preference is given to conservative methods of treating adenoiditis. Indications for surgery may be a significantly overgrown adenoid tissue that prevents nasal breathing, the lack of a positive effect from conservative therapy, and the development of complications. Surgical removal of adenoids can be performed at any age. Patient hospitalization for adenotomy is not required. The period of remission after surgery should be at least one month.
There are two main methods of surgical removal of adenoids - traditional and endoscopic adenotomy. The advantage of the latter is the implementation of surgical intervention under visual control, which allows the operation to be performed with maximum accuracy (incomplete removal of the adenoids can cause a relapse). The operation can be performed under local or general anesthesia. Usually, the mucous membrane of the upper respiratory tract is completely restored in 2-3 months after surgery.
Attention! Photo of shocking content.
Click on the link to view. After adenotomy, patients are shown a course of drug therapy.
Due to the formed habit of breathing through the mouth, the child may need a set of exercises to restore nasal breathing, and in some cases - a course of treatment with a speech therapist.
Possible complications and consequences
Adenoiditis in children can be complicated by hearing and speech impairments, underdevelopment of the facial skull with the formation of a malocclusion, and deformation of the palate. Due to chronic hypoxia, the child's mental and physical development may be delayed. In addition, adenoiditis in children can contribute to the development of anemia.
In adults, adenoiditis often becomes the cause of chronic headache, high allergization of the body. As a hotbed of chronic infection, it contributes to the emergence of other infectious and inflammatory diseases.
Forecast
With timely diagnosis and a properly selected treatment regimen, the prognosis is favorable.
Prevention
In order to prevent adenoiditis, it is recommended:
- timely treatment of acute respiratory diseases in children and adults;
- normalization of the indoor microclimate;
- measures that contribute to the overall strengthening of the body (balanced nutrition, optimal physical activity, sufficient stay in the fresh air, etc.).
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
