Adenoids in children: conservative and surgical treatment, causes, signs
The content of the article:
- Causes of occurrence
- Symptoms of adenoids in children
- Grades of adenoids
- Effects
- Diagnostics
- Conservative treatment of adenoids in children
- Folk remedies for the treatment of adenoids
- Surgical treatment of adenoids
- Prevention
- Video
Adenoids in children are one of the most common ENT pathologies. Hypertrophy of the nasopharyngeal tonsil (ICD-10 code - J35.2) can also occur in adult patients, but much less often than in childhood, and usually the onset of the process in this case also occurs in childhood. Most often, the disease is recorded in the age group from 3 to 7 years.
Adenoids are one of the most common childhood diseases
Causes of occurrence
The cause of hypertrophy of the nasopharyngeal tonsil is frequent inflammation of the upper respiratory tract of an infectious or allergic origin.
Contributing factors: genetic predisposition, decreased immunity, unhealthy diet, childhood infectious diseases, unfavorable environmental conditions.
In addition, the imperfection of the child's immune system, which is just in the process of maturation, plays a role, as well as the tendency of the cells of the child's body to increased growth, which causes a hypertrophic type of chronic inflammation.
Removed adenoids in children in the photo look like lumps of rather loose tissue.
Symptoms of adenoids in children
The disease is often detected at an advanced stage, since at an early stage of development there are few symptoms and they are nonspecific, that is, they are characteristic of many respiratory diseases. Since it is difficult for parents to recognize adenoids in a timely manner, it is necessary to undergo routine examinations with an otolaryngologist with the child - in 90% of cases of early diagnosis of the disease, they are the ones.
Adenoids are usually manifested by difficulty in nasal breathing, the appearance of mucopurulent nasal discharge, which differ from the usual rhinitis in duration. At an early stage of development, nasal breathing in a child is difficult only in a horizontal position of the body, usually during a night's sleep. This is manifested by noisy breathing, snoring, puffing. As the disease progresses, difficulty in nasal breathing becomes noticeable in the daytime. One of the signs of adenoids in children is a dry cough that usually occurs in the morning. Such a cough is caused by drainage of discharge from the nose along the back wall of the pharynx and its irritation, that is, it is of a reflex nature.
Often such children develop hearing impairments, eustachitis, otitis media - pathological processes develop where the nasopharyngeal tonsil is located. However, since the adenoids are a constant source of infection in the body, disorders can be not only local. Children with adenoids are susceptible to any infection, and decreased immunity contributes to the development of any other disease.
Grades of adenoids
Depending on the degree of overlap of the nasal passages by the adenoids, the disease is divided into three stages (degrees):
- The enlarged adenoids overlap about 1/3 of the height of the nasal passages.
- The adenoid tissue covers approximately half the height of the nasal passages.
- The adenoids cover the nasal passage almost completely.
Effects
In the absence of nasal breathing (grade 3 adenoids), cerebral hypoxia develops, since the body does not receive about 30% of oxygen. To understand what brain hypoxia is in a child, one should know that the children's nervous system is in an active phase of development, and the brain is one of the most resource-intensive organs. Prolonged lack of oxygen leads to the formation of physical and mental developmental delays, which may be irreversible. Hypoxia is manifested by weakness, rapid fatigability, frequent headaches, sleep disorders, increased irritability, and decreased cognitive abilities.
Cerebral hypoxia in children can also lead to anemia, bedwetting, and, in severe cases, to epileptic (convulsive) seizures.
When adenoid growths appear, it becomes difficult for the child to breathe through the nose
A child who does not breathe through his nose is forced to constantly keep his mouth open, which disrupts the formation of the bones of the facial skeleton - an adenoid type of face is formed (elongated lower jaw, open pathological bite, lowered corners of the eyes).
Diagnostics
An experienced doctor can identify the presence of adenoids at a late stage by external signs, however, in order to develop a treatment strategy, it is necessary to determine the degree of adenoid growths. An examination of the nasal passages (rhinoscopy) is performed. In order to determine the infectious agent, a bacteriological examination of the contents of the nose is prescribed. In diagnostically difficult cases, there may be a need for radiography, computed or magnetic resonance imaging.
Differential diagnosis is carried out with curvature of the nasal septum, vasomotor and allergic rhinitis, tonsillitis and some other pathologies.
Conservative treatment of adenoids in children
The debate about how to treat adenoids - with or without surgery - has been going on in the medical community for decades. Previously, it was believed that the most reliable method is the surgical removal of the hypertrophied tonsil as early as possible. However, reviews from physicians with extensive clinical experience show that this is not always the case. Removal of the hypertrophied nasopharyngeal tonsil cannot guarantee the absence of recurrence of the disease in the future, since it does not affect the cause of the pathology, and it is completely impossible to remove the lymphoid tissue of the tonsil.
At present, most specialists, including the famous pediatrician Komarovsky, believe that surgical treatment should be carried out only according to strict indications, in other words, when it cannot be done without it.
With adenoids of 1-2 degrees and the absence of pronounced disturbances in nasal breathing, conservative therapy is indicated. The main treatment is local, which consists in flushing the nasopharynx with antiseptic solutions, anti-inflammatory drugs and / or saline solutions. Usually children over 5 years old can rinse their nose on their own. After washing, anti-edematous and anti-inflammatory drugs are instilled into the nose.
From the means of general therapy, antihistamines, restorative therapy can be prescribed. If, according to the results of bacteriological analysis, a bacterial pathogen is identified, antibiotics are prescribed taking into account microbial sensitivity.
Outside of active inflammation, physiotherapy is indicated: electrophoresis, ultra-high-frequency therapy, endonasal ultraviolet irradiation, laser therapy.
Physiotherapy is an effective method of treating adenoids
Folk remedies for the treatment of adenoids
Folk remedies can cure adenoids only at the earliest stage of their development, subject to their regular use and in the absence of allergies. Without exception, all traditional medicines must be agreed with the attending physician, self-medication of children is categorically unacceptable.
- A decoction of calendula flowers, St. John's wort, horsetail, heather, coltsfoot, which are mixed in equal proportions: 15 g of the mixture is poured into 250 ml of water, brought to a boil and boiled for 10 minutes. After they insist for 2 hours, filter, use to rinse the nose and / or instill 15-20 drops every 3-4 hours. In the same way, you can prepare a decoction from chamomile flowers, white rose, clover, carrot seeds, rhizomes of the mountaineer snake, calamus, licorice, leaves of fireweed, birch, wild strawberries, herb yarrow, St. John's wort, wormwood, string, duckweed, horsetail.
- An infusion of a mixture of leaves of mother-and-stepmother, St. John's wort, fireweed, marshmallow root, rose hips, watch leaves for oral administration. 6 g of the mixture is poured into 250 ml of boiling water, insisted in a thermos for 4 hours. Take infusion in a warm form of 50 ml 4-5 times a day. In the same way, an infusion of chamomile and calendula flowers, birch and blackberry leaves, string grass, elecampane rhizomes, yarrow flowers, viburnum flowers, clover, raspberry leaves, rose hips, thyme and meadowsweet herb are prepared and taken.
- Thuja essential oil (15%) is instilled in 1-5 drops in each nostril before going to bed for 14 days, after which a break is taken, then the course is repeated.
Surgical treatment of adenoids
Surgery to remove the adenoids is called adenotomy.
Indications for adenotomy in children:
- prolonged absence of nasal breathing (formed hypoxia);
- hearing impairment;
- improper formation of the bones of the facial skeleton;
- lack of effect from several courses of conservative treatment in the progression of hypertrophy of the nasopharyngeal tonsil.
In the presence of strict indications, adenotomy can be performed at any age, but if possible, they try not to operate on children under 2 years of age.
Contraindications to surgical removal of adenoids can be hematological diseases, clefts of the hard palate, anomalies in the development of the soft and hard palate, the presence of malignant neoplasms, acute infectious diseases of the upper respiratory tract; the operation is not performed for a month after vaccination.
Removal of adenoids can be performed both on an outpatient basis and in a hospital. Usually, after the operation, the child goes home on the same day, less often he spends several days in the hospital. Adenotomy is performed mainly under local anesthesia, but in some cases general anesthesia may be applied. It is recommended to use it in children no earlier than 4 years old.
Removal of adenoid growths is performed with a special knife (adenotome), which is a single-edged instrument with a loop-shaped working part.
One of the disadvantages of traditional surgery is the lack of visual control of the manipulation. More effective methods are endoscopic, aspiration, and shaver adenotomy.
Endoscopic adenotomy is performed under visual control, which is carried out thanks to a fiber-optic camera inserted into the operating field, the image from which is transmitted to the monitor in the operating room, due to which the accuracy of manipulations increases many times over.
During endoscopic adenotomy, the image of the operating field is displayed on the monitor
Aspiration adenotomy is performed using a special instrument - an aspiration adenotome, which has a receiver for adenoids and suction, which excludes damage to nearby anatomical structures and inhalation of fragments of adenoid tissue during surgery.
Shaver adenotomy is performed using a shaver (microdebrider) - an electromechanical instrument with replaceable cutting attachments for rhinological operations. The working tip of the instrument is inserted through one nostril, removal of the nasopharyngeal tonsil is carried out under the control of an endoscope, which is inserted through the second nostril or oral cavity.
Also, adenoids can be removed by electrocoagulation, coblation, radio waves and a laser.
After the operation, the doctor gives explanations regarding the recommendations in the postoperative period, which must be strictly adhered to in order to avoid complications.
For several days, the child's body temperature is regularly checked. At this time, the patient has a sore throat, which is relieved with analgesic drugs. A gentle diet is recommended, the food should be warm and semi-liquid, any irritating foods (hot, cold, sour, salty, spicy, etc.) are excluded.
For 10 days after the operation, it is necessary to limit physical activity, avoid the child's stay in crowded places and in the open sun. Hot baths and any other thermal procedures are prohibited.
Often, children after surgery continue to breathe through their mouths due to the formed habit. In this case, breathing exercises are prescribed, aimed at strengthening the respiratory muscles, the formation of nasal breathing. Respiratory gymnastics is prescribed and monitored by a doctor.
Prevention
In order to prevent adenoids, timely treatment of diseases of the upper respiratory tract, balanced nutrition and daily regimen, adequate physical activity, and hardening are recommended.
Video
We offer for viewing a video on the topic of the article.
Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
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