Adenoids (in other words, the pharyngeal tonsil) is a peripheral organ of the immune system. And although he does not appear on the stage immediately, but at his hour he performs almost a solo part several years long.
Up to a year, the adenoids rarely inflame. There are two main reasons.
First, the pharyngeal tonsil is not fully developed at this stage. Secondly, babies rarely come into contact with the big world, with their peers and older children, so the chances of meeting with the infection are slim.
However, the situation is changing very soon. Already in 2 years, the “secular” life of a karapuz, as a rule, is getting better, and with it the risk of infection significantly increases.
From this very moment adenoids are included in the defense baton.
The pharyngeal tonsil is a part of the lymphoid apparatus of the pharynx, more precisely, the Valdeyer-Pirogov lymphoid ring. It also includes palatine, tubal and lingual tonsils.
All these details are designed to protect the respiratory tract from the aggressiveness of the external environment. Only now they are commissioned at different times. The first to enter are adenoids.
Like other components of the lymphoid ring, they consist of lymphoid tissue. Its main purpose is to respond to inflammatory or allergic processes triggered by infectious agents or allergens.
Thanks to this feature, the adenoids produce immune cells and control local immunity, protecting the mucous membranes of the nose and paranasal sinuses from enemy invasions. Moreover, up to 5–7 years, they remain the main filter on the path of infection. That is why bacteria and viruses that cause acute respiratory diseases in this interval of life often provoke inflammation of the adenoids (adenoiditis) or their growth (hypertrophy of adenoid vegetations).
If you remove the amygdala at an early age, the child will be left without an immune barrier. And this is a direct path to frequent quinsy, bronchitis and even pneumonia.
As the child grows, the adenoids continue to develop and acquire the porous structure of the sponge, which allows you to absorb a maximum of microbes, dust particles, allergens. However, over the years, the role of this body is gradually reduced to zero. On average, after 6–7 years, palatine tonsils begin to perform a protective function.
During puberty in the region of 11–13 years, the adenoid tissue under the influence of hormones begins to decrease at all. As a result, in 90% of adults, it completely disappears, while in 10% it remains in the form of a small tubercle.
The most active adenoids work up to 7 years, and all this time they can grow. However, their dimensions must be controlled.
In the absence of inflammation, I and II degrees of growth are considered physiological, and III is immediately recognized as pathology. However, in addition to the size of the adenoids, it is important to consider the direction of their growth.
One of the main dangers of increasing pharyngeal tonsil is a violation of nasal breathing, which can lead to chronic lack of oxygen, deformation of the facial skeleton and bite. This problem occurs if the adenoids germinate in the posterior nasal cavity.
The second threat is the development of otitis (inflammation of the middle ear) that can cause temporary and even irreversible deafness. The nasopharynx has the shape of a dome. Adenoid tissue hangs from above, and on the sides there are mouths of auditory tubes, through which, normally, air enters from the nasopharynx into the tympanic cavity.
If the pharyngeal tonsil expands to the sides, it may be dangerously close to them. In such conditions, mucus containing microbes will enter the ear with air and otitis will begin. If the adenoids permanently block the mouth of the auditory tubes, otitis media can acquire a recurring or chronic form, which will entail a persistent hearing loss.
At the age of 2 years, such a hindrance prevents the development of speech, because this skill develops only on condition that the baby can hear well. In such circumstances, surgery is usually required.
The causes of overgrowth are most often either inflammatory processes, which are caused by acute respiratory viral diseases (tonsillitis, flu, banal “colds”), or allergic reactions. The hypertrophy itself is a phenomenon of a purely physiological order.
This is only a consequence of the enhanced function of the lymphoid tissue due to the high need for protection. As soon as contacts with the outside world begin to expand, the body needs to build up immunity and learn to cope with infections. However, to the aggression from the outside, the adenoids react differently.
In case of allergies they swell and, as soon as the irritating substance is eliminated, they return to their previous size. In inflammatory processes, adenoids can both swell and grow.
Overgrowth occurs due to microcling of tissues in response to the invasion of infection. The more often the baby suffers from acute respiratory diseases and the more serious and longer their course, the greater the likelihood of pathological changes.
After all, lymphoid tissue will change its structure after each viral or bacterial attack, adding more and more in volume.
An increase in adenoid tissue (due to edema or hypertrophy) can only be noted by a doctor. The task of the parents is to pay attention to the characteristic symptoms. These include worsening nasal breathing and hearing, night snoring, dark circles under the eyes, general lethargy, and copious mucus that causes a runny nose or cough.
In this case, the “adenoid” cough has special signs. As a rule, it increases after sleep, when the baby gets out of bed, or during physical activity.
In the resting hours there is a stagnation of mucus that accumulates in the adenoids. But as soon as the child takes a horizontal position, starts to dance or jump, she starts to flow down and irritate the pharyngeal wall, causing a reflex cough.
With an allergic reaction, the symptoms are often the same, only mucus is more likely to appear from the nose, while it is usually transparent and resembles water in consistency.
In order to prevent, especially if the baby goes to kindergarten, the “protective filter” must be constantly cleaned, otherwise it will not be able to fulfill its direct duties. Use better nasal showers that provide a jet of fluid.
Ordinary sprays wash the microbes from the adenoids will not work. The procedure should be carried out 2 times, in the morning and in the evening (before and after kindergarten).
The irrigation itself should last a few seconds.
Adenoiditis and hypertrophy of adenoid tissue can be easily mistaken for an inexperienced doctor and parents as an allergy or a common cold (rhinitis). An ENT doctor should examine a child with such symptoms. The pharyngeal tonsil can be examined through the nose, but this method is uninformative.
In this perspective, to consider it from all sides will not succeed. If the nasal septum is curved, seeing the amygdala will not work either.
Finger research is quite subjective: the doctor turns his finger over the soft palate and feels the adenoids, determining their size and consistency by touch. An x-ray gives a clearer picture, but it does not show which way the adenoids move when breathing and swallowing and how close they are to the mouths of the auditory tubes. The most modern diagnostic method is endoscopy.
It allows you to assess the situation in all respects.
It is not always easy to remove lymphoid edema. In case of allergies, it is necessary to take a blood test or make skin tests to identify a specific irritant. Next you need to stop any contact with allergens.
In parallel, the doctor will prescribe medications that will relieve swelling. As a rule, these are antihistamines and hormones. Fear of the latter is not necessary.
The composition of these drugs include non-steroid hormones, which does not occur addictive. However, children under 3 years of age are prescribed only in exceptional circumstances.
If the swelling has caused an infection, the ENT doctor’s help and an integrated approach to treatment will be needed. If it turns out that adenoids are enlarged due to hypertrophy, the situation is chronic and there are complications, the doctor will refer the child for surgery.
There are two main ways to remove adenoids (adenotomy).
In the first case, the operation takes place under local anesthesia and lasts a maximum of 1-2 minutes. The doctor removes the tonsils with a sharp movement of the arm using a special surgical instrument of the adenotome for 2–3 approaches, while acting blindly.
During the procedure, the child blows his nose and spits blood. To avoid psychological trauma, doctors may recommend delayed-acting drugs that cause retrograde amnesia to impressionable children. They are administered before surgery intravenously.
During adenotomy, the baby is fully conscious, and immediately falls asleep after it. After awakening, he does not remember what happened to him after the injection, miraculously forgetting his experiences. The only caveat: these “magic” drugs have contraindications.
If there are no complications, the child goes home on the same day.
The second option is adenotomy under general anesthesia. The operation lasts from 30 minutes to an hour and is carried out under the control of the endoscope, so the doctor can monitor their actions. Despite the advantages, this option is not for everyone.
Strong anesthetics are narcotic substances that affect the entire body, including the brain. For this reason, after anesthesia, the baby is left in the hospital for several days.
So the desire of parents alone is not enough. It requires a strong “for” and the absence of contraindications. In addition to impressionability, adenotomy under general anesthesia may be required in other cases.
If the amygdala has grown into the nasal cavity, another method simply does not remove it. If, after classical adenotomy, it has expanded again, it is better to make a second attempt under endoscopic control.
Often, after the first operation, adhesions are formed that need to be carefully cut. To do this, it is important to see them, and the child should not interfere.
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