Adenoids, also called pharyngeal tonsils or proliferators, are located at the top of the nasopharynx and the back wall of the pharynx and are lymphatic tissue with an orange flap-like surface. The adenoids, like the tonsils, grow gradually with age after birth and proliferate vigorously between the ages of 2 and 6, and gradually shrink after the age of 10. Adenoid hypertrophy is a pathological hyperplasia of the adenoids due to repeated stimulation of inflammation, which causes nasal congestion and open-mouth breathing symptoms, especially at night, snoring and sleep disturbance, children often turn over from time to time, more obvious when lying on their backs, and in severe cases, apnea can occur. The disease is most often seen in children and is often combined with chronic tonsillitis and tonsillar hypertrophy.
Etiology and pathophysiology
The common cause of this disease is pathological hyperplasia of adenoids due to recurrent inflammatory diseases such as acute and chronic rhinitis, tonsillitis, and influenza. This leads to increased nasal obstruction and obstruction of nasal drainage, and the secretions from rhinitis and sinusitis stimulate the adenoids to continue to proliferate, forming a vicious circle of mutual cause and effect. The disease often has a family history of inheritance.
Clinical manifestations of local symptoms
In children, the nasopharyngeal cavity is narrow, and if the adenoids block the posterior nostril and the pharyngeal orifice of the eustachian tube, they can cause symptoms in the ear, nose, throat, and other places.
(1) Ear symptoms: obstruction of the pharyngeal orifice of the eustachian tube causes secretory otitis media, resulting in hearing loss and tinnitus.
(2) Nasal symptoms: It is often complicated by rhinitis and sinusitis, with symptoms such as nasal congestion and runny nose. When speaking with an occlusive nasal sound, snoring sound when sleeping, and sleep apnea in severe cases.
(3) Pharynx, larynx and lower respiratory tract symptoms: Because the secretions flow downward and irritate the respiratory tract mucosa, it often causes nighttime paroxysmal cough and is easily complicated by bronchitis.
(4) Adenoid face: Due to long-term open-mouth breathing, the facial bone development is impaired, the jaw bone becomes longer, the palate bone is high arched, the teeth are not aligned, the upper incisors are protruding, the lips are thick and lack of expression, and the so-called “adenoid face” appears.
Systemic symptoms
The child presents with anorexia, vomiting, dyspepsia, followed by malnutrition. Inadequate lung expansion due to poor breathing can lead to thoracic deformities. Poor breathing at night can leave children in a long-term hypoxic state and endocrine dysfunction, causing growth and development disorders. Parents may find that their children have symptoms such as inattention, mood swings, night terrors, teeth grinding, night sweats, and bedwetting.
Adenoid hypertrophy is one of the most common causes of obstructive sleep apnea hypoventilation syndrome (OSAHS). The two main symptoms are excessive snoring and breath-holding during sleep. Open-mouth breathing during sleep, excessive sweating, morning headache, daytime sleepiness, and learning difficulties are also common symptoms.
The main danger is the formation of “adenoid face”.
As the nasopharynx of children is relatively small, when adenoid hypertrophy, due to nasal congestion affects breathing and mouth open breathing, long-term mouth breathing, airflow impact on the hard palate will make the hard palate deformation, high arch, over time, the development of the face will be deformed, the upper lip short thick cocking, jaw bone sagging, nasolabial fissure disappeared, hard palate high arch, teeth alignment is not neat, upper incisors protrude, poor bite, nasal septum flat curvature, etc., facial muscles The facial muscles are not easy to move, lack of expression, look like piggyback or ugly duckling, medically called “adenoid face”.
Prone to bronchitis
Adenoid hypertrophy in children can cause blockage of the nose, resulting in the backflow of nasal snot into the pharynx, stimulating the mucous membrane of the lower respiratory tract, often causing bouts of coughing and making the child prone to bronchitis.
Moodiness and unresponsiveness of children
Children who breathe through their mouths and noses for a long time are prone to head ischemia and hypoxia, resulting in mental depression, headache, dizziness, memory loss and slow reaction.
Affect the growth and development of children
As children need a lot of oxygen for development, snoring will make children seriously lack of oxygen during sleep, which will directly lead to insufficient oxygen supply for brain development and reduce secretion of growth-promoting hormone, which will not only affect children’s height, but also decrease body resistance and affect children’s intelligence in the future.
Therefore, these children are not only prone to respiratory infections, but also prone to chicken chest, funnel chest, and even induce pulmonary heart disease. Therefore, snoring in children has more harmful effects than adults.
Diagnostic examination
(1) The child breathes with open mouth, and sometimes the typical “adenoid face” can be seen.
(2) Oropharyngeal examination shows a high and narrow hard palate and mucous secretions flowing down from the nasopharynx at the posterior wall of the pharynx, mostly accompanied by enlarged palatine tonsils.
(3) Anterior rhinoscopy shows a large amount of secretions in the nasal cavity and swelling of the mucosa.
(4) Fiberoptic nasopharyngoscopy reveals lobulated lymphoid tissue with longitudinal fissures on the surface of the top and posterior wall of the nasopharynx, like half of a small peeled orange. It often blocks more than two-thirds of the posterior nostril. This is currently the most common method of adenoids examination.
(5) Lateral nasopharyngeal film measurement: the degree of obstruction of the nasopharyngeal airway can be measured.
(6) Palpation: Palpation of the nasopharynx with the finger can reveal soft masses in the roof and posterior wall of the nasopharynx.
(7) CT: CT axial image shows deformation and narrowing of the nasopharyngeal airway, thickening of the soft tissue in the posterior wall, and uniform density.
Disease prevention
1, adenoid hypertrophy should not be taken lightly. Early detection and early treatment are necessary. When children have poor hearing or frequent nasal congestion and runny nose, they should
When a child has poor hearing or frequent nasal congestion or runny nose, it is important to think that it may not only be a disease of the ears or nose, but also to check whether there is adenoidal hypertrophy.
2. In daily life, parents should pay special attention to children’s colds and other conditions. Especially during the period of 2-10 years old, children should improve prevention, such as try to avoid children with long-term colds, runny nose, nasal congestion, coughing, rubbing nose, rubbing eyes, sneezing and other symptoms, if also accompanied by poor hearing, obvious snoring and other symptoms, then they should go to the hospital for diagnosis and treatment.