What is adenoids?
Adenoids, also known as pharyngeal tonsils and proliferators, are a large lymphoid tissue located in the midline of the posterior wall of the nasopharynx and are present after birth. respiratory immune response and protection of the respiratory tract is most active. Most of the literature reports physiological hypertrophy from 2-10 years of age, which develops faster in infancy, is maximal at 6 years of age, gradually shrinks after 10 years of age, and disappears after puberty.
II. Epidemiology
Pediatric adenoid hypertrophy is a relatively common disease in pediatrics, most common in children under 10 years old, especially in those aged 6-7 years old, with an incidence of 9.9%-29.9%, with no significant gender differences, with nasal congestion, snoring, open-mouth breathing as the main clinical manifestations, and in severe cases can cause apnea, affecting the brain oxygen supply and thus affecting intelligence. The incidence is higher in cold and wet areas, and although there is no obvious seasonality, it is more likely to worsen in winter and spring. The disease is recurrent and difficult to cure, and can easily lead to a variety of complications, seriously affecting the physical and mental health of children and their growth and development. In recent years, the incidence has been increasing year by year.
Third, the etiology and pathology of adenoid hypertrophy
1. Etiology.
① Acute upper respiratory tract infection, acute infectious diseases (such as measles, scarlet fever, whooping cough, influenza, etc.), acute adenoiditis, can make the adenoids hypertrophy.
② chronic rhinitis or sinusitis secretion stimulation, so that the adenoid hypertrophy; and adenoid hypertrophy impede the ventilation and drainage of the nasal cavity and sinuses, rhinitis or sinusitis is not easy to cure, the two are mutual cause and effect, vicious circle.
③Pathological reaction can make adenoid hypertrophy.
④The disease often occurs in cold, humid and changing climates, as well as poor home hygiene and ventilation.
⑤ Adenoid hypertrophy may be a local manifestation of generalized lymph node enlargement.
(6) Genetic factors.
⑦Children over 5 years old are often combined with chronic tonsillitis, where the etiology of chronic tonsillitis is also the cause.
2. Pathology.
Adenoid hypertrophy often shows chronic inflammation, and the surface ciliated columnar epithelium is transformed into squamous epithelium. Submucosal lymphocyte infiltration, eosinophilia, thickening of the vessel wall, and swelling and thickening of fibrous tissue. The adenoids are thicker near the posterior nostril and thinner at the posterior wall of the nasopharynx, sometimes blocking the nasopharyngeal cavity or blocking the posterior nostril.
IV. Clinical manifestations
1. Symptoms.
(l) Local symptoms:
①Ear symptoms: Adenoid hypertrophy blocks the eustachian tube, thus causing secretory otitis media. In some patients, ear symptoms are the first symptoms of adenoid hypertrophy.
Nasal symptoms: Adenoid hypertrophy can block the posterior nostril, not only poor nasal ventilation, but also can make nasal secretions not easy to discharge, complicating rhinitis and sinusitis. Symptoms such as nasal blockage, runny nose, open mouth breathing, occlusive nasal sound and snoring during sleep may occur.
③Symptoms such as throat and respiratory tract infection:Due to the downward flow of secretions from the pharynx, it stimulates the throat and trachea and bronchus, causing corresponding inflammation. Symptoms such as pharyngeal discomfort, hoarseness, coughing and spitting, and shortness of breath appear.
Adenoid facial features: Long-term open-mouth breathing affects the development of facial bones, resulting in narrowing of the maxilla, narrowing of the high arch of the hard palate, exostosis of the teeth, misalignment, poor bite, drooping jaw, thick lips, upturning of the upper lip, hanging of the lower lip, pulling down of the outer canthus, and shallowing and flattening of the nasolabial fold. The facial expression is dull, dull, and mentally uninspired, and this series of performance is called adenoid face.
(2) Chronic toxicity and reflex neurological symptoms:
The manifestations are poor nutritional development, because nasopharyngeal secretions are often swallowed into the stomach, causing gastrointestinal activity disorders, resulting in anorexia, vomiting, indigestion, anemia, emaciation, fatigue, headache, inability to concentrate, boredom, easily startled, irritable temperament, grinding teeth during sleep, and urination. Inadequate lung expansion and thoracic deformity due to poor breathing.
2.Examination.
(l) Visual examination: There is a typical “adenoid face”, and purulent secretions from the posterior pharyngeal wall can be seen flowing downward from the nasopharynx when the mouth is opened. The palatine tonsils are enlarged.
(2) Indirect nasopharyngoscopy and fiberoptic nasopharyngoscopy reveal lobulated lymphoid tissue in the posterior wall of the nasopharyngeal apex with an uneven surface and 5-6 longitudinal furrows with purulent secretions. Adenoids can block the posterior nostril, or even block the entire posterior nostril. In uncooperative children, the adenoids can be touched with a finger from the mouth, and soft tissue masses can be palpated in the posterior wall of the nasopharynx.
(3) Lateral nasopharyngeal X-ray and CT scan: they can show the size and location of adenoids, and can be distinguished from tumors.
V. Diagnostic points.
(1) Examination: ENT endoscopy, the degree of adenoids in the posterior nostril should be more than 1/2. 1/2-2/3 is mild hypertrophy; 2/3-3/4 is moderate hypertrophy; more than 3/4 is severe hypertrophy.
(2) Snoring during sleep.
(3) Open-mouth breathing, nasal congestion, with sinusitis, with hearing impairment.
The diagnosis of pediatric adenoid hypertrophy can be made by having the above (1) and (2).
VI. Treatment
For physiologically enlarged adenoids and tonsils
. Surgery is the only effective treatment. Depending on the situation, tonsil stripping and adenoids scraping can be used. Our hospital has introduced the latest low-temperature plasma technology, which can perform adenoids and tonsils reduction. The enlarged adenoids will be reduced to the normal state to relieve snoring and breath-holding symptoms. This not only relieves the narrowing of the airway, but also preserves the immune function of the glands.