The most common cause of snoring in childhood is adenoid and tonsillar enlargement, and it is believed that about 99.9% of snoring in children is caused by adenoid and tonsillar enlargement. Although this figure is not very reliable, it is enough to show that enlarged tonsils have seriously endangered the healthy growth of children. Some children often complain when they visit the doctor, “My child always has a cold, and every time it is tonsillitis”, “My little Hai always has a sore throat, and he can’t eat well”, “My child’s throat is always blocked, and at night The snoring is scary enough” So, what exactly are tonsils? What can the old blockage in the throat area do? Can it be removed as easily as the appendix? Please see below for a series of questions
I. What are tonsils
Depending on where the tonsils are located, they can be divided into palatine tonsils and pharyngeal tonsils.
The palatine tonsils, referred to as tonsils, have a tonsil on each side of the pharynx, and are hidden between the palatal arch of the pharynx during the neonatal period, and the glandular fossa and blood vessels are not developed.
The pharyngeal tonsils, also known as proliferators or adenoids, develop before the age of 6 months and are at their peak when they are 4-6 years old, gradually shrinking during adolescence.
Acute tonsillitis usually refers to the acute inflammation of the palatine tonsils, referred to as tonsillitis, often accompanied by acute pharyngitis of varying severity, is an extremely common pharyngeal disease.
Tonsillitis in children is most common in the spring and fall when the temperature changes.
The pathogens that cause acute tonsillitis can be transmitted through droplets, food or direct contact, and are therefore contagious.
The reasons why children are susceptible to tonsillitis
Compared to adults, the nasopharynx and pharynx of children are relatively small and vertically positioned, and the nasopharynx is rich in lymphatic tissue, the development of which varies with age. The lymphatic tissues are not fully developed during the neonatal period, and then gradually grow up with the development of lymphatic tissues throughout the body by the end of the first year, and gradually degenerate after the age of 10. This explains why tonsillitis is common in school-age children and rare in infants under 1 year of age.
Let’s look at the etiology of tonsillitis. Streptococcus b is the main causative agent. Non-hemolytic streptococci, staphylococci, S. pneumoniae, H. influenzae, and adenovirus can also cause the disease. Mixed infections of bacteria and viruses are also more common. In recent years, cases of anaerobic bacterial infections have also been identified.
The above pathogens usually exist in the mouth and tonsils of normal people and do not cause disease, but when certain factors reduce systemic or local resistance, the pathogens will “take advantage of the situation” to invade the body, or at this time due to the proliferation of the original bacteria can also cause disease. The cold, humidity, fatigue, inhalation of toxic gases such as carbon monoxide, etc. can be triggering factors.
What are adenoids?
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. Adenoids, like tonsils, exist after birth, and grow gradually with age after birth, with the most vigorous proliferation at the age of 4-6, and gradually shrink after adolescence.
Children’s snoring is often caused by adenoid hypertrophy and tonsillar hypertrophy affecting nasopharyngeal ventilation, and such children have nasal blockage and open-mouth breathing even during the daytime non-sleep conditions.
Fourth, why adenoid hypertrophy occurs
There are many causes of pediatric adenoid hypertrophy, including the following.
1. Acute inflammation makes the glandular tissue congested, swollen, or enlarged due to purulence, when the child can have a blocked nose, open-mouth breathing, difficulty in exhalation within a short period of time, and there is often a large amount of secretions in the nasal cavity, snoring like thunder at night, and even a short pause in breathing, followed by a deep breath. In addition, it is often accompanied by systemic symptoms, such as fever and sore throat. Usually after anti-inflammation, most of the above symptoms can disappear.
2.Sleeping snoring due to chronic inflammation often develops gradually, from light to heavy or sometimes good to bad.
3.Adenoids are enlarged due to local edema caused by allergic reaction, and these children are mostly accompanied by other allergic diseases, such as allergic asthma, allergic rhinitis, pollen allergy, etc.
Five, adenoid hypertrophy how big is the danger
Children with adenoid hypertrophy often have coughing and phlegm due to inflammation of the throat due to secretions stimulating the mucous membrane of the respiratory tract; they are prone to nasal congestion and runny nose due to rhinitis and sinusitis; hearing loss and tinnitus due to otitis media; they may also have systemic symptoms, such as slow reaction, inattention, irritability, restlessness, headache, anemia and emaciation, night terrors, teeth grinding and urination, etc.
1. Why adenoid hypertrophy can cause otitis media
Adenoid hypertrophy can block the pharyngeal opening of the eustachian tube. The pharyngeal opening of the eustachian tube can also be blocked by the proliferation of lymphoid tissue around it or by inflammation and its secretions, causing non-suppurative otitis media, leading to tinnitus, hearing loss, tympanic membrane invagination, or tympanic chamber effusion. Purulent otitis media may also occur secondary to infection.
2. Why adenoid hypertrophy can cause sinusitis
Children with adenoid hypertrophy can suffer from rhinitis and sinusitis due to long-term posterior nostril obstruction and nasopharyngeal inflammatory stimulation, nasal congestion, runny nose, occlusive nasal sounds, slurred speech, sleep disturbance due to nasal congestion, and often snoring.
3.What does “adenoid face” mean?
Children with adenoidal hypertrophy have a narrow maxilla, narrow hard palate, uneven teeth, prominent upper incisors, thick upper lip, indifferent expression and dull face due to long-term open mouth breathing, which is called “adenoidal face”.
4, adenoid hypertrophy will affect the intelligence of children
Adenoid hypertrophy will make children’s sleep quality decreases, affecting the development of the body, especially in intelligence, because adequate sleep is essential for the development of the child’s nervous system, adenoid hypertrophy caused by sleep apnea will make the brain often appear hypoxic state and produce daytime sleepiness, inattention, memory loss, slow reaction, dull expression and other signs of mental retardation.
Most normal children do not have symptoms of airway obstruction, but when the adenoids are abnormally enlarged and hypertrophied, blocking the upper airway, snoring and sleep disturbance will occur, and children often turn over from time to time, more obvious when lying on their backs, so that the quality of sleep is reduced. The child’s daytime drowsiness, poor mental performance, memory loss, and decreased academic performance.
5, adenoid hypertrophy and thoracic deformity, pulmonary heart disease related
Adenoid hypertrophy causes obstruction of the upper airway during sleep, poor breathing, sleep apnea occurs when the negative pressure of the thorax increases, which may cause minor deformities, resulting in the formation of a chicken chest, funnel chest, but also affect the heart and lung function, serious cases can cause pulmonary heart disease, myocardial damage, and even right ventricular failure.
Therefore, adenoid hypertrophy is a disease that should not be taken lightly. If the above diseases are not treated in time, such as maxillofacial deformity and pulmonary heart disease, even if the adenoids are removed and the breathing is clear, it is still necessary to continue long-term treatment of other diseases.
6. Do children with adenoid hypertrophy need surgery?
Snoring caused by adenoid hypertrophy in children is often ignored by parents, but it mostly constitutes the cause of snoring together with tonsillar enlargement, so special attention should be paid to the presence of apnea, and adenoids should be checked in hospital if necessary.
The adenoids in children can be examined indirectly by nasopharyngoscopy, more advanced fiberoptic laryngoscopy or electronic laryngoscopy and nasal endoscopy can easily examine the adenoids. Children with adenoid hypertrophy who have otitis media, rhinitis or sinusitis, especially those with “adenoid face”, should undergo adenoidectomy as soon as possible if conservative treatment is not effective.
Surgery to remove adenoids can be done at the same time as tonsil surgery or separately. In recent years, some people think that plasma treatment can be taken for adenoid hypertrophy, which is simple and extremely painful.
7. Do children with enlarged tonsils have to be operated?
As an immune organ, tonsils have their own physiological functions, especially in children, and tonsils have an important protective role for the body.
During childhood, when the immune function is active, especially at the age of 3-5, the tonsils increase significantly due to more exposure to external allergens, and the tonsillar hypertrophy should be regarded as a normal physiological phenomenon. Arbitrary removal of the tonsils will eliminate the local immune response, and even develop immune supervision disorders.
Therefore, the indications for surgery must be strictly controlled. Only those tonsils with irreversible inflammation should be considered for surgical treatment.
For example, recurrent acute attacks of chronic tonsillitis or multiple episodes of peri-tonsillar abscesses; chronic tonsillitis that has become a focal point for other organ lesions or is associated with adjacent organ lesions; tonsillar hypertrophy that interferes with swallowing, breathing, sleeping and vocal functions should be considered for surgical treatment.