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Adenoids
(Latin adenoides, from ancient Greek ἀδήν – gland and εἶδος – type; synonym: adenoid growths, adenoid vegetations) – a pathologically enlarged pharyngeal (nasopharyngeal) tonsil, causing difficulty in nasal breathing, hearing loss and other disorders.
Enlargements of the tonsil are caused by hyperplasia of its lymphoid tissue.
What are adenoids
Pharyngeal tonsil is located in the fornix of the nasopharynx and is part of the lymphadenoid pharyngeal ring (together with the lingual, tubal and palatine tonsils).
During a routine examination of the pharynx, this tonsil is not visible; special ENT instruments are required to observe it.
Adenoid vegetations are widespread in children and are most often observed between the ages of 3 and 7 years. The development of adenoids is promoted by diseases that cause inflammation of the mucous membrane of the nasal cavity and tonsils (measles, scarlet fever, influenza, acute and chronic inflammatory diseases of the upper respiratory tract, etc.).
Diagnosis of inflammation of the adenoids
- Digital examination of the nasopharynx, the so-called palpation, is the least informative method, but it gives an idea of the consistency of the adenoids.
- X-ray of the nasopharynx is more informative, but is associated with radiation exposure to the patient.
- Computed tomography is more informative than the previous one, but quite expensive.
- The endoscopic method is the “gold standard” in the diagnosis of adenoids, it is carried out both through the nose – “endoscopic rhinoscopy”, and through the oral cavity – “endoscopic epipharyngoscopy”. It is performed either with a flexible endoscope – fiberoscopy (the least traumatic method, recommended for small children and adults), rigid endoscopy (suitable for patients of any age, provided there are no anatomical features in the nasal cavity that would prevent the use of an endoscope).
- Posterior rhinoscopy is a “classical” method of examination through the mouth using a special mirror, sometimes difficult to perform in young children.
In addition, the surface of the adenoids is visible during anterior rhinoscopy (examination through the nose).
Degrees of adenoid development
There are 4 known degrees of adenoid development
- 0 degree – the pharyngeal tonsil has normal physiological dimensions.
- 1st degree – the enlarged pharyngeal tonsil covers only the upper part of the vomer or the height of the nasal passages.
- 2nd degree – an enlarged pharyngeal tonsil covers 2/3 of the vomer or the height of the nasal passages.
- 3rd degree – an enlarged pharyngeal tonsil covers almost the entire vomer.
According to another classification, there are 3 degrees of adenoid hypertrophy
- 1st degree – the pharyngeal tonsil covers one third of the vomer
- 2nd degree – the pharyngeal tonsil covers two thirds of the vomer
- 3rd degree – the pharyngeal tonsil covers the vomer completely.
clinical picture
An enlarged adenoid can cause two groups of symptoms:
- Impaired nasal breathing due to closure of the airways at the level of the nasopharynx
- Hearing impairment and predisposition to otitis media. This occurs when the adenoid closes the opening of the eustachian tube, which leads to disruption of the outflow of mucus from the middle ear.
Adenoiditis
– inflammation of the pathologically enlarged (hyperplastic, hypertrophied) pharyngeal (nasopharyngeal) tonsil (adenoids). It can occur alone or in combination with inflammation of enlarged palatine tonsils. A healthy adenoid looks lumpy and “loose”, but at the same time pink. When the adenoid is inflamed (this is called adenoiditis), due to swelling it becomes smooth and even, but at the same time covered with pus.
Treatment of adenoids
Treatment is carried out by an otolaryngologist.
Removal of adenoids
- Enlargement of the adenoid more than the second degree (if they cover the lumen of the nasopharynx by more than two-thirds) and the associated violation of nasal breathing, with the exclusion of possible other causes. These reasons include: deviated nasal septum, inflammatory or allergic swelling of the mucous membrane of the nasal turbinates (the most common), as well as polyposis, neoplasms of the nasal cavity (more rare).
- Closure of the excretory anastomosis of the Eustachian tubes by an enlarged adenoid and the associated disruption of the drainage function of the Eustachian tube. At the same time, the mucus that normally forms there does not come out of the middle ear, and the accumulation of this mucus disrupts the conduction of sounds. The child begins to hear worse, in addition, such an ear may be more often susceptible to inflammation (otitis media).