Generality
The adenoids are small masses of lymphatic tissue, located on the posterior wall of the nasopharynx (behind the nose).
Together with the palatine tonsils, the adenoids compete, to perform an immune protection function, important especially during childhood .
In children, enlargement of the adenoids (adenoid hypertrophy ) and inflammation ( adenoiditis ) are frequent pathological conditions, which can lead to respiratory problems and other complications that must never be neglected.
If adenoids cause respiratory limitations or recurrent infections and are resistant to medical treatment, an indication is given to their removal ( adenoidectomy ).
What are
The adenoids are cluster-shaped structures, located in the posterior wall of the nasopharynx (structure that connects the nasal cavities to the throat), above the plane of the soft palate.
Also known as pharyngeal tonsils, these formations constitute a first barrier against infections of the upper respiratory tract and favor immunization against microorganisms from the outside, which penetrate through the nose and mouth. Sometimes, however, this function fails and the adenoids become chronically inflamed or hypertrophic .
The colonization of these structures by germs can cause occasional or recurrent infections, especially in children, and can make breathing through the nose more difficult. In this case, moreover, the adenoids represent an infectious focus that can be responsible for diseases affecting other organs, such as eyes, joints, muscles, kidneys and heart.
What are they for
Adenoids are lymphatic formations, present from birth, which develop progressively and reach their maximum size at the age of about 3-5 years. Normally, in children, a soft mound is formed in the upper and rear part of the nasopharynx, just above and behind the uvula.
At the age of about 7, the adenoids undergo an involution process, reducing their size due to the physiological atrophy, which makes them barely visible during adolescence. In adulthood, adenoid tissue becomes practically inactive.
Although these formations are useful during early childhood to prevent infections, the body has more effective means to fight bacteria and viruses. For this reason, if the adenoids grow excessively and cause significant breathing difficulties, it is recommended to remove them surgically.
Causes
In children, adenoid tissue dysfunction causes two main consequences:
- Respiratory obstruction : adenoids can increase their size in response to infectious processes, allergic reactions or various other phenomena. Their pathological enlargement causes a significant encumbrance in the cavity in which they develop, such as to occlude the posterior part of the nose and throat. Adenoid hypertrophy in children therefore makes nasal breathing more difficult and can interfere with the correct outflow of mucus from the ear.
- Inflammation : by increasing in volume, adenoids are more likely to be infected and, due to their particular anatomical and histological structure, they become excellent deposits of infectious material. Adenoid inflammations (adenoiditis) can cause other health problems, including sinusitis and serious respiratory problems, especially during the night.
adenoiditis
Adenoiditis is the inflammation of the adenoids. This process is usually caused by bacterial or viral infections. Adenoiditis occurs mainly in children, sometimes in association with acute tonsillitis or otitis media.
Hypertrophic adenoids
Adenoid hypertrophy is frequent especially in children aged between 2 and 6 years. This phenomenon is not always pathological. Commonly, adenoids increase their size in response to infectious processes (viral or bacterial) and, for most children, this causes only slight discomfort, which does not require any specific treatment.
The enlargement of the adenoids may also depend on constitutional factors (lymphatic diathesis) and on environmental factors (cold-damp climate, exposure to allergens, etc.).
Symptoms and complications
Adenoid disorders in children cause extremely varied manifestations, including:
- Sore throat;
- Otalgia (earache);
- Closed nose;
- Abundant nasal secretions;
- Cough;
- Epistaxis (nosebleed);
- Dyspnea (difficult breathing);
- Hearing loss (hearing loss);
- Dysphagia (difficulty swallowing food);
- Halitosis;
- Anosmia (inability to perceive odors);
- Rinolalia (nasal voice);
- Obstructive sleep apnea and snoring (in severe cases);
- Sleep disorders, morning headaches and daytime tiredness;
- Ogival palate (if the respiratory problem persists for a long time, a deformation of the palate may occur, which may appear narrow and hollowed upwards, besides being a cause of dental malocclusion).
Adenoid hypertrophy
The obstruction of the airways associated with the enlargement of the adenoids typically involves the " adenoid facies ", since the child tends to always be with the mouth open (oral breathing), the upper lip raised and the expression "asleep".
When the nasopharynx is completely obstructed, otitis media, sore throat and bronchitis can appear, since the inspired air is no longer filtered by the nose, but goes directly into the respiratory tract.
Even the child's voice is modified, as it reduces the pharyngeal resonance and thus there is an accentuation of the nasal timbre (rhinolalia). The enlarged adenoids can also cause halitosis and difficulty in swallowing.
Furthermore, by obstructing the normal flow of air, hypertrophic adenoids can make it more difficult to sleep: at night, the child breathes loudly or manifests episodes of obstructive sleep apnea (a condition that involves the suspension of breathing for a few seconds), enuresis (loss of urine in sleep) and pavor nocturnus (episodes in which the child wakes up suddenly, as terrified and in the grip of nightmares).
In addition to obstructing breathing, enlarged adenoids in children can compress the Eustachian tubes, which connect the tympanic cavity with the nose, preventing ventilation and elimination of middle ear secretions.
This phenomenon can predispose to hypoacusis: if a child cannot hear sounds clearly, he can report consequences on learning, intellectual development and social interaction.
adenoiditis
Adenoiditis occurs mainly during childhood, sometimes in association with acute tonsillitis or otitis media due to the extension of the inflammatory process to neighboring organs.
Adenoiditis usually involves the following manifestations:
- Temperature;
- Nasal respiratory obstruction;
- Sleep apnea and snoring;
- Rhinorrhea with serous secretion (in viral forms) or muco-purulent (in bacterial forms).
Symptoms due to a viral infection tend to resolve spontaneously after 48 hours; the bacterial adenoidites can instead persist up to a week.
Serious or recurrent infections can lead to adenoid hypertrophy that can block the back of the nose and throat. If neglected, the adenoiditis can therefore cause a series of complications, including:
- Chronic or recurrent nasopharyngitis;
- Inflammation of the middle ear (otitis);
- Sinusitis and respiratory infections (bronchitis or pneumonia).
The presence of persistent phlegm in the middle ear can also lead to a reduction in hearing ability; in children, conductive hearing loss can influence learning and social interaction.
Diagnosis
In the presence of symptoms suggestive of an adeno-tonsillar disorder, an otorhinolaryngological examination is essential, also to exclude the presence of a different or concomitant pathology.
To confirm a diagnosis of inflammation or adenoid hypertrophy, the child is subjected to a rhinoscopic examination (or nasal fibroscopy), with which it is possible to carry out an accurate exploration of nasal cavities and nasopharynx. In children with adenoid problems, the hearing function with tympanometry should also be evaluated.
Occasionally, x-rays or other imaging methods may be indicated to check the size of the adenoids.
Anterior rhinoscopy
Anterior rhinoscopy is an examination that involves minimal discomfort and does not require any anesthesia, therefore it is indicated especially in younger or uncooperative children . This survey involves the use of a speculum that serves to spread the nostrils, while a beam of light illuminates the nasal cavities to allow observation. Unfortunately, the evaluation is limited to the front portion of the nose only.
Posterior rhinoscopy
In older children, posterior rhinoscopy allows assessment of the extent of obstruction and involvement of the Eustachian tube by introducing a flat, round-shaped mirror in the oral cavity. This instrument is passed behind the uvula to allow observation of the nasopharyngeal space.
The endoscope with optical fibers can confirm the diagnosis, directly highlighting the inflamed adenoids.
Therapy
When the defense function fails, inflamed or hypertrophic adenoids can represent a serious obstacle to breathing and become harmful to the body, to the point of necessitating their surgical removal. Surgical treatment is however to be considered the last of the solutions (ie when, despite medical treatment, the disease becomes chronic and the symptoms become worse).
Pharmacological therapy
In the early stages, the treatment of adenoid hypertrophy is pharmacological. Bacterial forms of acute adenoiditis usually include antibiotics, such as amoxicillin-clavulanic acid or cephalosporin. In the case of viral infection, on the other hand, the administration of analgesics and antipyretics is often sufficient.
Depending on the triggering cause and symptoms, the doctor can also prescribe nasal decongestants, mucolytics and cortisone orally or aerosol.
Surgical treatment
If the symptoms are severe or persistent, the adenoids can be surgically removed, using an adenoidectomy .
Often, this option is recommended when:
- Adenoiditis or adenoid hypertrophy does not respond to drug therapies;
- The child manifests obstructive sleep apnea (OSAS);
- Episodes of infection are frequent (more than four episodes of otitis media occur per year).
Adenoidectomy is also appropriate when:
- There is an obvious hearing loss (hypoacusis) in children over 3-4 years of age (a condition that could interfere with language development);
- Breathing through the nose is difficult
- There is a risk of possible complications, such as dental malocclusion and numerous febrile episodes.
How an adenoidectomy is performed
Adenoidectomy involves the administration of a general anesthetic (less commonly topical) and is performed in about 30 minutes. In most cases, the child can go home the same day as the surgery.
Adenoidectomy involves the use of an instrument, the adenotome, which, introduced into the oral cavity, "hooks" the adenoids behind the soft palate and detaches them - through currettage (scraping) or ablation - from their insertion into the nasopharynx. To seal the operative wound, the surgeon can cauterize or apply some resorbable suture.
If the child is subjected to severe or frequent attacks of tonsillitis, the simultaneous removal of tonsils and adenoids ( adenotonsillectomy ) may be indicated.
Complete recovery from an adenoidectomy usually takes 1-2 weeks. The post-operative course may be accompanied by some minor health problems, such as pain in the throat and otalgia, difficulty swallowing, stuffy nose, halitosis, uvula edema, difficulty in eating, fever and vomiting. These symptoms are mostly temporary and rarely require further treatment.
Adenoidectomy is a low-risk procedure that rarely causes complications. However, as with all surgical procedures, there is a small risk that some complications may occur such as infections, bleeding or allergic reactions to anesthesia.
After surgery, most children who suffer from recurrent adenoid disorders:
- Finds a significant health improvement;
- Breathe better through the nose;
- There are fewer infections of the throat and ear.
Some advice
In the case of enlargement of adenoids in children, it is possible to put into practice some tricks to avoid the onset of acute inflammation, such as:
- Wash the nose with saline solutions (such as the physiological one) to be instilled several times a day, especially in children who cannot blow it, so as to keep it clean and prevent the development of germs;
- Blow the nose of the child often and let him drink a lot to keep the secretions more fluid, therefore easily eliminated;
- Use night-time environmental humidifiers and aerosols with saline solution;
- Prepare liquid or creamy meals, which the child can consume in small bites;
- Let the child sleep with the head slightly raised to promote night-time breathing.
