At times, all children have a sore throat, and sometimes the tonsils in their mouth can become infected. However, the tonsils are not the only vulnerable glands. In the nasopharynx, the adenoids can also become infected. Inflammation of the adenoids, called adenoiditis, can make breathing difficult and lead to recurrent respiratory infections. We will help you find out what chronic adenoiditis in children is and how to cope with it.
A little about adenoids
The adenoids are an area of tissue located high in the throat, just behind the nose. They, along with other tonsils, are part of the lymphatic system. The lymphatic system cleanses the body of infection and keeps body fluids in balance. The adenoids and tonsils work by trapping bacteria that enter the nose and mouth.
Adenoids begin to grow at birth and reach their peak size at the age of 3 to 5 years. After 7 years, they decrease. In adolescents, they are barely noticeable.
Infants and very young children have a deficient immune system. At this age, the adenoids are a useful reserve in the fight against infections. The adenoids store white blood cells and antibodies that help kill possible infections that threaten the baby's health. Later, when the immune system is better developed and copes more effectively with infections, they are not needed.
In contrast to the tonsils, which can be seen when the mouth is opened near the mirror, the adenoids can be seen by the doctor using a special mirror.
Although the adenoids help filter out germs, sometimes they can become overloaded with bacteria and become infected. When this happens, the glands become inflamed and swollen. This condition is called adenoiditis. If the adenoids become inflamed, they may not function properly.
Causes of adenoiditis
Adenoiditis can be caused by a bacterial infection such as Streptococcus. This condition can also be caused by a number of viruses, including the Epstein-Barr virus, adenovirus, and rhinovirus.
Risk factors
For the occurrence of adenoiditis, the influence of a number of factors is sufficient:
- artificial feeding;
- monotonous and mainly carbohydrate food;
- rickets (with vitamin D deficiency);
- diathesis;
- allergy;
- hypothermia;
- environmental impact (living in an area with dry, polluted air);
- recurrent throat infections;
- tonsil infections;
- contact with airborne viruses, germs and bacteria.
Symptoms of adenoiditis
The manifestations of adenoiditis may vary depending on the etiology, but mainly these are:
- stuffy nose;
- sore throat;
- enlarged cervical lymph nodes;
- ear pain.
If the nose is blocked, breathing through it becomes difficult.
Other signs of adenoiditis associated with a stuffy nose include:
- breathing through the mouth;
- speech with a nasal sound (nasal voice), as if a child is talking with a pinched nose;
- sleep disturbance;
- apnea or snoring.
Forms of adenoiditis
As with most existing diseases, the common forms of adenoiditis are acute and chronic.
Symptoms of acute adenoiditis
Acute respiratory and streptococcal infections are distinguished as etiological factors of this form of the disease.
The onset of the disease is accompanied by an increase in temperature (from 39 ºС and more). When swallowing, the child feels a slight pain in the depths of the nose. As a rule, the nose is stuffy, the child has a runny nose, and a paroxysmal cough appears at night. When examining the throat, on the second or third day, there is redness in the posterior pharyngeal wall, of moderate intensity. Mucus of a thick consistency is secreted from the nasopharynx.
Severe acute adenoiditis occurs in infants and is often difficult to diagnose because symptoms are inconsistent.
They are mainly expressed in manifestations characteristic of intoxication: difficulty in sucking, indigestion (feeling of fullness in the stomach, premature satiety, too long food retention in the stomach), a feeling of fullness in the epigastric region, nausea and dysphagia syndrome (swallowing disorder).
The posterior cervical and submandibular lymph nodes enlarge and become painful.
Typically, this form of the disease lasts up to five days. The tendency to relapse is typical, there are complications - acute inflammation of the middle ear and sinusitis, damage to the lower respiratory tract. Laryngotracheitis, bronchopneumonia may develop.
Symptoms of subacute adenoiditis
This form of the disease is characterized by a longer duration and is typical mainly for children with severe adenoid hypertrophy.
The onset of the disease is characterized by severity, often after purulent tonsillitis. The duration is about 15 - 20 days. Recovery after a sore throat occurs with a low-grade fever, with irregular fluctuations, with an evening rise in temperature. The cervical and submandibular lymph nodes remain in a swollen state, characterized by sensitivity to palpation.
Subacute adenoiditis develops mainly against the background of acute adenoiditis with subfebrile fever. Long-term purulent rhinitis, acute otitis media and cough are also troubling. The disease in this form sometimes lasts several months with variable changes in the state.
Chronic adenoiditis
The chronic form is a consequence of the previously developed acute form of the disease and is often combined with an increase in the pharyngeal tonsil (hypertrophy of the adenoids).
In the medical literature, 3 degrees of adenoid hypertrophy are usually distinguished. But there are sources that extend this classification to 4 levels.
1 degree of enlargement of the adenoids:
- difficulty in nasal breathing. Because of this, in a dream, the child breathes through the mouth, although his breathing during wakefulness remains normal. Parents should always pay attention to the baby's slightly open mouth while sleeping;
- even if the mouth is closed, breathing becomes noisy and the child at times opens his mouth to exhale and inhale;
- in the nasal cavity, an increase in mucous secretion occurs, mucus due to tissue swelling flows out or flows into the nasopharynx and the child swallows it;
- unusual sniffing in a dream, not previously observed.
All of the above manifestations are due to the fact that the adenoids increase slightly and close about a quarter of the lumen of the nasal passages. The adenoids take up more space in the supine position, and this greatly complicates breathing during sleep.
Difficulty breathing through the nose during sleep worsens nighttime rest, as a result of which the child wakes up tired and overwhelmed, his cognitive processes slow down, and his success decreases.
The second degree of enlargement of the adenoids
This stage in children is manifested by problems with breathing through the nose during sleep and while awake. In this case, the lumen of the nasal passages at the exit from the nasopharynx is closed by half.
Other, more serious ones are added to the signs characteristic of the 1st degree of the condition:
- normally in the nasal passages, the air entering the body is purified and humidified, but now the air is bypassed. Since the child breathes through his mouth constantly at night and during the day, this provokes an infection in the lower respiratory tract, which does not linger in the nose, the disease lasts longer and in a more severe form;
- the child in a dream not only snores, but also clearly snores, since the adenoids block the airways;
- the timbre of the voice changes, it becomes more deaf or slightly hoarse, nasal;
- As a result of a lack of oxygen and poor quality night rest due to breathing difficulties, the child's overall well-being deteriorates, which makes him irritable;
- there are constant problems with the ears: ears are blocked, hearing deteriorates, frequent recurrences of otitis media disturb;
- nutritional problems begin to appear. Due to lack of appetite, the child either refuses to eat at all, or eats little and reluctantly.
Hypertrophic third degree adenoids
Almost completely block the nasal passages, leaving only a narrow lumen for nasal breathing. The ability to breathe through the nose is practically nonexistent. Oxygen enters the body very little, the child suffocates and leaves painful but unsuccessful attempts to restore normal breathing.
The child breathes exclusively through the mouth in any weather. Freely penetrating into the nasopharynx and even deeper, viruses and bacteria cause persistent respiratory infections and inflammation. Due to frequent illnesses and the presence of bacteria in the nasopharynx, the child's immunity is significantly reduced.
The strong growth of lymphoid tissue is certainly accompanied by inflammatory reactions in the tonsils.
Due to a lack of oxygen, due to difficulty breathing, speech and cognitive abilities of the child are impaired. It is difficult for a child to concentrate, difficulties in remembering.
Due to incorrect breathing, the chest is deformed, the contours of the face change, the nasolabial triangle is smoothed out.
Common signs
As a rule, in general, chronic adenoiditis in children has the following symptoms:
- difficulty in nasal breathing;
- runny nose (persistent catarrhal, rarely purulent);
- regular exacerbations of the disease, which are manifested by an increase in temperature up to 38 ºС (on average), as well as an increase in colds and nasal congestion.
Quite often, secondary otitis media and sinusitis of a purulent nature occur with concurrent diseases, as well as with inflammation in the lower respiratory tract or in the acute phase of chronic diseases associated with ENT organs.
Exacerbation of chronic adenoiditis is represented by symptoms of an acute form of the disease. After therapy, acute manifestations disappear, but reducing the severity of symptoms, however, does not remove the chronic condition itself. Accordingly, it is this feature that is distinctive for the chronic form. In the acute course, after treatment, the structure and functions of the tonsils are restored, which were more or less impaired.
In chronic adenoiditis, the general condition of the child is satisfactory, the temperature outside the exacerbation is normal. Symptoms of this form appear primarily in older children. At the same time, the chronic form is accompanied by a lag in the child's cognitive and physical development, which affects academic performance.
Often, along with the development of chronic adenoiditis, inflammation of the mucous membrane of the Eustachian tube occurs. The latter is accompanied by hearing impairment in a progressive form.
Diagnostics of the chronic adenoiditis
An otorhinolaryngologist will do a physical exam to determine where the infection is. He will also ask about your family history to determine if the condition is hereditary.
Other tests may include:
- taking a throat swab to obtain samples for laboratory research (to identify bacteria and other organisms);
- blood tests to check for inflammation;
- X-rays of the head and neck to determine the size of the adenoids and the extent of infection.
Treatment of chronic adenoiditis in children
For chronic adenoiditis with grade 1 hypertrophy, treatment is conservative. This implies the need for topical application of vasoconstrictor and anti-inflammatory drugs. It is necessary to use drops twice a day.
Also, in this case, rinsing of the nasal cavity with the use of antiseptic solutions, mucus pumping, ozone therapy and laser therapy can be used. Inhalation is prescribed as an additional effect.
The use of antibiotics has often been successful in treating chronic inflammation in the adenoids.
With adenoiditis, breathing exercises are indicated. In the chronic form, breathing exercises should be carried out in the interval between exacerbations of the disease.
Treatment of chronic adenoiditis in a child with folk remedies is also possible.
- Add a pinch of turmeric powder and black pepper to a glass of warm milk. Drink before bed. It helps relieve congestion, pain and swelling of the mucous membranes.
- Add a few drops of lemon juice and a pinch of pepper to a teaspoon of honey. Offer formula to your child twice a day. Honey has a strong anti-inflammatory and antibacterial effect, which reduces the size of enlarged adenoids.
- Mix a teaspoon of fresh ginger juice with a teaspoon of honey and two teaspoons of warm water. Have your child gargle with this mixture for instant relief from pain and swelling.
- Combine fresh fig puree with honey. Have your child eat this once a day to speed up the healing process.
- Grind 2 - 3 cloves of garlic into a homogeneous gruel and squeeze the juice out of it. Add some honey to the garlic juice. Drink this juice very slowly, once a day.
In the case of adenoiditis with grade 2 and 3 hypertrophy, when therapeutic treatment becomes impotent, a surgical operation called adenoidectomy is performed. In the process, the adenoids are removed. When an adenoidectomy is done, no additional incisions are made and the hypertrophied tissue is removed through the baby's mouth. This entire process is performed under anesthesia.
Adenoidectomy, its risks and complications
The operation is performed safely and with care to get the best results. You have the right to be informed that there is a risk of unsuccessful results, complications or injury during the operation, both for known and unforeseen reasons.
Because people differ in their response to surgery, to anesthesia, and because everyone has a different recovery process, in the end there can be no guarantee of outcomes or potential complications.
There is a list of complications in the medical literature. This list does not include all possible complications. They are listed here for informational purposes only and not to scare parents into becoming more aware of this surgical procedure.
Here are just a few of them:
- bleeding. It is extremely rare that there is a need for blood transfusion;
- the need for further and more aggressive surgery, such as repairing the nasal septum or removing the tonsils;
- infection;
- inability to improve the condition of the nasal airways or eliminate snoring, sleep apnea, or mouth breathing;
- the need for allergy treatment. Surgery is neither a cure nor a substitute for good allergy control or treatment.
Preparation before adenoidectomy
In most cases, the procedure is performed on an outpatient basis in a hospital or surgery center.
A child should not take Aspirin or any product containing aspirin for 10 days before the date of surgery. Non-steroidal anti-inflammatory drugs (such as Ibuprofen) should not be taken within 7 days of the date of surgery. Paracetamol is an acceptable pain reliever. The doctor will suggest several recipes from postoperative pain when visiting before surgery. It is best that they are purchased before the date of the surgery.
It is recommended that you be honest with your child when explaining about the upcoming surgery. Encourage the child to think that surgery is necessary to maintain good health.Let him know that he is safe and that you will be there. A soothing and affectionate attitude will greatly ease the child's anxiety. Reassure him that most children experience pain after adenoidectomy, but they are minimal. Inform that if there is pain, it will only be for a short time and that he can take medications that will significantly reduce it.
The child should not eat or drink anything 6 hours before the surgery. This even includes water, candy, or chewing gum. Anything in the stomach increases the chances of complications from the anesthesia.
If the child is sick or has a fever the day before surgery, tell the doctor. If the child wakes up sick on the day of the operation, still come to the operation as planned. The doctor will determine if the surgery is safe. But if your child has chickenpox, do not bring your child to a health facility.
On the day of surgery
It is important that you know exactly what time you must register with the surgery and that you allow adequate time to prepare. Bring all paperwork and forms with you, including preoperative appointments and medical history sheets. The child should wear comfortable loose clothing (pajamas will do).
During the operation
In the operating room, the anesthesiologist will usually use a mixture of gas and intravenous medication for general anesthesia. During the procedure, the child will be constantly monitored by a pulse oximeter (a machine that monitors blood oxygen saturation) and an electrocardiograph. The surgical team is well prepared for any emergency. In addition to the surgeon and anesthesiologist, there will be a nurse in the room.
After administering anesthesia, the doctor will remove the adenoids through the mouth. There will be no external incisions. The base of the adenoids will be cauterized with an electric coagulator. The entire procedure usually takes less than 45 minutes. The doctor will go to the waiting room to speak to you as soon as the child is safely in the recovery room.
After adenoidectomy
After the operation, the child will be taken to a regular ward, where a nurse will look after him. The child will be able to return home the same day when he fully recovers from the anesthesia. This usually takes several hours.
It is best for the child to eat light, soft and cool food as soon as he fully recovers from the anesthesia (ice cream). Avoid hot liquids for several days. Even if the baby is hungry, it's best to take your time feeding to prevent postoperative nausea and vomiting. Sometimes a child may vomit once or twice immediately after surgery.
It's important to remember that a good diet with plenty of rest will help you recover.
The child is prescribed antibiotics after surgery and needs to complete the full course. Paracetamol will also be prescribed and should be taken as needed. You should not give any other medicines than those prescribed unless you have discussed it with your doctor.
Recovery
The examination should be carried out 10 to 14 days after the procedure.
Rarely, after surgery, a child's nose breathes immediately. Nasal congestion can last for several months until the swelling subsides. Saline nasal drops can be used to dissolve any clots and to reduce swelling. You may notice persistent or even loud snoring for several weeks. A temporary change in voice is common after surgery and usually returns to normal sounding after a few months. After the operation, the child's speech will be less "nasal".
Bleeding after adenoidectomy is rare. The child may have very mild nosebleeds. If this is not significant, your doctor may advise you to use a baby nasal vasoconstrictor drops. Sometimes you can see blood in the corner of the eye.
However, if the bleeding is persistent and bright red, see your doctor.
Most patients require at least 7 to 10 days to stay at home. After 3 weeks, you can resume physical activity.
Tell your doctor if your child has:
- an unexpected increase in the number of nosebleeds not caused by injury;
- fever of more than 38 ° C, which persists despite an increase in the amount of fluid consumed, cool baths and the use of Paracetamol;
- persistent sharp pain or headache that is not relieved by the prescribed pain reliever;
- excessive swelling or redness of the nose or eyes.
Prevention
There are several things that can be done to prevent chronic adenoiditis in young patients.
- It is important to treat acute adenoiditis in a timely manner, provide the child with healthy food and plenty of fluids.
- In addition, adequate sleep and proper rest are essential.
- Good hygiene can minimize the chance of infection.
