Children who are often sick, snotty and coughing almost constantly are not such a unique phenomenon. Many parents are faced with the fact that a child goes from one sick leave to another and so almost all year round.
Perhaps it's not a weak immune system, as grandmothers and mothers think, but adenoids. We will describe in detail in this article what it is and how to treat a child with adenoiditis.
What it is
Adenoiditis - a disease that refers to pathological changes in the pharyngeal tonsil. The tonsils (palatine, lingual, tubal, pharyngeal) have a specific purpose, which is to protect the body from the penetration of viruses and bacteria. They are composed of lymphoid tissue. When this or that pathogen attacks the nasopharynx, the tonsils react with hypertrophy (that is, an increase in size).
The people call the tonsils simply - tonsils. Normally, in a healthy child, they are small, do not cause anxiety and do not interfere with breathing. If the tonsils are enlarged, this always indicates that the body is desperately fighting some foreign pathogenic agent or bacterium.
If the child is sick more often than his peers, then the unpaired pharyngeal tonsil ceases to cope with the constant load and begins to grow. This property of the lymphoid tissue, which, in fact, is the body's natural filter, is also characteristic of other tonsils. Hypertrophied tonsils themselves become a big problem, since their inflammation causes adenoiditis.
This disease rarely affects adults and is considered in medicine to be truly childhood.
At risk are babies from 2 to 7 years old, and at 2 years old it occurs less often, and the bulk of patients are between 4 and 6 years old. Adenoids bother about 6% of children of different sexes, and it does not matter whether they live in the northern or southern regions.
Classification
Depending on how long the child has been suffering from nasal breathing disorders, coughing, adenoiditis is acute, subacute and chronic.
The acute form of the disease proceeds in parallel with ARVI or other viral disease, and lasts about a week. Subacute adenoiditis is a disease that lasts no more than three weeks, it is usually recorded in children with already hypertrophied tonsils. An ailment in a chronic form is a disease lasting more than six months, with it usually complaints are no longer only that the overgrown pharyngeal tonsil interferes with normal breathing through the nose, but also for the insufficient functions of neighboring organs - the child begins to hear worse, he often has a sore throat.
According to the totality of the clinical manifestations of inflammation, catarrhal adenoiditis, serous (exudative) and purulent adenoiditis are distinguished. Allergic adenoiditis, which develops as a result of prolonged contact with allergens, should be considered separately.
For a better understanding of the child's condition, it is important for parents to know not even the morphological and clinical types of the disease, but its degree, because they most fully reflect the real picture and allow them to make predictions for treatment:
- Adenoiditis 1 degree. With it, the overgrown pharyngeal tonsil closes about a third of the vomer (the bony part of the nasal septum). Nasal breathing is possible, although it can be difficult.
- Adenoiditis 2 degrees. A hypertrophied amygdala obstructs half of the opener, and therefore breathing is often difficult.
- Adenoiditis 3 degrees. Nasal breathing is very difficult, the child almost always breathes through the mouth, since the amygdala is enlarged so much that it closes two-thirds of the lumen.
- Grade 4 adenoiditis. In principle, the child cannot breathe through his nose, since the overgrown lymphoid tissue completely blocks the nasal passages. The fourth degree is not recognized by all doctors, some assess the disease in three degrees and consider the third as extreme. Here it is not so much the ordinal number before the word "degree" that matters, but the proportion of closure of the nasal passages.
With a disease of 1-2 degrees of manifestation, there can be only one side - only one nostril is constantly blocked or there was a hearing loss in only one ear. However, both nasal passages or both auditory tubes are more often affected.
Causes
- The main reason for the proliferation of adenoids is acute respiratory viral infections common among children. SARS, influenza, acute respiratory infections most often provoke increased growth of the tonsils. If, for some reason, the child's immunity is not strong enough, temporarily weakened, for example, due to a recent illness, then the likelihood of tonsil hypertrophy increases significantly.
Children's immunity cannot compete with an adult at all, and if in the first six months of a child's life the antibodies received from the mother during pregnancy (which explains the very low prevalence of adenoiditis in infancy), then, when there is no innate protection, the whole burden falls on the child's own, not yet fully formed immunity.
- The second most popular reason for the enlargement of the tonsils is an individual tendency to allergies. If a child suffers from allergic reactions with the manifestation of their reparative - allergic rhinitis, cough, then he has an increased risk of developing chronic adenoiditis, which will worsen every time there is contact with an allergen (during seasonal flowering, for example).
If a child lives or most of the time is in a room where it is hot and breathes excessively dry or dusty air, then he is more likely to develop pathological adenoids. Under such conditions, nasal mucus dries out faster, and pathogens can almost freely penetrate through the nose and settle in the throat. At the same time, inflamed tonsils will grow at a faster pace.
Chronic diseases of the nose and throat also have a significant impact on the formation of the disease. If a child has a runny nose for a couple of months, this creates excellent conditions for the growth of adenoids. Therefore, every respiratory illness must be treated promptly and correctly.
Contrary to popular belief, adenoiditis is not contagious to others. A child is contagious only during the acute stage of the disease with a viral infection, since the vast majority of viruses are transmitted by airborne droplets. In this case, the child "shares" with others not adenoiditis, but the influenza virus or other infection.
Viruses usually cause acute adenoiditis. In children with a chronic illness, they can cause an exacerbation. Purulent adenoiditis is often evidence of a secondary bacterial infection.
Symptoms and Signs
Symptoms are varied and extensive, and are not at all limited to a runny nose and cough, as it might seem at first glance. Unlike most diseases of the oropharynx, adenoiditis cannot be seen at home when examining the throat. The adenoids are located in the vault of the nasopharynx; only an ENT doctor can look there, and even then with the use of a special mirror with a flashlight on a long handle.
However, parents can suspect a child's problems with the pharyngeal tonsil without visual assessment of the adenoids.
There are several signs that may indicate illness:
- Prolonged rhinitis. Difficulty nasal breathing up to the complete inability to breathe through the nose. In this case, the child begins to breathe through the mouth.
- Excessive discharge of nasal mucus, which is not only marked off, but also flows into the nasopharynx. With purulent adenoiditis, the discharge is greenish and has a very unpleasant odor.
- Body temperature in acute and purulent adenoiditis can be quite high (up to 38.0-39.0 degrees). Chronic large tonsils usually do not cause fever, and symptoms proceed without fever.
- The child's sleep is disturbed due to the fact that in a dream he has to breathe mainly through his mouth. The baby sleeps restlessly, often wakes up. A clear sign of the disease is the appearance of snoring.
- During the day, the baby is sluggish, inactive, inactive, he has a reduced ability to memorize new information, interest in everyday affairs that were previously important to him.
- Older children may complain of headaches, hearing loss.
- The voice loses its bright color, becomes more husky and monotonous.
- Cough does not always appear, therefore, it cannot be considered a mandatory symptom of adenoiditis. If it is, it is chronic, dry, unproductive.
- The appearance of the so-called adenoid mask. With long-standing chronic adenoiditis, the child's facial expression changes. Because of the constantly open mouth, the child looks somewhat moronic, the expression of the eyes is not meaningful. The nasolabial folds are smoothed, severe salivation is noted, the bite changes. The ribcage can become sunken.
Diagnostics
Children's ENT will use several methods to diagnose and determine the degree of the disease.
First, he will independently examine the pharyngeal tonsil. Not so long ago it was probed by hand. The procedure is unpleasant. Now it is also officially recognized as uninformative, because the size of the pharyngeal tonsil is quite individual, and palpation cannot be a way to determine the pathological proliferation of adenoids.
However, the manual method of examination has one definite plus - the doctor gets an idea of the consistency of the tonsils. If they are not just large, but also loose, this will certainly alert the specialist. If softness is observed with systematic observation and in the dynamics of the child's tonsils are constantly enlarged, this is a reason for a more detailed examination.
Visual examination is called "posterior rhinoscopy". With her, the doctor examines the pharyngeal tonsil and the surrounding space with a special mirror, which is inserted through the mouth. If the child is small, then doing this manipulation can be incredibly difficult. Then another way comes to the aid of the ENT - anterior rhinoscopy, when the examination of the tonsils is carried out with instruments that are inserted through the nose.
The most informative method is x-ray of the nasopharynx, however, not all parents agree to it, and not all doctors offer it, since the procedure is associated with irradiation of the child's body. If there is a need to obtain a detailed image of the nasopharyngeal region, the doctor can prescribe a computed tomography, which also allows obtaining informative and accurate data.
Not every hospital and clinic has a tomograph, and it can be quite expensive for parents to conduct a study at their own expense. The most common way to diagnose adenoiditis is endoscopic examination. With it, the doctor inserts a soft flexible endoscope tube into the nasopharynx through the nose or through the mouth and gets a fairly accurate picture of the surface of the adenoids.
All these methods and a combination of several of them with each other allow the doctor to establish the presence or absence of adenoiditis, its clinical features (purulent or catarrhal), to determine the degree of the disease by the area of overlap of nasal breathing relative to the norm, when the child breathes freely. In addition, the doctor should rule out the presence of tumors in the nasopharynx, polyps, and other diseases that can give similar symptoms. All these data are very important for making decisions about treatment tactics.
Treatment
All parents are concerned with only one question - how to reduce the tonsils and alleviate the child's condition. The answer is unequivocal - the child needs to be treated. Without therapy, adenoiditis always turns into a chronic stage, which can cause a lot of troubles - from the appearance of a "adenoid mask" on the face to serious complications in the heart and kidneys.
If the doctor assessed the disease at 1-2 degrees, then the treatment is prescribed conservatively. If the child has a 3-4 degree, in which the lumen is closed by an overgrown pharyngeal tonsil by two-thirds or more and is complicated by inflammation, then surgical intervention is recommended. The operation is also recommended for children in whom the growth of the amygdala (even if it is grade 2) has led to the overlap or partial closure of the Eustachian tubes, as a result of which hearing has significantly decreased.
Surgical methods
The operation to remove the adenoids is called "adenotomy". The operation is performed under local or general anesthesia. Many representatives of the older generation remember that before the tonsils were removed without anesthesia at all, because the adenoids themselves are devoid of nerve fibers. It was not so much painful as it was scary, and therefore today anesthesia is used not even for pain relief, but for the child to undergo surgery more comfortably.
Today in medicine there are several methods of performing such an operation:
- Classical adenotomy using a round knife, which is used to cut off the overgrown tonsils;
- Laser adenotomy using high-precision laser equipment instead of a knife;
- Cold plasma adenotomy using the bloodless method.
The first method, although "rolled back" on many generations of young patients, is considered the most traumatic... After it, recovery takes longer, there is a likelihood of relapse. Laser surgery is more accurate and less traumatic. Cold plasma techniques are relatively new; they show excellent results in terms of the quality of the intervention performed and the short duration of the recovery period. The choice of the method and method of anesthesia is the task of doctors, because each particular child may have individual indications and contraindications.
Opponents of surgical treatment often point out that it is undesirable to remove tonsils as an important immune organ.... Indeed, doctors may prescribe not a complete removal, but an undercut or partial removal of an inflamed and hypertrophied tonsil, if there is reason to believe that the remaining part of the lymphoid tissue will not grow further.
There is no need to be afraid of adenotomy, experts say, because the operation lasts about 15 minutes, after which the child feels great in a few hours. In the absence of complications from the postoperative period, he is discharged home after 3-5 days.
Treatment without surgery
With uncomplicated grade 1-2 adenoiditis, the baby is prescribed conservative treatment, which includes several areas at once. It is important not only to reduce inflammation in the area of the tonsils, but also to stop the process of their growth, and this can be done only by strengthening the child's immunity.
Rinsing of the nose and throat and rinsing of the nasopharynx contribute to the removal of edema and inflammation. Usually saline solution, furacilin solution, local antiseptic "Miramistin" are used for this. If a child is diagnosed with a purulent course of the disease, the doctor, after the results of the analysis for bacterial culture of nasal mucus, will be able to prescribe the most accurate antibiotic against the "culprit" of purulent inflammation. Antibiotics of the penicillin group are usually used. It is possible both local instillation in the nose and taking antibiotics in tablets.
When treating non-suppurative adenoiditis, antibiotics are not used at all.The doctor prescribes drugs - glucocorticosteroids (Beclomethasone, Flixonase, etc.) in a nasal form, that is, they will need to be instilled and sprayed into the nose. With allergic adenoiditis, the doctor prescribes antihistamines in combination with calcium preparations. In different forms of the disease, a non-steroidal anti-inflammatory drug "Ibuprofen" can be prescribed.
The duration of the course and dosages are determined by the doctor, taking into account the age of the small patient and the severity of the symptoms. In addition to medicines, the doctor prescribes a whole range of measures to strengthen the immune system. It is advisable for the child to do a general strengthening massage, to do breathing exercises according to the Strelnikova system. It has not been officially proven by medicine, but climatotherapy for adenoiditis is widely practiced. Parents are advised to take their child to the sea, breathe in the sea breeze and bask in the sun.
Physiotherapy procedures related to exposure of the glands to heat, rays, medicinal aerosols can be prescribed. And only if after six months the result from therapy does not follow, the child's condition remains the same or worsens, then the parents will be advised to give consent to the operation.
Postoperative period
Most of the children will really like the rehabilitation period after the tonsil surgery, because doctors recommend giving ... ice cream to the operated patients! Eating it can be difficult because it will hurt to swallow for at least a week after surgery. Some children have a fever after surgery, even if there was none at all before the operation. Doctors advise against giving in this case antipyretic drugs based on acetylsalicylic acid, as this can cause bleeding.
In the first 7 days, the child should not take a hot bath, go to a bathhouse and even just sunbathe in the sun. After adenotomy, a special diet is recommended based on the consumption of pureed, pureed foods, cereals, jelly, broths, which will not additionally irritate and injure the throat.
Increased physical activity, sports should be postponed for at least a month, but a lot of walking in the fresh air is possible and necessary, this helps to strengthen immunity and faster recovery.
If the operation was carried out in the fall or winter, when there is an increase in seasonal viral diseases, after it, you need to protect the child from contact with other people for at least a couple of weeks. This will increase the likelihood that he will not "catch" another virus again and will not start to get sick again. If there is a salt chamber in the city where the child can go for several sessions, this will be an additional plus. By itself, inhaling salt ions does not help to heal, but sterile air (in such chambers it is) will be beneficial in the process of realbitation.
Folk remedies
Parents, whose child has been diagnosed with adenoiditis, must go to the Internet in search of a remedy that "without pills and surgery" will help cure the child. Such recipes are even sought after by those whose children have 100% indications for surgery. Believing in a miracle cannot be prohibited, but it should be understood that all folk remedies can be both useful and harmful if the child has a stage no more than 1-2. And in the case of stage 3-4, home treatment is a real parental crime.
However, traditional medicine can be very useful in the recovery phase after surgery, and even doctors of the "old school" who do not accept "quackery" in any form speak of this.
Safe means include:
- Saline solution. It is prepared from a teaspoon of salt and a liter of water. The solution can be used to rinse the nasopharynx with conservative treatment and for the prevention of adenoiditis at the first signs of a beginning ARVI or flu.
- Decoction of chamomile or sage. Decoctions made from the pharmacy collections of these herbs can be used for gargling, for washing the nasopharynx, for drinking both during treatment without surgery (with a slight increase in the tonsils), and after surgery (as a drink). For rinsing and rinsing, you can use decoctions of St. John's wort and calendula. The main thing is not to replace the treatment prescribed by the doctor with his own herbal rinses. Home methods can only slightly complement the main therapy, not replace it.
- Let us dwell separately on inhalations. Many parents believe that a child with adenoids who breathes over boiled potatoes under a blanket is treated this way. In fact, hot inhalation can only aggravate the inflammation process, especially if it is purulent. In addition, this method (over potatoes or a bowl of boiling water) can cause burns to the respiratory tract, and this will only worsen the baby's condition and may require hospitalization.
Inhalation with steam inhalers, if available at home, can be relatively useful only for acute catarrhal adenoiditis, when additional hydration of the mucous membranes is an obvious benefit. For all other forms of the disease, such procedures are useless. And with a purulent form, they are dangerous to life and health. Nebulizers are not used for the treatment of adenoids, since they are intended for procedures with the use of drugs in the treatment of diseases of the lower respiratory tract (bronchi, lungs).
Only competent actions of the doctor and the patient's desire to follow all the recommendations can relieve swelling and reduce the size of the tonsils. There is no magic herb or pill for adenoiditis.
Prevention
Prevention measures for this disease should be aimed at strengthening the child's immune defenses. By and large, prevention should be dealt with from the very birth of a baby.
- Creation of optimal conditions. If a child breathes dry and dusty air, as well as chemical vapors, not only persistent adenoiditis will form, but also a couple of other chronic diseases of the respiratory system by the age of 3-4.
It is best if the children's room is no higher than 20 degrees Celsius with a relative humidity of 50-70%. Under such conditions, the mucous membranes of the nose and oropharynx will not dry out, and this is an excellent prevention (and treatment!) Of ARVI, influenza, bronchitis, laryngitis and other diseases, including problems with the tonsils.
- Allergy prevention. In the child's room, there should be no objects and things potentially dangerous in an allergic sense - carpets, large soft toys that stand in the corner and act as household dust collectors. Books should be stored in a cabinet behind glass. To clean the house, it is best for mom to use household chemicals that do not contain chlorine, and if the child is prone to allergies, then the floors should be washed without household chemicals at all. Baby's clothes and bedding should be washed with hypoallergenic baby washing powder.
- Strengthening the immune system. The body's ability to repel attacks of viruses and bacteria is directly influenced by the lifestyle the baby leads. A mobile child who spends enough time in the fresh air has less illnesses, and if they do, they proceed much faster, without serious complications. From an early age, a child needs to be tempered, not to be introduced to a computer, but to sports and walking. Local immunity (in the throat) will be higher if the child drinks not only warm, but also cold drinks, as well as systematically eat ice cream.
- For any infectious diseases parents must be able to act competently in order to minimize the possible negative consequences, which include adenoiditis. You can not independently prescribe antibiotics, antiviral and other medicines to a child. The only exceptions are antipyretics, and even then - at temperatures above 38.5-39.0. Everything else should be appointed exclusively by a doctor, whom the prudent and sensible mom and dad will call at home on the first day.
Reviews
Parents wrote volumes of reviews on the surgical treatment of adenoiditis on the Internet. Therefore, those who are to undergo an operation may well familiarize themselves with them and draw their own conclusions. Most mothers who for a long time could not decide on the surgical removal of the tonsils from the child, and even with the 3rd degree of the disease continued to fight with conservative methods, in the end they still went with their children for the operation and did not regret it. Constant enduring illnesses stopped, children became more active, curious.
Feedback on reoperations deserves special attention. Unfortunately, adenoiditis often returns, and some children have to undergo the intervention two or even three times. There is not much difference in which clinic to receive treatment. In any case, mothers who have chosen paid private organizations for their children note only one advantage - they let them go home in a day, or even earlier. As for the rest, the level of equipment and the qualifications of surgeons are about the same.
Reviews about the treatment of adenoids without surgery, although numerous, are more reminiscent of advertising brochures, because at the end of each sad story about 3-4 degrees of adenoids in a child, there is always a mention of a certain "balm", "Dr. Ivanov from such and such a clinic" or " author's methodology ".
Doctor Komarovsky will talk about adenoids in the next video.
