The diagnosis - adenoides of
your child became sluggish and whimsical, sleeps with an open mouth, often is ill and quickly gets tired? In what the reason of feeling sick of the kid? It is possible that fault to they are adenoides which sometimes remember when they already have to be deleted. Meanwhile, almonds protect an organism from an infection and are in the service of immunity. Why they begin to expand and turn from colleagues into enemies?
Growth of nasopharyngeal almonds - a widespread disease among the children`s population, better known as adenoides. The reasons of developing of adenoides are various: hereditary predisposition, frequent catarrhal diseases, various infections - for example, flu, measles. When the kid is three years old, the circle of his communication extends: kindergarten, friends on the platform near the house, theater, sports sections. Almonds during this period work with an overload, and if immunity is weakened, they turn into the real center of infections, increase and provoke emergence of many serious the ENT SPECIALIST - diseases: otitises, adenoidit, tonsillitis, adenotonzillit which give complications on other internals
Adenoidny growths (vegetations) or adenoides (from the Greek aden - gland and eidos - a look) is a pathological increase (hypertrophy) in a pharyngeal almond which inflammation is called adenoidity.
Chronic tonsillitis (in article we will not consider cases of sharp tonsillitis, i.e. quinsy) - infectious - an allergic disease with local manifestations in the form of permanent inflammatory reaction of palatal almonds, with growth of their fabric. Chronic tonsillitis at children is, as a rule, combined with a chronic adenoidit, and in this case the disease carries the name chronic adenotonzillit.the Diagnosis chronic adenotonzillit
is put at such condition of almonds when their natural protective functions are weakened or lost and they become the chronic center of an infection and an allergization of an organism. Chronic adenotonzillit it is shown in a look:
- of the complicated nasal breath. Extent of violation of nasal breath depends on size and a form of a pharyngeal almond which creates a mechanical obstacle for air passing, and also from the size and a shape of a nasopharynx and the accompanying changes of her mucous membrane. Violation of nasal breath can have constant character at significant increase in adenoides or periodically be observed, during the periods of sharp respiratory infections of a nasopharynx, and also in a prone position (during a dream) when adenoides increase from - for a polnokroviya of venous vessels.
- of existence slizisto - a purulent secret in a nasopharynx that leads to oppression of protective function of a mucous membrane of a nose, its inflammation (chronic rhinitis). Besides, promotes violation of nasal breath, from - for what there is a twang of a voice, violation of its timbre and pronunciation of sounds.
- of decrease in hearing. Adenoidny vegetations are a mechanical obstacle for intake of air in an acoustical pipe. This state is shown by relative deafness of the sound carrying out type. Besides, the constant inflammatory phenomena in a nasopharynx lead to bacterial infection of a middle ear through an acoustical pipe owing to what there are average otitises (an inflammation of a mucous membrane of an ear).
- of snore and a syndrome obstructive apnoe (breath violations) during a dream. Adenoides, being an obstacle in a way of passing of an air stream, force the child to breathe through a mouth that leads to decrease in a tone of muscles of a throat. Besides, adenoidny vegetations do the direction of an air stream more swirling, than normal, from - for what there is a vibration of a soft palate which is shown snore and even a delay of breath from - for overlappings of air ways (a syndrome obstructive apnoe). A consequence of the complicated nasal breath both during a dream, and during wakefulness at children is constant drowsiness, increased fatigue, irritability, decrease in attention and memory.
- of cough which is connected with the irritation of a mucous membrane of a throat pathological separated, which is flowing down from a nasopharynx. Usually cough arises during a dream or when awakening the child.
Prevalence of these diseases depends on age of the child: at children of 2 - 3 years it is small - 2%, from 3 to 7 years - 5%, and during puberty and at teenagers raises to 14%. It should be noted that girls are much more often subject to diseases of the top airways, than boys.
of the Almond - regional bodies of immune system which work at the same time as an immune barrier of mucous membranes and as “plant“ on production of cages of immune system - lymphocytes. The main work of a so-called limfadenoidny pharyngeal ring (set of the almonds located around an entrance to a throat from oral cavities and a nose) is creation and maintenance at the normal level of system of immunity of mucous membranes. Part of a limfadenoidny pharyngeal ring are palatal almonds (represent a congestion of the lymphoid fabric which is between palatal handles at an entrance to a throat cavity) and a pharyngeal almond (it is located in the arch and partially on a back wall of a nasopharynx).by
Factors of development of a disease
To seven-year age at children notes the moderate physiological hypertrophy (increase) of almonds connected with their high functional activity during the early periods of life.
the Pathological hypertrophy palatal and pharyngeal almonds is caused by a microbic infection and often arises under the influence of repeated respiratory diseases (ORZ) or average otitis (an inflammation of a middle ear).
according to microbiological researches of contents of lacunas of almonds at children of 3 - 14 years with a chronic adenotonzillit, among pathogenic microorganisms the leading role is played by a piogenny streptococcus and golden staphylococcus. Following on detection frequency - a brankhamell (moraksell), diagnose a hemophilic stick less often. At the vast majority of sick children combinations of 2 - 4 pathogenic microorganisms come to light. Development of chronic inflammatory diseases of a lymphoid pharyngeal ring is caused not only microbes, but also a condition of immune system of an organism. The risk of a disease of the child is considerably increased in the presence of a chronic adenotonzillit at mother.
Classification of an adenotonzillit provides allocation typical and special atypical forms of a chronic hypertrophic adenotonzillit (at these diseases pathological growth of fabric of a pharyngeal almond - adenoides of I, II, III degrees is observed).
I degree of adenoides - Joana (from Greek. choane - a funnel), the internal nasal openings connecting a nasal cavity with oral and to a throat are closed by adenoides on one third;
II degree - Joana are closed by adenoides on two thirds;
III degree - Joana are closed by adenoides completely.
Typical chronic adenotonzillit
1) Compensated - prevalence of local inflammatory processes in palatal and pharyngeal almonds over the general reactions of an organism. Deterioration in the general condition of children only at recurrence (repetitions) of a chronic adenotonzillit or at repeated ORZ.
2) Subcompensated - against the expressed inflammatory changes in palatal and pharyngeal almonds moderate deterioration in health (the general weakness, slackness, a headache, joint pain) appears, often there are aggravations of a chronic adenotonzillit.
3) by Dekompensirovanny - chronic inflammatory changes in palatal and pharyngeal almonds are combined with full insufficiency of system of local immunity, the expressed deterioration in the general health and development of the serious accompanying chronic diseases of connecting fabric, such as rheumatism - an inflammatory disease of connecting fabric with primary damage of heart, chronic diseases of bronchopulmonary system, zheludochno - an intestinal path or complications (paratonzillyarny abscesses - a pus congestion behind palatal almonds, chronic lymphadenitis - an inflammation of nearby lymph nodes, etc.)Atypical chronic hypertrophic adenotonzillit
with adenoides of I, II, III degrees as a special form of a disease, on many external signs is comparable with typical, however directly in almonds inflammatory process is expressed poorly.
according to experts, adenotonzillit influences the frequency of viral infections at the child, breaks work of the eyelashes covering a mucous membrane of a cavity of a nose (which are carrying out function of self-cleaning of a nose), from - for the complicated breath blood is saturated with oxygen insufficiently that leads to oxygen starvation of a brain. Adenotonzillit can promote development of various pathological states, such as violation of formation of a facial skeleton as a result of lack of nasal breath, to violation of a normal arrangement of teeth, to inflammatory diseases of an ear, nose and okolonosovy bosoms, inflammatory diseases of a throat, throat and underlying airways, etc.
Inspection of the child is performed by the otolaryngologist. The diagnosis is made on the basis of carefully collected history of development of the child, history of a disease (anamnesis) and the following inspections:
- of a faringoskopiya - survey of a mouth. At the same time the condition of a rotoglotka, existence slizisto - purulent separated on a back wall of a throat, a condition of palatal almonds is estimated. It is also possible to estimate a condition of a pharyngeal almond and extent of increase in adenoides;
- a rinoskopiya - survey of the nasal courses. The otolaryngologist estimates a condition of the nasal courses, existence of the hypostasis separated in a nose cavity. After an instillation of vasoconstrictive drops in a nose the doctor can see the adenoidny growths closing Joana. When swallowing or pronouncing words by the child the soft palate is reduced and, resting against the hanging-down mass of adenoides, shakes them. At the same time there is a fluctuation of the light patches of light which are reflected from a brilliant surface of an almond;
- endoscopy of a nasopharynx - survey of a nasopharynx by means of the optical device of the rinoskop entered into a cavity of a nose or through an oral cavity in a rotoglotka. Advantages of endoscopic research of a nasopharynx is informational content, harmlessness, a possibility of a photo - and video filming of object of research; the nasopharynx X-ray analysis and additional bosoms of a nose allows to establish to
- degree of adenoides precisely. For diagnostics the lateral projection of the roentgenogram is used. For the best contrasting of a nasopharynx air the patient has to open a mouth.
Treatment of a chronic adenotonzillit at children is subdivided by
into conservative (medicinal) and surgical .
Treatment of a chronic adenotonzillit first of all consists in restoration of the broken nasal breath. For this purpose it is necessary to dig in a pipette in the nasal courses mineral water or to use preparations on the basis of sea water (AKVAMARIS, SALIN) that promotes mechanical removal of crusts, dust, slime with the microbes which are contained in them. Preparations dig in 3 times a day in each nasal course. Then it is necessary to blow the nose carefully. Instead of the specified medicines it is possible to use water solution of a St. John`s Wort or a camomile (to fill in 1 teaspoon of a grass ½ a glass of boiled water to insist on a water bath). After a toilet of a nose it is possible to dig disinfecting solution (2 - 3% solution of a kollargol or protargol, 20% albucid solution, juice of a kalanchoe or strong tea leaves of green or black tea). For the best hit of funds for almonds of the child it is necessary to put on a back. During developing of an acute respiratory disease after washing of a nose for reduction of hypostasis inflamed mucous nasal sinks it is recommended to dig in in the nasal courses vasoconstrictive drops (NAZIVIN, OTRIVIN, etc.) 3 times a day or before going to bed, but no more than 3 - 5 days.
Conservative treatment is appointed when almonds are increased moderately and there are no complications. Such treatment has to be carried out in policlinic at the place of residence or in a hospital. The indication to hospitalization is inefficiency of conservative therapy in policlinic. Duration of hospitalization makes 10 - 15 days depending on complexity of pathology.
Conservative therapy consists of 4 main types of local and general influence which should be carried out in a complex that is guarantee of successful treatment of a chronic adenotonzillit.
- Treatment of inflammatory processes in palatal and pharyngeal almonds in the form of of washings with use phyto - and biological products.
- Laser radiation palatal and pharyngeal almonds.
- Immunomodulatory therapy with use of solution of a dimefosfon locally and inside.
- Respiratory nasal gymnastics and massage .
of Washing . In out-patient conditions for the purpose of local treatment of almonds washing of palatal and pharyngeal almonds which is carried out by the otolaryngologist (the number of sessions - 10 is applied, it is necessary to repeat a course each half a year). Washing is carried out by the tincture of an eucalyptus divorced 0,9% sodium chloride solution in the ratio 1:10, 2 times a day by means of the special device - an irrigator the ENT SPECIALIST - 1. Introduction by means of the syringe to a cavity of a nose and a nasopharynx through one half of a nose of the medicinal solution which is warmed up to 37 º can be option of washings; With, and its simultaneous suction from other half of a nose an electrosuction. Lacunas of almonds wash out by means of the simple syringe. Except tincture of an eucalyptus also other phytopreparations - tinctures of a calendula, a camomile, and also a biological product - propolis solution are used. Washing palatal and pharyngeal almonds comes to the end with their processing with 1% spirit tincture of an eucalyptus. After this procedure (in the same day, the number of sessions same) the physiotherapist carries out inhalations of medicinal solutions (preparations of an eucalyptus, INGALIPT) through a mouth by means of an inhaler.
Laser therapy. Radiation of palatal almonds is carried out through a mouth, and a pharyngeal almond through a nose (the light guide from a laser radiator is entered on depth from 3 to 7 cm depending on age of the child under control of sight through a nasal mirror). Radiation in the visible red and infrared range (600 - 920 nanometers) is used. Duration of radiation of each almond of 30 seconds. Laser therapy is carried out once a day (perhaps in polyclinic conditions), number of sessions - 10, is recommended to repeat a course every year. Also simultaneous washing and laser radiation of almonds by means of the device an irrigator the ENT SPECIALIST - 1 practices: via one its channel the light guide from a laser radiator is passed, two other channels serve for giving and suction of medicinal solutions.
Instead of laser therapy depending on opportunities of policlinic or a hospital can apply on area of a nose ultra-violet radiation, an electrophoresis with drugs, UVCh currents (ultrahigh frequency).
Immunomodulatory therapy. Such therapy allows to increase functional activity of immune system in general. For maintenance of immunity of the child carry out washings of almonds. At the subcompensated and dekompensirovanny chronic adenotonzillit 11% solution of a dimefosfon in combination with phytopreparations (eucalyptus tincture, the calendula tincture) having immunomodulatory effect are used. Procedures are carried out 1 time a day within 10 - 15 days. Dimefosfon 3 times a day during 2 - x weeks are applied also in the form of 1% of water solution to intake.by
Also appoint preparations from group of bacterial lysates which contain parts in a special way of the processed microorganisms, the most often defiant diseases of the top airways and against which the organism begins to produce protective proteins - antibodies: BRONHOMUNAL, IRS - 19, IMUDON, RIBOMUNIL. As a result there is a possibility of decrease in number of sharp and chronic diseases, considerable reduction of duration and reduction of weight of a course of disease, prevention of complications.by
Also at an adenotonzillita for maintenance of immunity use various homeopathic medicines. In an initial stage of a disease the instillation in a nose of juice of crude carrots on 5 - 6 drops of 4 - 5 times a day gives a positive effect. In addition appoint the same juice on 1/4 glass a day inside irrespective of age.
Respiratory nasal gymnastics . It consists of two sets of exercises:
needs Previously to blow the nose separately each nostril. Having closed one half of a nose (having pressed a finger a nose wing), deep breath and an exhalation (the mouth has to be closed) through one nostril - 10 times, then through another - 10 times and both nostrils - 10 times are taken.
Having closed one half of a nose (preparation for exercises same, as well as in the first case) the deep breath is taken by one half of a nose, the breath for one second is held, and the exhalation is carried out through other half of a nose which was closed before. At the same time it is necessary to close that half of a nose through which the breath was made. And so - 10 times and then to repeat exercise by other nostril.Respiratory nasal gymnastics needs to carry out
daily on 8 - 12 times a day (on the street and indoors) during 3 - x months. These exercises teach the child to breathe correctly, through a nose.the Facial massage and sheyno - a vorotnikovy zone leads
to improvement of blood circulation and increase of a tone of face muscles, the number of sessions - 10 - 15, it is recommended to repeat a course of times in half a year.
as a result of such complex treatment the child will be ill much less often ORZ that will create prerequisites to reduction of almonds. Besides, in process of growth nasopharynx volume at children increases that leads to improvement of nasal breath.At conservative treatment the otolaryngologist has to watch
the child constantly. If therapy is inefficient, and the resistant difficulty of nasal breath will become the reason of frequent infectious diseases of the child, decrease in hearing, the recurrent (repeating) otitises (ear inflammations) or inflammations of okolonosovy bosoms (sinusitis), a syndrome obstructive apnoe (breath violations) during a dream, developing of the accompanying chronic diseases, then removal of almonds - an adenotomiya (adenoidektomiya) is shown.
of Contraindication to carrying out an adenotomiya:
- of anomaly of development of a soft and hard palate, crevice of a hard palate;
- age of the child (till 2 years);
- of a disease of blood;
- suspicion on oncological diseases;
- sharp diseases of the top airways;
- the period till 1 month after preventive inoculations.
Surgical treatment is carried out in a hospital. Classical operation on removal of almonds is performed under local anesthesia. On lymphoid fabric it is imposed adenoty - a steel loop on the long thin handle, one edge of a loop - sharp which makes removal. There are also more modern techniques, for example an endoscopic adenotomiya. In this case the surgeon under control of sight by means of the endoscope - the optical device of an adenotom or an aspiration adenotom (a hollow tube with the receiver expanded on the end for lymphoid fabric in the form of a boot, other end of a tube is connected to a suction) carries out removal of limfadenoidny fabric. This procedure is carried out under the general anesthesia. It is necessary to tell that the best results are achieved at the adenotomiya executed in the conditions of visual (visual) control i.e. by means of the endoscope is a priority direction. Incomplete removal of adenoidny fabric is characteristic of “blind“ carrying out an adenotomiya that is the reason of a retsidivirovaniye (repeated emergence) of pathology, traumatizing surrounding fabrics, connected with “mobility“ of the patient, the wrong selection of the size of an adenotom etc.
At a normal current of the postoperative period the child can attend kindergarten or school for the 5th day after an adenotomiya. Having ended a course of treatment, many children continue to breathe through a mouth though obstacles for normal breath are eliminated. These patients need purpose of respiratory nasal gymnastics which is carried out under control of the expert in physiotherapy exercises or in house conditions after the corresponding consultation.
, How effectively surgical treatment? Complex conservative therapy yields the best results much more preferably. After removal fabric of almonds can expand again. If at the same time there is a deterioration in nasal breath and so forth, then carrying out conservative therapy is shown. If adenoidny growths provoke exacerbations of the accompanying chronic diseases of connecting fabric of bronchopulmonary system, zheludochno - an intestinal path, then repeated surgical intervention is required.
the Current of a chronic adenotonzillit can be complicated by development of paratonzillyarny abscess - a purulent inflammation of the fabrics located about palatal almonds owing to penetration of an infection from lacunas (the superficial deepenings located on almonds). Happens mainly unilateral and it is characterized by rise in temperature higher than 38,0 º With developing of sharp pain when swallowing on the one hand which gives to an ear, refusal of meal. On the party of defeat the swelling of lymph nodes, sharply painful is observed at a palpation. The child tries to hold the head with an inclination in the sick party. The bed rest, antibiotic treatment anesthetizing and febrifugal preparations, opening of abscess are shown in the surgical way.
can carry To possible complications also chronic lymphadenitis - an inflammation of lymph nodes, adjacent to a limfadenoidny pharyngeal ring, for example submaxillary which is followed by their increase. To the touch knots dense, low-painful, mobile. Treatment has to be directed to elimination of the main disease.to
For prevention of development of an adenotonzillit showed timely dental care, additional bosoms of a nose, restoration of free breath through a nose, an organism hardening. For the prevention of possible complications of a disease it is necessary to delete in due time pathologically changed almonds. Besides, it is useful daily, to wash out as hygienic procedure a nose cavity solution of a camomile or a St. John`s Wort and after that carefully to clear it of contents.