Remove adenoids from a child or not. Do I need to remove adenoids: all the pros and cons. When is the best time to have an adenoidectomy?
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This is one of the most important issues in the field of health of preschool children.
Why do adenoids grow? Do they threaten the health of the child? How to treat them and is it necessary to operate? All these problems concern many parents.
The mention of the pharyngeal tonsil is found in the writings of the medieval anatomist of Santorini. Adenoids are the nasopharyngeal tonsil, which consists of lymphoid tissue and is part of the so-called “Pirogov-Waldeyer pharyngeal ring”. Adenoids are located in the nasopharynx and are part of immune system.
We all know that with a sore throat, the lymph nodes in the neck increase, which sometimes hurt. These "balls" can be felt in the submandibular region. So the adenoids are the same lymph node, which increases with inflammation in the nasal cavity, only you can’t feel it.
The most common proliferation of adenoids occurs between the ages of one and a half to seven years.
What is the danger of inflammation
Children with inflamed adenoids are different from healthy babies. Since their nasopharynx lives as a "feeder for infections", numerous complications are possible.
Often because of the adenoids, the child cannot breathe normally through the nose. Children with adenoids even sleep with their mouths open, their sleep is restless, they snore loudly. Breathlessness may also occur. In the morning they get up sluggish, complain of a headache, are absent-minded and inattentive at school. Because of the adenoids, babies cannot learn to speak for a long time. This is also the reason for involuntary movements - a nervous tic, frequent blinking.
Sometimes adenoids lead to hearing loss, as they block the openings of the auditory tubes. And studies by virologists have shown that adenoids serve as a receptacle for adenoviruses that cause acute respiratory diseases, runny nose, tonsillitis, exacerbations of diseases of the bronchi and lungs.
Due to the fact that a child with adenoids always has an open mouth, lower jaw sags, nasolabial folds are smoothed out, the nose and other parts of the face are formed incorrectly, there is often an incorrect bite.
There is even such medical concept like an adenoid type of face. It is enough for a specialist just to look at a child to understand what is the reason for his poor health.
Causes of the disease and its symptoms
An increase in adenoids is the response of the immune system of a child's body to some strong irritant. If its effect is often repeated, then the tonsils try to produce more substances that stimulate the protective process. This is what causes them to grow. Here are the main causes of inflammation of the adenoids:
* Heredity. Adenoids increase primarily in children whose parents had the same problem in childhood.
* Allergic diseases of the upper respiratory tract (sinusitis, bronchial asthma).
* Frequent colds.
* Infectious diseases that reduce immunity (scarlet fever, measles, rubella, infectious mononucleosis).
* Low air humidity in the house during the heating period, rare ventilation.
* Strong dustiness (old carpets, pile of upholstery of upholstered furniture, books standing on open shelves).
* Unfavorable environmental living conditions, such as industrial emissions.
How is an increase in adenoids in a child determined? First of all, parents notice the problem - the baby becomes restless at night, snores, breathes through an open mouth during the day, asks again during a conversation. In this case, you should definitely contact an ENT doctor! To make a diagnosis, anterior and posterior rhinoscopy is performed, that is, examination with a special mirror, palpation of the nasopharynx with fingers, and endoscopic examination of the nasopharynx.
Enlargement of the adenoids is divided into several degrees.
Zero degree- normal size of the tonsils, no growths.
1 degree- a slight growth that closes ¼ of the lumen of the nasal passages.
2 degree- more significant growth, in which 2/3 of the nasal passages are closed.
3 degree- the nasopharyngeal tonsil almost completely or completely blocks the nasal passages.
Can surgery be avoided?
Back in 1873, the Danish physician Meyer compiled a clinical description of the disease, and since then adenoids have been treated surgically. A few minutes - and there is no problem. Moreover, the effect is observed quite quickly. The luminaries of medicine can read: "After the removal of the adenoids, the child is like a blossoming rosebud."
Indeed, having got rid of them, the baby quickly catches up with peers both mentally and physical development. The asymmetry of the face is also smoothed out. But relapses often occur: after a while, the adenoids grow again. So should they be removed?
Each case is individual, there are very specific indications for such an operation. Therefore, be sure to consult a good lore, who will select methods based on individual characteristics. It is harmful to self-medicate - even if you want to use folk remedies, it is better to talk to your doctor first.
You should start by looking for the cause of enlarged adenoids. Consult with a pediatrician, an ENT doctor, and, if necessary, an allergist and an immunologist. And you also need to remember: an increase in adenoids is much easier to prevent than to cure.
In principle, it is possible to avoid surgery, but it is not easy. After all, there are quite a few reasons for an increase in adenoids, and it is they that need to be eliminated in the first place. Since the process is initially an immune response of the body, only the body itself can stop it. Parents should identify the causes of colds in a child and exclude them, at least for a while, until the symptoms disappear completely. Conservative treatment is aimed at getting rid of inflammatory process in the nasal cavity. Held drug therapy combined with physiotherapy and physical therapy. Once a month, the child should be examined by a doctor to identify the development of complications. If, despite conservative therapy, there is a decrease in hearing, impaired nasal breathing, recurrent sinusitis, an operation to remove the tonsils is still necessary.
Removal: features and contraindications
Surgical removal of adenoids is performed in a hospital under local or general anesthesia. In the first option, a classic adenotomy is performed. To do this, a surgical instrument adenotome, resembling a spoon with a long handle, is inserted through the mouth into the nasopharynx and fast moving enlarged adenoids are removed from the mucosa. The disadvantage of the method is the frequent re-growth of vegetations. During removal, the surgeon does not have the opportunity to see the nasopharynx and determine the presence of remnants.
With general anesthesia (narcosis), the operation is performed with endoscopic equipment. Under visual control, the surgeon removes the lymphoid tissue, and after stopping the bleeding, examines the surgical field and removes the remnants.
In the postoperative period, the child returns home on the first day and observes the home regimen for a week. These days, fever, stuffy ears and the development of acute otitis media are possible.
Contraindications for removal of adenoids:
* Anomalies in the development of the soft and hard palate.
* The age of the child is up to 2 years.
* Diseases of the blood, accompanied by increased bleeding.
* Sharp infectious diseases upper and lower respiratory tract.
* The first month after preventive vaccinations.
Recipes of the peoples of the world
Don't overlook funds traditional medicine. In all corners of the globe, people are fighting this disease with the help of natural medicines, passing old recipes from generation to generation.
In Russia, especially in the outback, celandine grass is used to treat adenoids. But the plant is poisonous, and the dosage must be strictly observed!
In 1 liter of milk, boil 2 tablespoons of fresh or dried celandine grass with flowers, cool, filter and instill 2-3 drops in each nostril 3-5 times a day. At night, with this decoction, compresses are made on the calves and throat.
The peoples of the Mediterranean prefer to use aloe for this purpose, in the Caucasus - rhododendra honey, in Switzerland - infusions from the fruits of mistletoe. In England, mistletoe is also considered a panacea for many diseases; adenoids are also treated with it.
In Ukraine, dandelion milk is instilled 3-5 drops into each nostril. In Transcarpathia, juice is squeezed from flowering mountain arnica and mixed in half with grape wine. 2 drops are instilled into each nostril 3 times a day, and a compress is made at night.
In the Czech Republic, propolis (1 part) is insisted on water (5 parts) for 40 days. The infusion is instilled into the nose 5 drops at night.
In Poland, grated onions are grated, mixed in half with honey, 1/4 of apple cider vinegar is added and insisted for three days in a tightly sealed container. Then filter and instill 5 drops into the nose in the morning and evening. In addition, compresses are made on the neck at night, but the infusion is diluted with 1/2 water.
The Chinese and Vietnamese treat adenoids with black radish. Wash, grind together with the peel and pour sesame oil (equally). Infuse for three days in a container with a lid. This drug is used both internally and externally.
let's talk about adenoids in children, or tonsils, as they are also called. Raising a child without ever hearing from a doctor the phrase that the child has adenoids is almost impossible. What are adenoids? Should adenoids be removed from a child? When is the best time to remove adenoids in a child?
Parents always have a lot of questions about this disease, for example, where are the adenoids in a child. The fact is that a person has 6 tonsils. All of them are in the nasopharynx. Three of them are very small, and three more are large. Two large tonsils are located near the sky, they are palpated by hand. Their inflammation is called tonsillitis. Another large tonsil is located in the nasopharynx, where air comes out of the nose. This is what is called an adenoid.
As a rule, adenoids are small in size. They can be seen with a special mirror, like a dentist. In the reflection of the mirror, the doctor may notice their increase. If the tonsil enlarges in the mouth, it will be visible. And if it increases in the nose, then it will be well felt by the child. This can lead to snoring, children sniffling, sleeping with their mouths open.
Enlargement of the adenoid tonsil will cause nasal breathing to be difficult. Parents should understand that even if the child has grown up without ever having had respiratory viral infections, the probability that the adenoids will not increase is extremely small. It is impossible for a child not to get sick without getting inflammation of the adenoids, if you live in the city, communicate with peers, go to kindergartens and schools. Therefore, an increase in adenoids will happen sooner or later in all children. But not all children have this increase to the point where the adenoids must be removed surgically.
Adenoid face in a child
But what is the adenoid face in a child? The fact is that a long absence of nasal breathing leads to a specific deformation of the facial skeleton and a change in the bite. A child who suffers all the time and breathes through his mouth, otherwise sleeps, chews and eats differently from ordinary children.
His facial skeleton is changing. This change in medicine is called adenoid face. Deformation of the face and facial skeleton is one of the main indications for the removal of adenoids.
What are the preventions for adenoids? First of all, parents should understand that the severity of adenoid disease is very often directly related to the severity of the viral infection and how moms and dads help children with viral infections. The higher the concentration of viruses in the inhaled air, and the worse the parameters of the air we breathe, the more dust, drier and warmer the air, the greater the load on the child's local immunity system and on the functioning of the mucous membranes.
If a child easily tolerates viral infections, then, naturally, the adenoids react moderately to this. All doctors are well aware that it is completely unrealistic for any working mother to sit at home for 2 weeks with every childhood illness. However, there are things that can be influenced. Everything must be done to ensure that viral infections are as rare and easy as possible.
In order for viral infections to proceed easily, it is necessary to ensure that the mucous membrane does not dry out. Timely maintenance of air parameters, moistening of the mucous membranes of the nasal passages leads to the fact that the disease will proceed easily, and the adenoids will be moderate. In this case, even if they increase, then their recovery will take not 2 weeks, but only 3-4 days.
However, parents should understand that very often adenoids found in a child are perceived by moms and dads as a sign of maternal inferiority. Allegedly, the parents themselves brought the child to the point that inflammation arose. But you need to know that no one is to blame for this inflammation, because it is impossible to find Kindergarten, where the required temperature in the bedroom is 19 degrees, and the children often walk, it is impossible to find a school where every break is ventilated in the classroom. It is impossible at all to raise a child in our beloved country in such a way that health is in the first place. Due to the fact that all this is impossible, parents have to pay.
Effective treatment of adenoids in children - is there any?
Moms and dads, because of the shortcomings of our schools and kindergartens, have to pay for the health of the child with a bunch of medicines. And here the most interesting begins. Everyone thinks that there are some magic pills and drops that can be given to a child, and he will not have adenoids, or they will go away on their own. In fact, it is clear that if the cause of enlarged adenoids is allergy, then, naturally, the active use of antiallergic drugs can reduce allergic swelling of the adenoid tissue. But if a child is often sick with viral infections, then there are no pills that can affect the reduction of inflammation.
In the vast majority of cases, conservative, that is, non-surgical methods of treating adenoids, are only business and deception. ordinary people. To do this, charlatans offer the use of ultrasound, heating, frostbite and various expensive drops. So it is impossible to cure adenoids, but it is possible to help the child in a different way. To do this, you need to walk more, moisten and ventilate the room, play sports with your child. Although not called a cure, it helps with inflammation.
Ways to remove adenoids in children
When should adenoids be removed? And can they be frozen? You need to know that there are very specific indications for removal. There is a basic procedure for removing adenoids in children - the first and most important indication is that the child's nose does not work, that is, he does not have nasal breathing.
This is very often manifested by the fact that the child does not get enough sleep, snores at night, he has respiratory arrests in his sleep. And when this occurs, it does not matter how old the child is, how he feels, what kind of sores he has. That is, if a child has respiratory arrests at night, then there is nothing to invent, it is necessary to definitely remove the adenoids.
Why are adenoids dangerous in children? Parents should understand that adenoids are closely related to the work of the hearing organ. The ear cavity is connected to the nasal cavity by a special tube called the auditory tube. Very often, the adenoids block this auditory tube. In this regard, the child has frequent otitis media. The fact that otitis in children occurs many times more often than in adults is primarily due to the fact that it is the enlarged adenoids that can block the auditory tube. Therefore, frequent recurring otitis is also a clear indication that the child needs to remove the adenoids. And another indication for surgery is the deformation of the facial skeleton. This is also an indication for surgical removal.
Do I need to use anesthesia for surgical operation to remove inflamed adenoids? Well, by and large, removal began to be widely practiced from the end of the 18th century. Before that, no one had done it. And, of course, for many years, the removal took place solely with the help of local anesthesia or no anesthesia at all. In this case, the biggest danger was in bleeding after surgery. After that, the technique of local anesthesia appeared. For this, special drugs with an analgesic effect were instilled into the nose.
And recently, the standard is the removal of adenoids under general anesthesia, since there are a huge number of options for modern safe anesthesia, which acts very briefly. The operation usually lasts a maximum of 5-10 minutes. 10 minutes is the maximum duration of this operation. When removing adenoids, not only knives are often used, but also an electrical device that allows you to cauterize the vessels. AT modern conditions there is practically no bleeding during this operation. In our country, it is customary to carry out such an operation in a hospital, and in America it can be performed even at home.
It should be emphasized that this is very important, because over the past 130-140 years, mankind has accumulated vast experience in adenoid surgery. We are talking about hundreds of millions of transactions. It has now been unambiguously proven that there are no subsequent minuses and shortcomings in such a surgical intervention. That is, if we operate on adenoids, then the child will not have any negative manifestations after that. He won't hurt more than usual. That is, this operation does not threaten children. He only improves nasal breathing and appetite. This must be understood.
However, this does not mean that everyone should be operated on without real evidence. Since any operation is a risk of anesthesia, bleeding or infection. If there is an opportunity to avoid the operation, then it is better to use this opportunity.
Temperature with adenoids in children
Is it true that children with adenoids often have a bacterial complication of viral infections? This complication of SARS is different. This is most often manifested by pneumonia or otitis media. Naturally, a child cannot breathe through the nose during a viral infection, but breathes through the mouth.
Consequently, the likelihood of drying out of the mucus in the bronchi and impaired lung ventilation is much higher than usual. Therefore, the presence of adenoids increases the likelihood of purulent otitis media. This statement is absolutely correct. But this does not mean at all that children with adenoids should receive antibiotics at the slightest sign of the disease. Since the appointment of antibiotics for prophylaxis in viral infections does not reduce, but increases the likelihood of bacterial complications.
Is there any special treatment for SARS in a child with adenoids? The answer is no. There are standard rules for the treatment of SARS. If a child has enlarged adenoids, then the body of such a child does not forgive mistakes in providing assistance during the treatment of acute respiratory viral infections. The average child needs plenty of fluids, cool, moist air, and a saline nasal rinse. A child with adenoids needs all this 3 times more. That's the whole secret.
What can a child eat after the removal operation? Parents have such a question in vain, since after the operation there are no restrictions. The operation takes 5-10 minutes. The effects of anesthesia will not appear after 2-3 hours. Of course, there will be some mild pain when swallowing. Painkillers after removal are needed for no more than 30-40% of children. Usually paracetamol is enough.
If it is still painful for the child to swallow, then it is better to use some kind of mashed potatoes for food. Again, nothing hot is recommended after the operation. Moreover, on the contrary, cold is recommended, even something icy, ice cream is best.
Treatment methods for adenoids in children
Is there folk remedies from adenoids in children? Some parents say that for those with adenoid problems, being active in sports can help. Is it really? In general, lymphoid tissue reacts to air parameters and to frequent infections. Naturally, if you play sports such as athletics, that is, if the child spends more time in the fresh air, then there is much less chance that the adenoids will grow. If a child chooses, for example, chess or wrestling as a sport, that is, an occupation in a confined space and in dust, then such a sport is unlikely to reduce the likelihood of adenoid growth. Most likely, it's not about sports, but about the intensity of the child's stay in the fresh air.
At what age is it better to remove adenoids? Is it possible to do this at 3 years old or is it better to wait until 6 years old? At 3 years old, parents do not want to remove, because there is a high risk of re-inflammation. But if there are indications for removal, then the age of the child does not matter.
To summarize, the main thing, please, moms and dads, do not take adenoids as a tragedy. Also, do not perceive their removal as a terrible operation that endangers the life of your child. It should also be noted that quite often there are numerous drugs that supposedly can reduce or cure adenoids. But in fact, they do much more harm to the child's body than the disease itself.
If parents want the child not to need surgery and treatment, then it is necessary to adequately educate the children, create normal living conditions for them and, if possible, influence the administration of the children's institution so that the premises are ventilated and the normal temperature is observed.
First, let's understand the question - Why are adenoids needed?
Adenoids are a natural part of our body, which must protect against viruses, bacteria and infection. In particular, adenoids are important for children under the age of 5 years, when the immune system is not yet fully formed.
If we deprive a child at this age of the nasopharyngeal, then we deprive him of his natural protection. Bacteria, viruses and infection can easily get inside. In addition, doctors strongly recommend considering the issue of removing adenoids in children, because the operation may not solve health problems. Even if the adenoids are removed “under the spine”, a recurrence of the growth of the adenoid tissue is still possible. And if there is a risk of tissue re-growth, should they be removed then?
Removal of adenoids in children This is a serious stress, both for the psyche of the child and for the body. In general, any surgical intervention in the body is stressful. After the operation, you will have to go through a lot of additional procedures - breathing exercises, regular washing of the nose, instillation of special drops.
Another factor that is completely on the side of the adenoids is age. As a rule, the growth of the nasopharyngeal tonsil is a children's problem. By the age of 14-15, they generally cease to bother. So maybe it makes sense to wait?
But, despite the above facts, there are many reasons for removing the adenoids anyway.
- Inflamed adenoids this is fertile ground for the constant development of a focus of infection. When the adenoids are inflamed, the outflow of mucus from the sinuses is disturbed, which in turn naturally cleanse the nasal cavity of foreign bacteria and infections. As a result, any infection that enters the nose successfully develops and leads to the development of the disease. The consequences of this condition can already be chronic diseases, because the mucus that accumulates in the nasopharynx can sink lower and lead to respiratory diseases, pharyngitis, laryngitis, etc.
- Inflamed adenoids in children lead to persistent ear congestion. As a result, the child does not hear well, it causes discomfort, disrupts the quality of life, and hinders the process of learning and development.
- Adenoids in children have symptoms, which experienced doctors immediately determine even by appearance. A persistent stuffy nose forces the child to breathe through the mouth and speak through the nose. This leads to disorders in the development of the facial skeleton, so when children grow up with this problem, their face takes on a specific appearance.
- Adenoids in children lead to oxygen starvation of the brain. Indeed, due to a violation of nasal breathing, the child receives less than 20% of oxygen.
- If you do not resort to surgical treatment, then the process of conservative treatment can last a very long time. Constant washing of the nose, special drops, hardening may not give any result as a result.
Summing up
Remove adenoids or not, of course, you decide. But you should still heed the doctor's advice, because sometimes the adenoids grow so much that they completely block the nasopharynx. The child will constantly suffer from acute respiratory viral infections, otitis, tonsillitis. The only option in this case is surgery. Alternative treatment adenoids it is possible, but only as prescribed by the doctor - he will write out the names of herbs, doses, method of application, etc.
Adenoids are found mainly in children from 3 to 12 years old and cause a lot of discomfort and trouble for both the kids themselves and their parents, and therefore require urgent treatment. Often the course of the disease is complicated, after which adenoiditis occurs - inflammation of the adenoids.
Adenoids in children can occur at an early age. preschool age and persist for several years. AT high school they usually decrease in size and gradually atrophy.
In adults, adenoids do not occur: the symptoms of the disease are characteristic only for childhood. Even if you had this disease in childhood, it does not return in adulthood.
Reasons for the development of adenoids in children
What it is? Adenoids in the nose in children are nothing more than an overgrowth of the tissue of the pharyngeal tonsil. This is an anatomical formation that is normally part of the immune system. The nasopharyngeal tonsil holds the first line of defense against various microorganisms seeking to enter the body with inhaled air.
With illness, the amygdala enlarges, and when the inflammation passes, it returns to normal. In the event that the time between diseases is too short (say, a week or even less), the growths do not have time to decrease. Thus, being in a state of constant inflammation, they grow even more and sometimes "swell" to such an extent that they block the entire nasopharynx.
Pathology is most typical for children aged 3-7 years. Rarely diagnosed in children under one year old. The overgrown adenoid tissue often undergoes reverse development, therefore, adenoid vegetations practically do not occur in adolescence and adulthood. Despite this feature, the problem cannot be ignored, since an overgrown and inflamed tonsil is a constant source of infection.
The development of adenoids in children is facilitated by frequent acute and chronic diseases of the upper respiratory tract:,. The starting factor for the growth of adenoids in children can be infections - influenza, etc. A syphilitic infection (congenital syphilis) can play a certain role in the growth of adenoids in children. Adenoids in children can occur as an isolated pathology of lymphoid tissue, but much more often they are combined with tonsillitis.
Among other reasons leading to the appearance of adenoids in children, there is an increased allergization of the child's body, hypovitaminosis, nutritional factors, fungal invasions, unfavorable social conditions, etc.
Symptoms of adenoids in the nose of a child
In the normal state, adenoids in children do not have symptoms that interfere with normal life - the child simply does not notice them. But as a result of frequent colds and viral diseases, the adenoids, as a rule, increase. This happens because, in order to fulfill its immediate function of holding and destroying microbes and viruses, the adenoids are strengthened through growth. Inflammation of the tonsils is the process of destroying pathogenic microbes, which is the reason for the increase in glands in size.
The main signs of adenoids the following can be named:
- frequent prolonged runny nose, which is difficult to treat;
- difficulty in nasal breathing even in the absence of a runny nose;
- persistent mucous discharge from the nose, which leads to irritation of the skin around the nose and on the upper lip;
- breaths with an open mouth, while the lower jaw sags, the nasolabial folds are smoothed out, the face acquires an indifferent expression;
- poor, restless sleep;
- snoring and sniffling in a dream, sometimes - holding the breath;
- lethargic, apathetic state, decrease in academic performance and working capacity, attention and memory;
- attacks of nocturnal suffocation, characteristic of adenoids of the second or third degree;
- persistent dry cough in the morning;
- involuntary movements: nervous tic and blinking;
- voice loses sonority, becomes dull, hoarse; lethargy, apathy;
- complaints of headache, which occurs due to a lack of oxygen supply to the brain;
- hearing loss - the child often asks again.
Modern otolaryngology divides adenoids into three degrees:
- 1 degree: adenoids in a child are small. At the same time, during the day the child breathes freely, difficulty in breathing is felt at night, in a horizontal position. The child often sleeps with his mouth open.
- Grade 2: adenoids in a child are significantly enlarged. The child is forced to breathe through the mouth all the time, and snores quite loudly at night.
- Grade 3: adenoids in a child completely or almost completely cover the nasopharynx. The child does not sleep well at night. Not being able to restore his strength during sleep, during the day he easily gets tired, attention is scattered. He has a headache. He is forced to constantly keep his mouth open, as a result of which facial features change. The nasal cavity ceases to be ventilated, a chronic runny nose develops. The voice becomes nasal, speech becomes slurred.
Unfortunately, parents often pay attention to deviations in the development of adenoids only at stages 2-3, when difficult or absent nasal breathing is pronounced.
Adenoids in children: photo
How adenoids look in children, we offer detailed photos for viewing.
Treatment of adenoids in children
In the case of adenoids in children, there are two types of treatment - surgical and conservative. Whenever possible, doctors tend to avoid surgery. But in some cases, you can't do without it.
Conservative treatment of adenoids in children without surgery is the most correct, priority direction in the treatment of pharyngeal tonsil hypertrophy. Before agreeing to the operation, parents should use all available methods of treatment to avoid adenotomy.
If the ENT insists on surgical removal of the adenoids, take your time, this is not an urgent operation, when there is no time for reflection and additional observation and diagnosis. Wait, watch the child, listen to the opinion of other specialists, make a diagnosis after a few months and try all conservative methods.
Now if drug treatment does not give the desired effect, and the child has a constant chronic inflammatory process in the nasopharynx, then for advice you should contact the operating doctors, those who do the adenotomy themselves.
Adenoids of the 3rd degree in children - to remove or not?
When choosing - adenotomy or conservative treatment, one cannot rely solely on the degree of growth of the adenoids. With 1-2 degrees of adenoids, most believe that it is not necessary to remove them, and with 3 degrees, an operation is simply mandatory. This is not entirely true, it all depends on the quality of the diagnosis, there are often cases of false diagnosis, when the examination is performed against the background of an illness or after a recent cold, the child is diagnosed with grade 3 and the adenoids are advised to be removed promptly.
A month later, the adenoids noticeably decrease in size, as they were enlarged due to the inflammatory process, while the child breathes normally and does not get sick too often. And there are cases, on the contrary, with 1-2 degrees of adenoids, the child suffers from constant acute respiratory viral infections, recurrent otitis media, sleep apnea occurs - even 1-2 degrees can be an indication for the removal of adenoids.
Also, the famous pediatrician Komarovsky will tell about grade 3 adenoids:
Conservative therapy
Complex conservative therapy is used for moderate uncomplicated enlargement of the tonsils and includes drug treatment, physiotherapy, and breathing exercises.
The following drugs are usually prescribed:
- Antiallergic (antihistamine)- tavegil, suprastin. Used to reduce the manifestations of allergies, they eliminate swelling of the tissues of the nasopharynx, pain and the amount of separation.
- Antiseptics for local use- collargol, protargol. These preparations contain silver and destroy pathogenic microflora.
- Homeopathy is the safest method known and goes well with traditional treatment(although the effectiveness of the method is very individual - it helps someone well, someone weakly).
- Washing. The procedure removes pus from the surface of the adenoids. It is performed only by a doctor using the “cuckoo” method (by introducing a solution into one nostril and sucking it out of the other with a vacuum) or by a nasopharyngeal shower. If you decide to do washing at home, drive the pus even deeper.
- Physiotherapy. Quartzization of the nose and throat, as well as laser therapy with a light guide into the nasopharynx through the nose, are effective.
- Climatotherapy - treatment in specialized sanatoriums not only inhibits the growth of lymphoid tissue, but also has a positive effect on the child's body as a whole.
- Multivitamins to strengthen the immune system.
From physiotherapy, heating, ultrasound, ultraviolet are used.
Removal of adenoids in children
Adenotomy is the removal of the pharyngeal tonsils by surgery. The attending physician will best tell you how adenoids are removed in children. In a nutshell, the pharyngeal tonsil is grasped and cut off with a special instrument. This is done in one motion and the whole operation takes no more than 15 minutes.
An undesirable way to treat the disease for two reasons:
- Firstly, adenoids grow rapidly and, if there is a predisposition to this disease, they will become inflamed again and again, and any operation, even as simple as adenotomy, is stressful for children and parents.
- Secondly, the pharyngeal tonsils perform a barrier-protective function, which, as a result of the removal of adenoids, is lost for the body.
In addition, in order to carry out an adenotomy (that is, the removal of adenoids), it is necessary to have indications. These include:
- frequent recurrence of the disease (more than four times a year);
- recognized ineffectiveness of ongoing conservative treatment;
- the appearance of respiratory arrest during sleep;
- the appearance of various complications (, glomerulonephritis,);
- nasal breathing disorders;
- very frequent recurring;
- very frequent recurring SARS.
It should be understood that the operation is a kind of undermining the immune system of a small patient. Therefore, for a long time after the intervention, it must be protected from inflammatory diseases. The postoperative period is necessarily accompanied by drug therapy - otherwise there is a risk of tissue re-growth.
Contraindications to adenotomy are some blood diseases, as well as skin and infectious diseases in the acute period.
Adenoids. If the doctor makes such a diagnosis for you right away, when the child suddenly starts snoring at night and does not breathe through his nose, this is not entirely correct. On the simple basis that there are more than one reason for snoring and difficulty breathing through the nose.
Let's try to check the words of the district ENT that your baby has enlarged adenoids. Just by looking into the nose and throat of the baby, you will not see the adenoids. This means that in order to establish a diagnosis of adenoids, the doctor is simply obliged to take some special steps, prescribe or conduct some examinations in order to make his verdict on their basis.
So let's see what kind of examinations they are, and what information they can give the doctor.
Inspection of adenoids with a mirror
What does it look like
After examining the throat, the doctor takes a small (5-15 mm in diameter) round mirror with a long handle and for some reason looks at the baby's throat again, although, it would seem, he just looked at it. So in American action films, the police look under the bottom of the car or around the corner, waiting in a small mirror to see something big and bad. In fact, the doctor looks beyond the baby's soft palate and examines his adenoids.
What the doctor sees
What cannot be seen during a normal examination is the child's nasopharynx, the size of his adenoids, their condition. If the doctor knows how to use this method well, he can also see the choanae (holes in the nose opposite the nostrils) and the mouths of the Eustachian (sometimes called auditory) tubes.
What does the child feel
If the doctor is experienced and knows how to use this method, then nothing. Or almost nothing - just a slight spasm in the throat.
Advantages of the method
Again, with the known experience of the doctor, it is possible to assess not only the condition of the adenoids, but also the degree of their increase and even suggest why they have increased - this is very important for choosing a method of treatment. If the adenoids are enlarged due to inflammation, then they do not need to be removed - they need to be treated. If the adenoids are simply large, you are likely to undergo surgery. Such an examination is good because it can be carried out in any ENT room, even if all the equipment consists of a table lamp, a reflector and a set of tools. I almost forgot - in the outpatient chart, this method will be called posterior rhinoscopy.
Flaws
Still, one must be able to look at the nasopharynx with a mirror. And the picture that the doctor saw cannot be documented in any way - you have to take the doctor's word for it.
How to deal with a diagnosis
If the doctor simply says "adenoids of the 3rd degree, it is necessary to remove", then this is too little for such an informative method. Therefore, in order to agree or disagree with the recommendations, ask the doctor a few leading questions. Remember - only hypertrophied, that is, overgrown, adenoids should be removed. If the adenoids are enlarged due to inflammation - that is, they are simply swollen, the operation is not justified.
These questions look quite innocent, so any doctor will be happy to answer them. So what are these questions?
- Is there mucus or pus on the surface of the adenoids? If there is, then there is nothing to think about the operation - you must first get rid of mucus and pus, and then watch how the child breathes. And if breathing through the nose is fully restored, then the alarm about the adenoids was false from the very beginning.
- What color are the mucous membranes of the adenoids? The question, of course, will alert the doctor, but you always have to talk with advanced parents longer than usual; besides, what the inflamed mucous membrane looks like in a child, every mother already knows. Pale, bluish or bright red mucous membranes are signs of inflammation. So, again, adenoids should at least try to cure without surgery. And only if the mucous membrane is pink, you will have to agree with the direction for the removal of adenoids.
- Do adenoids have a flat surface? The surface of healthy adenoids is "folded"; if it is smooth, then there is swelling, which is the result of inflammation. Well, we already know that while there is inflammation on the adenoids, they need to be treated without resorting to surgery.
Examination of adenoids with a finger
What does it look like
The doctor suddenly stands up, presses the child's cheek to his thigh and puts his finger in his mouth. The child, naturally, screams and resists.
How does the doctor feel?
Adenoids can be felt if for some reason they could not be seen (for example, if the doctor does not know how to look at the baby with a mirror). When feeling, the doctor can suggest the degree of enlargement of the adenoids, as well as understand whether they are soft (this is a sign of inflammatory edema) or dense (and this is already a sign of hypertrophy, which can only be removed surgically).
What does the child feel
He is disgusted and hurt. Very disgusting.
Advantages of the method
All that is needed to conduct such a study is rubber gloves (at best) or clean hands of a doctor (at worst). And the doctor can also assess the degree of enlargement of the adenoids and understand why they have increased.
Flaws
First, the child is hurt. Secondly, with such a study, injuries are possible - both for the child and for the doctor's fingers. Yes, and it is extremely unpleasant for parents to observe such a picture.
How to deal with a diagnosis
If the doctor puts, say, grade 3 adenoids and does not talk about anything other than surgery, overcome yourself and ask him how the adenoids felt to the touch - soft or dense.
I repeat - soft adenoids are edema, which means that the prospect of conservative treatment; dense means an inevitable operation. I'm sorry, but since you didn't have time to prevent such a cruel examination, try to at least get the most information out of it - this will help the child much better than your complaints.
X-ray of adenoids
The most common way to diagnose enlarged adenoids. And the worst. In addition to the fact that an x-ray is always radiation (which means that within six months after that, doctors will have to think hard about whether to prescribe an x-ray for your baby if they suspect, God forbid, of course, a fracture or pneumonia), he also shamelessly lies - however, only in cases where it concerns the adenoids.
The trick is that the X-ray, firstly, does not give the slightest idea of what the adenoids are enlarged due to; secondly, if pus or mucus has accumulated on the surface of the adenoids, the x-ray will see it in the same way as the adenoids themselves - and add a degree or two to your baby.
The matter is further complicated by the fact that an x-ray is a document. And this means that in any disputes, it is not you, but your doctor who will be right. Here, they say, look - the operation was justified: the picture shows the adenoids of the real 3rd degree.
Degrees of enlargement of adenoids
It was radiologists who came up with the degrees of enlargement of the adenoids - because the degree of enlargement of these same adenoids is the easiest to see on an x-ray. Ask the doctor (if you did take a picture) to show you where the baby has a nasopharyngeal lumen, and where the "shadow of the adenoids" is located (that's what it is called). And then you yourself will evaluate how enlarged the baby's adenoids are.
I degree. Adenoids occupy up to 1/3 of the lumen of the nasopharynx. Even if the baby still snores at night and breathes poorly through the nose, you do not need to remove the adenoids. The point, most likely, is a protracted runny nose, which is treated with drops and physiotherapy, but not surgically.
II degree. Adenoids occupy exactly half of the lumen. They can be blamed for difficulty breathing during sleep, snoring and reduced speech intelligibility. Just remember that the degree of enlargement of the adenoids has nothing to do with indications for surgery. This is just a description of the state of the nasopharynx - that's all.
I-II degree. Adenoids somewhere between 1/3 and half of the lumen of the nasopharynx. Outwardly, they appear not as the second, but as the first degree, therefore, it is not necessary to agree to the operation in any case.
III degree. Adenoids occupy the entire lumen of the nasopharynx. The child does not breathe through the nose, day or night. And if he breathes, then this is by no means the third degree - this is an accumulation of mucus in the nasopharynx, even if it occupies it entirely. Hearing is reduced - sometimes to the point that the baby not only does not understand, but also does not hear the words addressed to him.
IV degree- it does not exist in nature. Adenoids can be only I, II or III degree. If the doctor diagnoses "IV degree of adenoids", he is simply illiterate.
Endoscopy of the nasopharynx
The most progressive, most informative, and in combination also the rarest and most expensive method for diagnosing adenoids. If the clinic has purchased an endoscope for the ENT doctor's office, rest assured, she will try to "recapture" it as soon as possible. And for a small particle of an expensive endoscope, they will bill you too. Let's first understand: what are we paying for?
What does it look like
An endoscope is a long thin tube, essentially a video camera lens, which is passed through the nose into the child's nasopharynx (i.e. to a depth of 3-4 cm). The doctor can see what is happening in the nose and nasopharynx either on the monitor screen or through the "peephole" at the other end of the endoscope.
Advantages of the method
Endoscopy allows you to examine the nasal cavity and nasopharynx in the most detail, and the resulting picture can be recorded on video or simply printed on a printer in the form of a color photo, so nasopharyngeal endoscopy is the best replacement for an x-ray.
Flaws
The thickness of modern endoscopes is 2-4 mm, therefore, in order to pass such an endoscope through the nose of a child, the doctor needs to anaesthetize the nasal mucosa. Most often, doctors use lidocaine in the form of a spray, which in itself is capable of irritating the mucous membrane, and is also a fairly strong allergen. So, if you do not know if the baby is allergic to lidocaine, or if such allergic reactions have already happened, it is better to refuse endoscopic examination. Endoscopy of the nose and nasopharynx without anesthesia is too painful.
How to deal with a diagnosis
If your child had a nasopharyngeal endoscopy, this is your chance to see what is happening with the child's adenoids. First of all, pay attention to whether there is swelling of the adenoids (the mucous membranes are pale, and the surface of the adenoids is smoothed) and whether there is mucus or pus on the surface of the adenoids (they can only be confused with each other). If nothing at all is visible on the monitor screen, except for pus, of course, it is impossible to immediately agree to the removal of adenoids - a course of local anti-inflammatory therapy, washings of the nose and nasopharynx and physiotherapy is necessary, and by no means an operation.
Remember:
Your task is not to get rid of the adenoids in the child, but simply to restore free breathing through the nose. Surgery can only help if the adenoids are hypertrophied without any inflammation. Inflammatory changes require conservative treatment, and only after the elimination of edema and pus from the nasopharynx, you can decide whether your baby needs to remove adenoids or not.
When conducting any research (first of all, we are talking about examining the nasopharynx with a mirror or using an endoscope), demand from the doctor a detailed description of everything that he saw; do not limit yourself to what the doctor will write down in the outpatient card "adenoids of such and such a degree." To determine the tactics of treatment, it is necessary to know not so much the degree of enlargement of the adenoids as the reason for which they are enlarged. Then you can adequately help your baby.
Discussion
I will tell the story of the struggle with adenoids in my 6 year old son. It started something like this: difficulty in nasal breathing, sleeping with an open mouth, they thought a runny nose - they constantly buried their nose, it helped. Moreover, the ENT also did not notice anything like that. Then they noticed the hearing loss. He asks again when we turn to him. I began to look through sources, read, analyze, because Re-applying to the LOR didn't really change anything. In particular, everything is intelligibly described here: [link-1] Then a constant sore throat began, then a decrease in working capacity (sweating) and poor performance at school In short, a nightmare! We decided to change the doctor, good, I read, I suffered. Went to the medical center. Diagnosis: Adenoids II degree. They suggested surgery, we refused medical and physiotherapy treatment. At first it became somehow better, but there were no cardinal changes for the better. Then the son caught a cold and the horror began in general ... .. The cold was cured and again for a consultation. I had to have an operation (I had to agree for the first time).
06/27/2018 17:13:03, OLGA7777Hello, my son is 13 years old, the adenoids were removed 5 years ago, but they are there again.
05/16/2018 23:10:22, GalaPHello. Mi vchera sdelali rengen, i u nas adenoidi 1oy stepeni. Naznachili Avamis spray (kurs lechenie 1 mesyac) Skajite pojaluysta, eto pomojet moemu malishu, or est drugie metodi lechenie 1 stepeni???
13.04.2018 09:38:49, Mariam KhachatryanHello, daughters 1 year and 9 months. at 1.5 (September months) we went to the kindergarten, as usual, adaptation of the snot ... as a result, the snot that was not treated or healed brought us to adenoid 3 st. there was pus and fluid in the ears, the child stopped breathing through the nose completely, and breathing through the mouth was intermittent, the adenoids healed, the pus was gone, the child began to breathe through the nose, but sometimes it breathes through the mouth, the fluid behind the eardrums has not gone away, the doctor says this can lead to hearing loss, she offered to make a puncture, but she herself made a reservation; this would be of little use. the adenoids will continue to put pressure on the membranes and the fluid will appear again, indications for surgery, but the operation is done from the age of 3, what should we do, how to be, advise me. THANKS IN ADVANCE!
18.01.2018 11:02:14, NatalyaIMy child is 3 years and 3 months old, we haven’t stopped counting since 1 year, now snoring has been added and breathes badly through the nose, we always get sick no less than a week. The ENT puts the 2nd degree of adenoids. what should I do?
11/16/2016 03:20:09 PM, Maria EremenkoHello! My daughter was diagnosed with adenoids of the 2nd degree, I came to Laura, he examined the nose and throat with a mirror, then said that it was necessary to treat for a month. I didn’t send it for examination, but only a month later is it the doctor’s illiteracy or is it supposed to be treated this way? Thanks
09/27/2016 05:38:30, EvgeniyaHello. I would like to get some clarifications. After the sea, my 13-year-old daughter had an earache, the ENT sent for an x-ray and diagnosed adenoids and sinusitis from the pictures, he strongly recommended removing the adenoids, explaining this with extra growths that are not needed. Along with this, antibiotic treatment was prescribed, which we performed exactly, the swelling went away, but the doctor insists on an operation. The daughter rarely gets sick, there is practically no runny nose, there is no nasal congestion, snoring, gnashing of teeth in a dream, too. I'm at a loss: what indications do we have for surgery? Thank you.
Hello doctor, thank you for your advice. I would like to send an endoscopic photo of my daughter. And I need your advice. How to send you a photo?
interesting and useful article. my son has been suffering from this disease since the age of 1.6 and so far we are only healing, and then for a very long time
The article is informative and everything is clearly stated, thanks to the author!
Very good article. Thank you!
Well written. And most importantly - very relevant information
A very useful article. Thank you. I understand what questions to ask and why.