Enlarged pharyngeal tonsils are known as adenoids, also known as polyps in laypersons. They express themselves through a disabled nasal breathing and frequent inflammation in the nasopharynx. Adenoids should only be surgically removed when certain symptoms appear.
- Constant runny nose and inflamed sinuses? Maybe the growths of the tonsils are the cause.
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The enlargement (hyperplasia) of the pharyngeal tonsil is an increase in the volume of the lymphatic tissue, of which the pharyngeal tonsil consists for the most part. It is referred to as pharynx growth (also known as adenoids).
Identify teething problems with these pictures
An enlargement beyond the normal level as pharynx growth is mostly constitutional (due to physical disposition). Inflammation of the pharyngeal tonsil (adenoiditis) means a pathological, bacterial colonization of the pharyngeal tonsil.
Popularly, the tonsils are often called Polyps designated. This term is not used in specialist circles because a polyp is a circumscribed mucosal bulge, while the pharynx is lymphoid tissue. This lymphoid tissue is able to form defense cells against pathogens.
Symptoms of enlarged tonsils
The nasopharynx can be partially or almost completely blocked by the adenoids. This leads to a hindrance of nasal breathing with constant runny nose and possibly accompanying sinus infections (rhinosinusitis).
Starting from the inflammation of the nasopharynx, the ear trumpet can cause otitis media as well as inflammation of the deep airways (bronchitis). The constantly recurring inflammation in the nasopharynx often causes swelling of the lymph nodes in the area of the jaw angle. Restricted nasal breathing also forces mouth breathing. The affected children usually stand out due to the constant opening of the mouth. An open mouth and a runny nose can give the child a facial expression that is very typical for the growth of the pharynx.
The parents mostly report pronounced snoring and sleep disorders in the child, which are also caused by the disabled nasal breathing. The children then appear sleepy and dreamy. It is estimated that about every hundredth child between the ages of four and six experiences obstructive sleep apnea syndrome due to impaired breathing (obstruction). Among other things, this is characterized by a breathing disorder that occurs during sleep with repeated breathing pauses (apnea) of more than five seconds and a decrease in oxygen saturation in the blood by at least five percent. The lack of oxygen leads to restless sleep as well as tiredness and poor concentration on the following day. In the long run, these can affect the child's development; it is discussed whether they may also represent risk factors for the occurrence of the hyperkinetic syndrome.
The language sounds like a runny nose when the pharynx is overgrown by moving the nasopharynx. This is called closed nasal rhinophonia clausa.
At the same time, the ventilation of the middle ear from the nasopharynx is blocked due to the large tonsils, which can result in fluid accumulation behind the eardrum in the middle ear (seromucotympanum). Due to the limited ability of the ossicles to vibrate, middle ear deafness develops. The children are often limited in their general and linguistic development because the perception of the environment and language is inhibited by poor hearing. This is particularly noticeable in that new, previously unknown words are not learned by the children or are not learned correctly. The children often ask questions, or language development is significantly delayed.
How do adenoids develop?
Hormonal and hereditary influences, but above all the constant contact with new pathogens in childhood are the causes of the adenoids.
Throat tonsil proliferation is caused by several beneficial influences. On the one hand, hormonal and constitutional influences (properties of the individual body structure) play a role. Above all, however, the repeated occurrence of spatially limited (local) and (systemic) bacterial and viral infections that involve the whole organism is a decisive cause for the enlargement of the pharynx.
The enlargement of the pharynx begins in the first years of life. This is the age at which the children's immune system is exposed to most infections from bacteria and viruses and the lymphatic tissue of the pharynx is of crucial importance in the defense against new pathogens. The immune system learns immunity to the various pathogens. The lymphatic tissue of the pharyngeal tonsil is in a state of permanent (chronic) inflammation due to constant contact with the disease germs.
In addition, there is an inherited predisposition to adenoids, which causes a family accumulation. Overeating also promotes the formation of large lymphoid organs.
In the case of a split disease (cleft lip, jaw or palate), swallowing and speaking may result in incomplete closure between the pharynx and nasopharynx due to the formation of the gap. The functionally important, balancing enlargement of the pharyngeal tonsil often ensures a complete closure of the nasopharynx during speech formation and when swallowing. In such cases, surgical removal of the pharynx growth must be carefully considered.
Adenoids: This is how the doctor examines them
With pronounced adenoids, the open mouth, runny nose and pale skin are often noticeable when the child is looked at. This very typical picture is referred to by the doctors as Facies adenoidea (facial expression with enlarged throat tonsil).
At the beginning of the examination, the parents are questioned by the otolaryngologist, pediatrician or family doctor according to their previous medical history. Of particular interest here are the frequency of infections of the upper airways, the presence of purulent or watery rhinitis, the appearance of ear infections, the existence of hearing loss or nocturnal snoring. The previous language development is also inquired in order to be able to conclude that the pharynx is overgrown.
This is followed by a complete ear, nose and throat medical examination, in particular the ears (with a microscope), the oral cavity and the nose being assessed with a nasal mirror. Here, the direct examination of the nasopharynx through endoscopy of the nasal cavity is essential. After swelling and anesthetic of the nasal mucosa with a spray, a rod about 2.5 millimeters thin is inserted painlessly into the nose.
When looking through this endoscope, the ENT doctor can see the nasal cavity and nasopharynx completely. However, this examination is not always possible in young children. A hearing test (audiogram) and a middle ear pressure measurement (tympanogram) are carried out to assess a possible co-disease of the middle ears.
When to remove the tonsils
Basically, only the multiplication of lymphatic tissue in the nasopharynx in childhood has no disease value, since practically all children experience such an increase in the context of immunological activity. Therefore, adenoids are only considered and treated as a disease when signs of disease appear.
Adenoids with disease signs like
- Snoring and / or sleep disorders
- constant mouth breathing
- frequent infections of the upper airways
- Hearing loss due to a middle ear ventilation disorder
- frequent otitis media
the tonsils should be surgically removed. Often, a small incision is made into the eardrum (paracentesis) during the same operation to improve ventilation in the middle ear if there is a middle ear deafness due to an effusion in the middle ear at the time of the operation. In cases with pronounced middle ear hearing loss due to viscous secretions in the middle ear, a longer-term improvement in ventilation by inserting a small tube into the eardrum (tympanic drainage) is necessary.
In the tympanic drainage, a small, button-like tube is inserted into the eardrum incision to allow the secretion to drain out of the tympanic cavity.
In Germany, throat tonsils are always removed under general anesthesia, usually in the form of an outpatient procedure, after which the children can leave the clinic on the same day, or as part of a short inpatient stay of one to two days.
The administration of decongestant nasal drops as a medicinal measure can temporarily alleviate the symptoms of the acute infection of the pharynx (which is usually accompanied by a runny nose), but does not make the pharynx overgrowth disappear.
Throat tonsil growth (adenoids): Prevention
Throat tonsil proliferation is initially a natural process in the development of the body's defenses. It is not possible to predict which child will suffer from signs of disease as a result of this enlargement.
For this reason, there are no preventive measures that prevent the child from being affected by the adenoids.
There is no risk of infection in this clinical picture, but it does exist in the recurring infections of the airways, which trigger the enlargement of the lymphatic tissue in the nasopharynx. An accumulation of infections can generally be observed in kindergarten and hard children. A possible preventive measure derived from this would be to avoid crowds, especially in winter and in closed rooms. However, this is not sensible and hardly practicable.