As adenoids are called swollen pharyngeal tonsils, known to laymen also as polyps. They are manifested by impaired nasal breathing and frequent inflammation in the nasopharynx. Adenoids should only be surgically removed for certain signs of the disease.
The enlargement (hyperplasia) of the pharyngeal tonsil is an increase in volume of the lymphatic tissue, from which the pharyngeal tonsil consists for the most part. It is referred to as pharyngeal tonsil proliferation (also known as adenoid in technical language).
An enlargement beyond the normal level as pharyngeal tonsillitis is mostly constitutional (due to physical predisposition). Inflammation of the tonsils (adenoiditis) refers to a pathological, bacterial colonization of the tonsils.
The folk tonsils are often referred to as polyps . In professional circles, this term is not used for this, since one understands a polyp a circumscribed mucosal protrusion, while the pharyngeal tonsil is lymphatic tissue. This lymphatic tissue is able to form defense cells against pathogens.
Symptoms of swollen pharyngeal tonsils
Through the adenoids, the nasopharynx may be partially or almost completely misplaced. This leads to a hindrance of nasal breathing with constant cold and possibly accompanying sinusitis (rhinosinusitis).
Based on the inflammation of the nasopharynx, the ear trumpet can cause inflammation of the middle ear as well as inflammatory processes of the deep respiratory tract (bronchitis) which are also diverted. The recurring inflammation in the nasopharynx often causes swelling of the lymph nodes in the mandibular area. In addition, the limited nasal breathing forces a 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 quite typical of pharyngeal tonsils.
The parents usually report pronounced snoring and sleep disorders of the child, which also have their cause in the disabled nasal breathing. The children then seem sleepy and dreamy. It is estimated that about every hundredth child between four and six years of age due to obstructed breathing (obstruction) comes to the so-called obstructive sleep apnea syndrome. This is characterized, among other things, by sleep disturbances with repeated breathing pauses (apnea) lasting more than five seconds and a drop in oxygen saturation in the blood of at least five percent. The lack of oxygen leads to restless sleep and fatigue and concentration disordersthe following day. These may affect the development of the child in the longer term; it is discussed whether they may also be risk factors for the occurrence of hyperkinetic syndrome.
The language sounds in the pharyngeal tonsil proliferation by the laying of the nasopharynx as in a cold. This is called closed nasal (Rhinophonia clausa).
At the same time, the large throat alfalfa also the ventilation path to the middle ear from the nasopharynx is laid out, whereby it can come to a fluid accumulation behind the eardrum in the middle ear (Seromukotympanon) on prolonged existence. Due to the limited ability of the auditory 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 the language is hampered by the bad hearing. This is mainly due to the fact that new, previously unknown words are not or not properly learned by the children. The children often ask, or the language development is delayed significantly.
How do adenoids develop?
Hormonal and hereditary influences, but especially the constant contact with ever new pathogens in childhood are the causes of adenoids.
Throat algae proliferation is caused by several beneficial influences. On the one hand, hormonal and constitutional influences (characteristics of the individual physique) play a role. Above all, however, the repeated occurrence of spatially limited (local) and total organism-implicated (systemic) bacterial and viral infections is a major cause of the enlargement of the tonsils.
The enlargement of the throat almond begins in the first years of life. This is the age when the child’s immune system is exposed to the most bacterial and viral infections and the lymphoid tissue of the pharyngeal tonsil plays a crucial role in the defense against ever new pathogens. The defense system learns immunity against the various pathogens. The lymphatic tissue of the pharyngeal tonsil is in constant, chronic inflammation due to its constant contact with the pathogens.
In addition, there is a hereditary predisposition to adenoids, which is due to a familial accumulation. Overeating also promotes the development of large lymphatic organs.
In a cleft palate (cleft lip, jaw or palate) swallowing and speech may result in an incomplete closure between the oropharynx and nasopharynx. Due to the functionally important, compensating enlargement of the pharyngeal tonsil, language formation and swallowing often ensure a complete closure to the nasopharynx. In such cases, surgical removal of pharyngeal tonsil enlargement must be carefully considered.
Adenoids: This is how the doctor examines
With pronounced adenoids, the open mouth, runny nose, and pale skin are often noticeable when looking at the child. This quite typical picture is called by the physicians as Facies adenoidea (facial expression with swollen throat almond).
At the beginning of the examination is the questioning of the parents by the ENT specialist, pediatrician or family doctor according to the previous medical history. Of particular interest is the frequency of upper respiratory tract infections, the presence of purulent or watery runny nose, the appearance of ear infections, the presence of hearing loss, or nocturnal snoring. The previous language development is also inquired, in order to be able to conclude from this possibly a pharyngeal allograft.
This is followed by a complete ear, nose and throat medical examination, whereby in particular the ears (with the microscope), the oral cavity and the nose are assessed with a nose mirror. Here, the direct examination of the nasopharynx by endoscopy of the nasal cavity plays an essential role. After swelling and numbing of the nasal mucosa with a spray, a 2.5 mm thin rod is inserted painlessly into the nose.
When looking through this endoscope, the ENT specialist can see the nasal cavity and the nasopharynx completely. In infants, however, this examination is not always possible. A hearing test (audiogram) and a middle ear pressure measurement (tympanogram) are carried out in order to assess a possible disease of the middle ear.
When the pharynx should be removed
Basically, the multiplication of lymphatic tissue in the nasopharynx does not initially have a disease value in childhood, since virtually all children in the context of immunological activity have such an increase. Therefore, adenoids are considered as a disease and treated only when signs of disease occur.
Adenoids with disease signs like
- Snoring and / or sleep disorders
- constant mouth breathing
- heaped infections of the upper respiratory tract
- Hearing loss due to a middle ear aeration disorder
- frequent middle ear infections
the pharyngeal tonsils should be surgically removed. In addition, a small incision into the eardrum (paracentesis) to improve the ventilation of the middle ear is often carried out during the same operation if there is a middle ear deafness due to an effusion in the middle ear at the time of the operation. In cases with severe middle ear hearing loss due to viscous secretions in the middle ear, a longer-lasting ventilation improvement is necessary by inserting a small tube into the eardrum (tympanic drainage).
During tympanic drainage, a small, button-like tube is inserted into the eardrum incision to drain the secretion from the tympanic cavity.
The removal of the tonsils in Germany is always carried out 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 nose drops as a medical treatment can temporarily alleviate the symptoms of the acute infection of the throat algae (which is usually accompanied by a cold at the same time), but do not make the pharyngeal tonsillosis disappear.
Throat algae proliferation (adenoids): prevention
The pharyngeal allograft is initially a natural process in the development of the body’s defense. Which child suffers from this enlargement under symptoms is not foreseeable.
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 disease, but very well in the recurring infections of the airways, which trigger the enlargement of the lymphatic tissue in the nasopharynx. An accumulation of infections in general can be observed in kindergarten and hard children. A possible preventive action derived from this would be to avoid crowds, especially in winter and indoors. However, this is not sensible and hardly practicable.