Today, surgical treatment is carried out only if the ENT doctor diagnosed "grade 3 adenoids". Immunologists have proven that the pharyngeal tonsil plays an important role in the development of the immune system. Removal of tonsils negatively affects local immunity, as evidenced by frequent relapses of infectious diseases. With a timely appeal to the otolaryngologist, adenoids can be tried to be treated with medications. And only in case of ineffectiveness of drug and physiotherapeutic treatment, the patient is prescribed the removal of the immune organ - adenotomy.
Adenoids 1, 2 and 3 degrees - differences
Outwardly, the adenoids resemble tumor-like formations, which consist of several lobules. A small immune organ is localized on the back wall inside the nasal cavity and performs a protective function - it destroys pathogenic viruses and bacteria that enter the body with the air. Hypertrophy, i.e. pathological enlargement of the nasopharyngeal tonsil, more often observed in young children aged 3 to 9 years. Much less often, adenoids are diagnosed in newborns and adults.
How are adenoids treated? Treatment methods are determined by the stage of development of the pathology and accompanying clinical manifestations. In otolaryngologists, it is customary to distinguish between the following degrees of hypertrophy of the immune organ:
- 1st degree - adenoid tissues only 1/3 overlap the vomer and nasal passages;
- 2nd degree - an enlarged amygdala by ½ blocks the airways in the nasopharynx;
- 3rd degree - adenoid growths more than 2/3 overlap the holes in the nasal cavity;
- 4th degree - the hypertrophied organ completely closes the vomer and choanae (nasal passages).
Adenoid vegetations of the third and fourth stages of development are practically not amenable to conservative treatment, therefore, patients with such a diagnosis are most often prescribed adenotomy.
To avoid surgery, you need to seek help from an ENT doctor when the first signs of adenoids appear.
The proliferation of soft tissues cannot be eliminated with the help of nasal drops, anti-inflammatory and antiseptic solutions, since they are formed tumor formations.
1 degree of hypertrophy
Grade 1 adenoids cover up to 35% of the nasopharynx, so they practically do not cause discomfort. For this reason, it is possible to diagnose pathology in a timely manner, as a rule, by accident, during routine examinations by a pediatrician. Is it possible to suspect the development of adenoids by external signs?
Difficulty in nasal breathing with a slight proliferation of adenoid vegetations are observed exclusively at night. The classic symptoms of adenoids of the first stage of development include:
- sniffing in a dream;
- nasal congestion;
- daytime sleepiness;
- serous discharge from the nasal passages.
With the horizontal position of the body, the ridge-shaped pharyngeal tonsil increases slightly in size, which leads to respiratory failure. Due to the lack of oxygen (hypoxia), the child may have nightmares. After waking up, children usually complain of lethargy and chronic fatigue.
Stage 1 hypertrophy of the pharyngeal tonsil is easy to treat conservatively. It is possible to restore the normal size of the organ with the help of lavages, inhalations and local preparations of anti-inflammatory, immunostimulating and antiseptic action.
2 degree of hypertrophy
Adenoids of the second degree lead to the appearance of more pronounced pathological symptoms. The overgrown lymphoid tissues overlap up to 50% of the vomer and nasal passages, as a result of which there are obvious disturbances in nasal breathing. Nevertheless, if the disease is diagnosed in time, it will be possible to eliminate its manifestations with the help of physiotherapy and medications.
How to recognize grade 2 adenoids? The characteristic signs of the development of the disease include:
- snoring and loud puffing during sleep;
- a clear decrease in the timbre of the voice;
- hearing loss;
- absent-mindedness and poor sleep;
- frequent mouth opening;
- lingering rhinitis;
- lack of appetite;
- apathy and chronic fatigue.
Grade 2 adenoid hypertrophy interferes with the normal physiological development of the child.
Chronic hypoxia (lack of oxygen) negatively affects the functioning of the brain. In this regard, the child begins to lag behind not only in physical but also in mental development. Sick children cannot concentrate, which affects school performance. In addition, if the patency of the nasal passages is not restored in time, the constant opening of the mouth will lead to deformation of the lower jaw.
How are grade 2 adenoids treated? It is possible to somewhat reduce the size of the tonsils with the help of drying and antiseptic agents. They prevent the development of inflammation in the nasal cavity, which stimulates the proliferation of lymphoid tissues.
Physiotherapeutic procedures such as ultrasound and laser therapy can help eliminate stagnant mucus in the nose and paranasal sinuses.
It must be understood that grade 2 adenoids lead to hearing impairment, which can lead to the development of otitis media. An enlarged amygdala clogs the opening of the auditory tubes, which are located in the nasopharynx. The subsequent disruption of the ventilation of the middle ear, which is connected to the nasal cavity through the Eustachian tubes, leads to the accumulation of serous effusion in the ear cavity. This is one of the key causes of inflammation of the mucous membranes and the development of otitis media.
3 degree of hypertrophy
Grade 3 adenoids are characterized by a strong proliferation of the nasopharyngeal tonsil, in which the lymphoid tissues overlap the vomer by about 70-80%. Outwardly, they resemble a cock's comb, which hangs from the back of the nasopharynx and closes the airways. Because of this, nasal breathing is very difficult, so the child breathes mainly through the mouth.
The development of grade 3 adenoids leads to blockage of the auditory tube openings, as a result of which hearing is sharply reduced and there is a risk of hearing loss.
The clinical manifestation of the disease depends on the age of the patient and, accordingly, the inner diameter of the airways. In children under 5 years of age, the nasal passages are very narrow, so the overgrown tissues almost completely block the nasopharynx. What are the symptoms of grade 3 adenoids?
- nasal congestion;
- constant breathing through the mouth;
- tension of the wings of the nose;
- nasal voice;
- snoring and puffing during sleep;
- frequent development of otitis media;
- lethargy and irritability;
- persistent inflammation of the paranasal sinuses (sinusitis, sinusitis).
How should grade 3 adenoids be treated? With severe hypertrophy of the nasopharyngeal tonsil, patients are prescribed surgical treatment. If you do not remove adenoid vegetations in a small child, subsequently this can lead to abnormal formation of the bones of the skull and chest. Due to the violation of gas exchange and the accumulation of large amounts of carbon dioxide in the blood, a decrease in mental abilities or the development of neuroses is observed.
4 degree of hypertrophy
Grade 4 adenoids are the most severe form of pathology, in which the amygdala 100% closes the nasal passages and the openings of the auditory tubes. In this regard, the flow of air into the throat through the nasal passages is blocked. Violation of the ventilation and drainage function of the nasopharynx leads to stagnation of serous discharge in the paranasal sinuses and middle ear. This leads to inflammation of the mucous membranes of the ENT organs and the development of such diseases as sinusitis, otitis media, ethmoiditis, sphenoiditis, etc.
Failure to remove grade 4 adenoids in a small child in time will lead to a change in the type of face, and constant inflammation of the middle ear will negatively affect hearing sensitivity. With a critical growth of the nasopharyngeal tonsil, it is necessary to agree to an operation. It is practically impossible to restore the patency of the nasal canals with 100% overlap of the vomer and choanas.
Thus, grade 3 and 4 adenoids can be cured only if an adenotomy is performed, i.e. surgical operation.
Diagnostics
How can adenoid vegetations be cured? It is possible to determine the optimal methods of treating pathology only after the diagnosis and determination of the degree of proliferation of lymphoid tissues. It is problematic to independently recognize the stage of development of the disease by clinical manifestations. Therefore, if adenoids are suspected, it is necessary to undergo the following types of examinations:
- posterior rhinoscopy - examination of the posterior wall of the nasal cavity using a special mirror;
- anterior rhinoscopy - a visual examination of the nasal passages, followed by an assessment of the degree of their patency;
- endoscopic examination - examination of the state of the nasopharynx by means of a flexible fiberscope;
- X-ray - determination of the location of the benign tumor and the degree of growth of the amygdala.
In the case of the development of inflammatory processes in the respiratory tract, it is necessary to determine the causative agent of the infection. To do this, the doctor takes a swab from the nasal cavity and laryngopharynx and, during microbiological and virological analysis, determines the type of pathogenic agents that provoked the inflammation.
Conservative treatment
Treatment without surgery is possible only with a slight hypertrophy of the tonsil, i.e. at stages 1 and 2 of the development of adenoids. Drug therapy allows you to restore the drainage function of the immune organ and prevent its subsequent growth. As a rule, the treatment regimen includes anti-inflammatory, antihistamine and antiseptic drugs:
vasoconstrictor drops ("Naphtizin", "Xymelin", "Suprima-Noz") - facilitate nasal breathing by reducing the swelling of the mucous membranes;- homeopathic remedies ("Angin Gran", "Edas", "Tonsilgon") - increase the body's resistance to pathogenic agents, as a result of which the normal activity of the nasopharyngeal tonsil is restored;
- antibiotics ("Augmentin", "Ampicillin", "Bioparox") - inhibit the reproduction of pathogenic microbes, which prevents the development of purulent inflammation;
- antiallergic drugs ("Fenistil", "Erius", "Zyrtec") - relieve swelling and inflammation, as a result of which there is a decrease in the volume of lymphoid tissue;
- hormonal aerosols ("Nasonex", "Avamis", "Nasobek") - prevent inflammation and increase local immunity, thereby eliminating the symptoms of a lingering rhinitis;
- immunocorrectors ("Transfer Factor", "Mipro-Vit", "Cordyceps") - increase nonspecific immunity and the body's resistance to disease-causing agents.
vasoconstrictor drops ("Naphtizin", "Xymelin", "Suprima-Noz") - facilitate nasal breathing by reducing the swelling of the mucous membranes;With the correct preparation of the therapy regimen and the timely elimination of the symptoms of pathology, the operation can be avoided.
In addition, after the age of 9 years, the nasopharyngeal tonsil begins to degrade and by the age of 16-17 it disappears almost completely. For this reason, adenoid vegetations are rarely diagnosed in patients after puberty.
Surgery
It is not always possible to use only medications, antiseptics for rinsing the nose and inhalation to treat adenoids. If the glandular tissue overlaps more than 50% of the vomer, the patient will most likely have to undergo an adenotomy. You need to understand that adenoid vegetation is an already formed tissue that cannot be absorbed under the influence of drying and antiallergic agents.
Abnormally overgrown tissue can be removed with:
- Beckman's adenotoma (classical operation);
- device "Surgitrona" (radio wave excision);
- laser "knife" (laser adenotomy);
- shaver (micro-breeder with a blade at the end).
The least traumatic is the laser and radio wave methods of removing adenoid vegetations, since during the operation the damaged vessels are "sealed", which prevents bleeding.
It is impossible to avoid surgery if the hypertrophied tonsil has completely blocked the nasal passages. Late treatment of the disease can lead to complications such as chronic sinusitis, tonsillitis, paratonsillar abscess, etc.
