Adenoidite

Adenoiditis (retronazalnaya angina (angina retronasalis), chronic inflammation pharyngeal tonsil ) - infectious-allergic process that develops due to violation of the physiological balance between macro and micro-organism, followed by local distortion of the immunological processes in the pharyngeal tonsils.

Epidemiology

Adenoiditis is predominantly observed in early childhood; while maintaining hypertrophy of the pharyngeal tonsil in adults, acute retronasal tonsillitis can also develop.

[1]

Causes of the adenoid

Acute adenoids usually develops on the background of acute respiratory diseases, inflammation lymphadenoid apparatus other departments pharynx.

Among the main etiological factors of chronic adenoiditis are the current inflammatory process, the immune response in the form of hyperplasia of lymphoid tissue, the immunoreactive state associated with increased bacterial dissemination, and the restructuring of the body due to postponed, septic and immune reactions. The cause of acute adenoiditis is the activation of conditionally pathogenic nasopharyngeal microflora with poorly expressed antigenic properties. Under the influence of frequently recurring local inflammatory changes against the background of insolvency and imperfection of general immunological processes in young children, the adenoids gradually become the focus of pathogenic infection, in their folds and coils may contain abundant bacterial microflora and contribute to the development of recurring acute and chronic inflammation of the pharynx, which in their queue cause recurrent chronic otitis, tracheobronchitis, sinusitis and other diseases.

[2], [3]

Pathogenesis

Chronic adenoiditis develops, as a rule, on an allergic background, with a weakening of phagocytosis, a state of dysfunction of immune processes. Due to frequent infectious diseases, the lymphoid tissue experiences significant functional stress, the dynamic equilibrium of the alteration and regeneration of the adenoids lymphoid tissue is gradually disturbed, the number of atrophied and reactive follicles increases as a manifestation of the stress of adaptation mechanisms in the imbalance of immune cells.

[4]

Symptoms of the adenoid

Acute adenoiditis is observed mainly in children during the development of the pharyngeal tonsil as a complication of the inflammatory process in the cavity of the paranasal sinuses and during various infections. If hypertrophied lymphadenoid tissue of the pharyngeal tonsil is preserved in adults, acute adenoiditis may also develop. Onset of the disease is characterized by acute hyperthermia, intoxication, obsessive cough. Patients complain of headache and pain in the nose, the depth of the soft palate during swallowing, radiating to the posterior segments of of the nasal cavity and into the ears, congestion of viscous mucus in the nose and throat, sometimes a dull pain in the neck, a feeling of rawness, tickle and sore throat, hearing loss and even ear pain due to the spread of edema in the area rozenmyullerovyh pits, sharp violation of nasal breathing, , dry cough intrusive. In infants, there is a violation of sucking, mucous-purulent yellow-greenish discharge, flowing down the back of the pharynx, obsessive wet cough, hyperemia of the back palatal arches, posterior pharyngeal wall with an increase in lymphoid follicles or lateral pharyngeal rollers. In the posterior rhinoscopy, the pharyngeal tonsil is hyperemic, edematous, with fibrinous plaque, as in lacunar quinsy, its grooves are filled with mucopurulent exudate. The disease adenoids in children occurs with severe lymphadenopathy. Regional submandibular, posterior cervical and occipital lymph nodes are enlarged and painful. The disease in young children may be accompanied by attacks of asphyxiation of the type of podskladochnogo laryngitis. Older children have a headache, a sharp violation of nasal breathing, nasalness is expressed, with posterior rhinoscopy, hyperemia and edema of adenoid tissue, mucopurulent secretion, hyperemia and edema of the mucous membrane of the posterior pharyngeal wall and nasal cavity are seen. In infants, the disease is severe, with severe intoxication, difficulty sucking, dysphagia syndrome, and parenteral dyspepsia.

Indirect signs of inflammation of the pharyngeal tonsil are lengthening and swelling of the uvula, posterior palatine arches, bright red tyazh on the side walls of the pharynx and prostate tubercles (clogged mucous glands) on the surface of the soft palate in infants and young children (Heppert symptom).

In the posterior rhinoscopy, hyperemia and edema of the pharyngeal tonsil, raids and viscous mucopurulent discharge in its furrows are found.

Acute adenoiditis usually lasts up to 5-7 days, has a tendency to relapse, may be complicated by acute otitis media, sinusitis, lesions of the lacrimal and lower respiratory tract, the development of laryngotracheobronchitis, bronchopneumonia, and in children under 5 years of age - the pharyngeal abscess.

In chronic adenoiditis patients are concerned about the difficulty of nasal breathing, frequent runny runny nose, snoring and restlessness in sleep, hearing loss, obsessive moist cough in the morning, low-grade fever, manifestations of intoxication and hypoxia, confusion, increased irritability, pallor skin and visible mucous membranes, enuresis and other symptoms characteristic of hyperplasia of adenoid vegetation.

[5]

Stages

There are acute and chronic adenoiditis. Acute adenoiditis is defined as retrophasic angina. Chronic adenoiditis has various clinical and morphological variants depending on the type of inflammatory reaction prevailing in the patient, the degree of allergization and immunological reactivity. There are several classifications of chronic adenoiditis.

• Catarrhal, exudative-serous and mucopurulent.
• According to the nature of the inflammatory reaction of the adenoid tissue, lummocytoma-eosinophilic with weak exudation, lymphoplasmacytic and lymphoreticular with serous exudate and neutrophilic-macrophage variant inflammation with purulent exudate are isolated.
• Taking into account the degree of allergization and the state of immunity, the following forms of chronic adenoiditis are determined: adenoiditis with a pronounced allergic component, adenoiditis with a predominant activity of the reactions of the humoral immunity (hyperimmune component), hypoimmune adenoiditis with insufficient functional activity of lymphocytes and purulent exudative adenoiditis, during stimulation., decrease in phagocytosis, increased killer activity of T-lymphocytes.
• According to the degree of expression of local signs of inflammation and damage to the adjacent anatomical structures, compensated, subcompensated and decompensated adenoiditis are isolated; superficial and lacunar adenoiditis.

[6], [7]

Forms

Surgical diseases tonsils and adenoids:

• J 35.1 Tonsil hypertrophy (enlarged tonsils).
• J 35.3 Tonsil hypertrophy with adenoid hypertrophy.
• J 35.8 Other chronic diseases of the tonsils and adenoids.
• J 35.9 Chronic disease of the tonsils and adenoids, unspecified.

[8]

Diagnostics of the adenoid

[9], [10]

Physical examinations

X-ray of the nasopharynx.

[11], [12]

Laboratory research

Cytological examination of smears from the surface of the adenoid vegetation to determine the quantitative ratio of inflammatory cells, pay attention to the lymphocyte-eosinophilic response of the adenoid lymphoid tissue (lymphocytes, neutrophils, macrophages, plasma cells, fibroblast accumulations). Immunological studies (determining the number of circulating immune complexes, IgA, IgM, in the blood plasma, the number of B-lymphocytes and their subpopulations, etc.). Microbiological examination of smears from the surface of adenoid tissue on the microflora and sensitivity to antibiotics.

[13], [14]

Instrumental studies

Back rhinoscopy, rigid endoscopy and nasopharyngeal endoscopy.

[15]

Screening adenoiditis

Finger study of the nasopharynx in children (available at any stage of medical care).

[16], [17]

Differential diagnosis

Symptoms of acute adenoiditis can occur in the initial period of diseases such as measles, rubella, scarlet fever and whooping cough, and when joining headaches - meningitis and polio. In this regard, in all doubtful cases, it is necessary to closely monitor the development of the disease and, if necessary, make appropriate changes to the treatment plan.

[18], [19], [20], [21]

Treatment of the adenoid

Objectives of treatment of adenoiditis: elimination of the bacterial focus in the parenchyma of the adenoid vegetation to prevent recurrent inflammation in the nasopharynx with the spread to the nasal cavity, paranasal sinuses, middle ear, traoreorchial tree.

[22], [23]

Indications for hospitalization

Urgent hospitalization for severe retronasal tonsillitis with severe intoxication and purulent complications (pharyngeal abscess, etc.). Routine hospitalization for adenotomy surgery.

[24], [25], [26], [27]

Non-drug treatment of adenoiditis

In acute adenoiditis, tubular quartz and a helium-neon laser are applied to the back of the throat, diathermy and electrophoresis of drugs for regional lymph nodes. Sanatorium-resort treatment is a combination of local treatment methods with general treatment of the natural physical factors of the resort. Endonasal electrophoresis of a mud patch, phototherapy (laser effect on the nasopharynx through a light guide or nasal cavity, NK-laser on the submandibular zone).

In chronic adenoiditis, health-improving measures are carried out (therapeutic breathing exercises, hardening, foot-temperature-contrast baths), physiotherapy, helium-neon laser irradiation of the adenoid tissue through the mouth and endonasal, mud therapy, cryogenic oxygen therapy, ozone ultrasound treatment, lymphotropic therapy (oxygen therapy, lymphotropic therapy (MF), oxygen therapy, lymphotropic therapy (MF, oxygen therapy, lymphotropic therapy (MF), oxygen therapy, lymphotropic therapy (MF, oxygen therapy, lymphotropic therapy (MF), oxygen therapy, lymphotropic therapy (MFR, oxygen therapy, lymphotropic therapy (MFR) other drugs in the region of the upper cervical lymph nodes - regional for the pharyngeal tonsil).

[28], [29], [30], [31], [32]

Drug treatment of adenoiditis

In acute adenoiditis prescribe the same treatment as in acute angina. At the beginning of the disease, they try to limit the development of inflammation and prevent the development of the suppurative process. In the presence of fluctuations, an abscess is opened. An antibacterial, hyposensitizing detoxification, irrigation therapy, aerosol inhalations of antiseptic agents are carried out. Additionally, vasoconstrictor nasal drops or nasal sprays, irrigation therapy, nasopharyngeal disinfectants (silver proteinate, collargol, iodinol, 0.1% oxyquinoline solution in 20% glucose solution) are prescribed.

Organ-preserving treatment methods, taking into account participation in the regulation of humoral and cellular immunity at the local and systemic levels. Taking into account the significant role of the lymphoid tissue of the tonsils as an organ of immunity that forms the immune barrier of the mucous membrane of the upper respiratory tract, they follow the tactics of conservative conservative therapy of chronic adenoiditis in the early stages of the disease. 3-4 times a year, cycles of complex therapy are carried out, including a direct effect on the inflammatory process in the nasopharynx and general therapy aimed at strengthening the child’s condition, correcting immunity, stopping allergic manifestations.

General therapy includes detoxifying measures, immunomodulating treatment, relief of allergic manifestations. Local treatment excludes irrigation therapy, the so-called nasal douche for the elimination of antigens from the mucous membrane of the nasal cavity and nasopharynx with the use of phyto- and biologics, mineral water, antiseptics. From the means of local therapy, therapeutic solutions and emulsions are used at a temperature of 37 ° C; washing the nasal cavity and nasopharynx with solutions of Hypericum, calendula and propolis; instances of antiseptic drugs into the nasal cavity: aerosol vacuum therapy and aerosol inhalations of homeopathic medicines; irrigation with emulsions of Kalanchoe, propolis, eucalyptus; instillation in the nose of therapeutic solutions and oils, immunomodulators; nasal infusion of starch-agar gel drops. Tonic intranasal glucocorticoids fluticasone, sofradex in the form of nasal sprays are widely used. Conduct immunotherapy with leukocyte interferon, lactoglobulin, thymus extract, levamisole. Inside prescribe etiotropic homeopathic drugs: umcalor, lympho myosotum, tonsilgon, tonzilotren, new-baby in the age dosage according to various schemes. A good therapeutic effect was noted when using a 15% solution of dimephosphone, instillation into the nasal cavity of a freshly prepared solution of superlymph (a preparation of local cytokine therapy).

Be sure to carry out measures to restore nasal breathing (suction of nasal discharge in infants and young children, instillation of vasoconstrictor solutions, collargol or silver proteinate, soda-tannin drops. If you suspect the development of complications, antibiotics are prescribed.

In infants do not use nasal sprays of vasoconstrictor drugs, as they can cause reflex laryngism or bronchospasm.

A mandatory component of complex conservative treatment is the conduct of hyposensitizing therapy, vitamin therapy and immunorehabilitation, taking into account the state of the immune status. Remediation of other inflammatory foci is shown.

Surgical treatment of adenoiditis

With persistent hyperplasia of adenoid vegetation with appropriate clinical symptoms, complications from the nasal cavity, paranasal sinuses, middle ear, tracheobronchial tree, with the development of secondary autoimmune diseases, frequent exacerbations of adenoiditis, unsuccessful conducted conservative treatment spend adenotomy with subsequent anti-recurrent treatment

Further management

Hardening, prevention of respiratory viral diseases, timely rehabilitation of the oral cavity, gargling with antiseptic agents.

[33]

Indications for consulting other specialists

The presence of related diseases of the internal organs and body systems, endocrine disorders, allergic manifestations, a thorough examination by the therapist before surgery.

Prevention

Removal of adenoids with often recurrent adenoiditis, carrying out recreational activities, timely reorganization of other foci of infection.

[34]

Forecast

Adenoiditis has a generally good prognosis. Timely diagnosis and rational therapy of acute tonsillitis of the pharyngeal tonsil helps to prevent severe purulent complications. Clinical observation and timely treatment of chronic adenoiditis in some cases, eliminates the need for adenotomy, and most importantly, prevents the development of associated infectious-allergic diseases of internal organs and ENT organs.