Acute simple adenoiditis

Acute simple adenoiditis, or retronasal tonsillitis, is an inflammation of the adenoid vegetations, which occurs most often in early childhood and the first years of life. The manifestations of this disease in early childhood (up to 1 year of life) and later in life are different. Acute or subacute recurrent and prolonged adenoiditis are also distinguished.

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Symptoms of acute simple adenoiditis

Acute simple adenoiditis in children begins suddenly with a rise in body temperature to 40-41°C, often accompanied by convulsive syndrome, laryngeal spasm, rapid breathing, tachycardia and arrhythmia. The sick baby refuses to breastfeed due to the inability to suck (absence of nasal breathing), which quickly leads to a decrease in the child's body weight. Pharyngoscopy reveals pus flowing down the back wall of the pharynx, which the child swallows. The submandibular lymph nodes are enlarged and painful to palpation. With predominantly unilateral damage to the nasopharyngeal tonsil, the enlarged lymph nodes on one side interfere with the function of the sternocleidomastoid muscle, which causes a forced position of the head, which is slightly turned to the affected side and lowered down. Otoscopy may reveal retraction of the eardrum. The increase in body temperature can last from 3 to 5 days. Complications that may arise with acute simple adenoiditis include acute inflammation of the upper respiratory tract (laryngotracheitis), bronchopneumonia, acute otitis, parapharyngeal abscesses and phlegmon, which makes the prognosis very cautious.

Acute simple adenoiditis in childhood also has an acute onset and is often accompanied by stridor laryngitis, otalgia, meningism, and hypoxia. The absence of nasal breathing is compensated by breathing through the mouth. Closed nasal speech is noted.

Anterior and posterior rhinoscopy reveals sharply enlarged, hyperemic or pseudo-film-covered adenoid growths that cover the choanae (posterior rhinoscopy) and protrude into the posterior-superior parts of the nasal cavity (anterior rhinoscopy). Purulent discharge flows down the posterior wall of the pharynx and is also detected in the nasal cavity. Associated palatine tonsillitis is also usually observed.

Recurrent adenoiditis in children, usually occurring in the cold season, is characterized by a significant frequency. This form of acute simple adenoiditis, starting from early childhood, leads with each new relapse to an ever greater hypertrophy of the adenoid tissue, which is accompanied by disturbances in the development of the facial skull, malocclusion and other undesirable consequences in the development of the child.

Complications with this form of acute simple adenoiditis are numerous (otitis, sinusitis, adenoid phlegmon, lower respiratory tract diseases, etc.). Such a child lags sharply behind his peers in development.

Acute prolonged adenoiditis differs from acute simple adenoiditis by a longer development and clinical course (several weeks). Some discrepancy is noted between the elevated body temperature and the relatively satisfactory condition of the child. Nasal breathing may be satisfactory, breastfeeding does not cause any particular difficulties. Endoscopic signs of the disease are less pronounced than in acute simple adenoiditis.

How is acute simple adenoiditis recognized?

The diagnosis of acute simple adenoiditis is established based on the clinical picture and inflammatory changes in the nasopharyngeal tonsil. In all cases, this form of adenoiditis should be differentiated from diphtheria by bacteriological examination of a smear from the nasopharynx and palatine tonsils.

Treatment of acute simple adenoiditis

Treatment of acute simple adenoiditis in infants should be aimed primarily at restoring nasal breathing, at least for the period of feeding. Otherwise, treatment is carried out as with follicular tonsillitis with the prescription of antibiotics and under the supervision of a pediatrician. In case of prolonged acute adenoiditis, European otolaryngologists perform adenotomy in the "warm" period with subsequent intensive penicillin therapy. Removal of adenoids is also recommended in the event of toxic syndrome or ineffective course of auricular complications. If the child has suffered from acute adenoiditis at least once, then it is advisable to perform adenotomy, since in the overwhelming majority of cases, acute simple adenoiditis inevitably turns into chronic adenoiditis with manifestations of focal infection syndrome.