Degrees of adenoids in children: what to do, is it worth removing?

Adenoids are a word that is constantly on the lips of many parents, especially in winter, when the problem of respiratory diseases is so urgent. Enlarged adenoids in a baby and the need to remove them as a dangerous source of pathogenic microorganisms cannot but worry caring mom and dad. However, different degrees of adenoids in children require different approaches to their treatment, and it is not always necessary to resort to surgery.

So, let's consider what adenoids are, why they are needed, what degrees of adenoids children have and what are the approaches to their treatment.

These scary adenoids

In fact, there is nothing scary about them. Adenoids are natural physiologically conditioned formations in the human body, consisting of lymphoid tissue. They are located in the area of the junction of the pharynx and the nasal part inside the oral cavity. It is these formations that help maintain children's immunity at a high level, delaying the penetration of the infectious factor further into the body through the respiratory tract.

Unfortunately, frequent untreated respiratory diseases of an infectious and inflammatory nature (ARI, flu, tonsillitis, etc.) lead to the proliferation of adenoid tissue, which no longer protects the body, but on the contrary, is an internal source of problems for it, promoting the proliferation of viruses and bacteria in the mouth. As a result of inflammation, blood supply and lymph flow are disrupted, stagnant processes occur in the body, leading to a weakening of the child's already not fully formed immune system.

In other words, what is meant to protect becomes a source of danger for the baby's body. Such changes can be noticed by the following symptoms:

• the baby sleeps with his mouth open because his nose is not breathing well,
• the child becomes lethargic and apathetic, complains of headaches,
• his hearing is getting worse,
• the baby feels tired even after waking up,
• changes in the voice are noted (it becomes more muffled, sometimes hoarse) or difficulties with speech,
• the child begins to suffer from respiratory diseases more often.

As the adenoids grow, the number of problems they cause increases. This includes changes in the shape of the face due to the need to breathe through an open mouth, problems with the digestive system, the development of anemia, enuresis, asthma attacks, an increase in body temperature above 39 degrees, problems with the central nervous system, deterioration in academic performance, etc.

Most often, enlarged adenoids in children are diagnosed at the age of 3-5 years. However, recently, cases of noticeable proliferation of lymphoid tissue in children around 1 year old are not uncommon. Children who did not attend kindergarten and rarely got sick before can suffer from adenoids at an older age (6-8 years), when they go to school, where, due to the crowding of children, any infection becomes widespread.

Fortunately, by the age of 12, a decrease in the size of the adenoids is observed. In most cases, by the onset of adulthood, the problem of adenoids disappears altogether, since the lymphoid tissue gradually atrophies. In adults, an increase in the size of the adenoids is considered an exception to the rule.

But in children this happens quite often. Inflamed lymphoid formations are associated with many unpleasant symptoms that increase as the disease progresses.

In medical literature, it is common to distinguish 3 degrees of adenoids in children. However, some sources expand this classification to 4 degrees. Of course, one can argue about the fairness of one or another classification, accuse doctors who diagnosed "adenoids of the 4th degree" in a child of incompetence, but this is unlikely to solve the problem itself. In the end, the final word will still remain with the attending physician, who at one time took the Hippocratic oath and is unlikely to violate it, harming the child's health with an incorrect approach to diagnosing and treating the disease.

Let's stop at the opinion that there are 4 degrees of adenoids in children. But adenoids of the 5th degree in a child is already a phenomenon from the realm of fantasy. Such a diagnosis would be clearly incorrect.

The final diagnosis of whether a child has adenoid hypertrophy and what degree it has reached is made by an otolaryngologist (or ENT, as they call it). To make a diagnosis, the doctor will, of course, have to conduct a certain examination of the patient.

The simplest and most accessible method of detecting enlarged adenoids is considered to be palpation of the tonsils. The doctor, wearing sterile gloves, inserts a finger into the oral cavity, reaching the posterior lower part of the nasopharynx, and tries to determine the nature and degree of enlargement of the adenoids by touch. The disadvantage of this method is the impossibility of visually observing the picture of the disease, the process of palpation of the tonsils, as well as the negative attitude of children to this procedure due to a certain discomfort during it.

In parallel with palpation, a posterior rhinoscopy procedure can be performed. A special mirror is inserted deep into the patient's mouth, which allows for a visual assessment of the appearance and size of the adenoids, as well as the degree to which they block the airways.

More modern research methods are:

• X-ray of the nose and nasopharynx (the disadvantage is a certain dose of radiation, so such a study is not always prescribed),
• an endoscopic examination that allows you to see the full picture of enlarged adenoids in all details using a fiberscope with a mini-camera inserted through the nose, the information from which is displayed on the monitor screen (disadvantage: slight discomfort during the insertion of the endoscopic tube into the nasal passages).

The latter method of examination is considered the most accurate and preferable. It allows establishing an accurate diagnosis when consulting a doctor about nasal breathing problems associated with adenoid proliferation.

It remains to consider how to determine the degree of adenoids based on symptoms and visual picture, as well as how to treat the disease at an established stage.

Adenoids 1st degree

As is accepted in medical terminology, the severity of the disease increases as the number designating it increases. This means that adenoids of the 1st degree in a child are the mildest stage of the pathology. In principle, this stage is still difficult to call a disease. We are talking rather about a borderline condition, the need for treatment of which is the subject of much debate among doctors.

As a rule, it is difficult to notice the enlargement of adenoids at this stage. But for an experienced doctor with the appropriate instrument, it will not be difficult to note some hypertrophy of the tonsils, indicating the proliferation of lymphoid tissue. At the same time, a pediatrician or ENT does not always talk about pathological enlargement of adenoids.

Much depends on the time of the visit to the doctor. If the child has a cold or has recently suffered from one of the infectious and inflammatory diseases of the upper respiratory tract, enlarged tonsils are not considered a pathology. This is a normal reaction, and the size of the tonsils should return to normal over time.

It's another matter if the doctor notes a slight increase in the volume of lymphoid tissue against the background of the absolute health of the baby. This is already an alarming symptom for the specialist. And what symptoms should worry parents?

So, grade 1 adenoids can manifest themselves as follows:

• The first thing to be noted is a disruption of nasal breathing. For this reason, the child begins to breathe through the mouth in sleep, although during wakefulness the child's breathing seems normal. Parents should be alerted by the child's constantly open mouth during night or daytime rest.
• Even if the mouth is closed, the child's breathing becomes noisy and he periodically opens his mouth to inhale or exhale.
• Mucus begins to appear in the nose, which, due to tissue swelling, is either released outward (runny nose) or flows into the nasopharynx, and the child swallows it.
• Unusual snoring during sleep, which was not observed before.

In principle, with adenoids of the 1st degree, only a slight increase in the tonsils is observed. All the above symptoms are associated with the fact that the adenoids are slightly enlarged and block about ¼ of the lumen of the nasal passages in the area of the vomer (bone of the posterior parts of the nose). In a horizontal position, the adenoids occupy an even larger area, noticeably complicating the child's breathing during sleep.

Impaired nasal breathing during sleep makes nighttime rest incomplete, as a result of which the child feels tired and exhausted, his cognitive processes slow down, and his academic performance deteriorates.

The methods of treatment of the first degree of adenoids in children selected by the doctor depend on the age of the little patient. If the child is 10-11 years old, you can take a wait-and-see attitude, as some doctors advise, and not take any treatment measures. As we have already mentioned, by the age of 12, the problem of adenoids usually resolves naturally, so it is quite possible to wait a year or two, if no further growth of tonsil tissue is observed.

This approach is unacceptable for young children. Slightly enlarged adenoids will not remain so for long. The addition of any respiratory infection will promote the growth of lymphoid tissue and the transition of the disease to a new level. While parents wait several years for the adenoids to atrophy, the child will develop various deviations, he will lag behind his peers and become the target of jokes about his appearance (a constantly open mouth makes the child's face more elongated, this face shape is sometimes even called adenoid).

In case of enlarged adenoids in small children, doctors recommend conservative treatment, which involves the use of both medications and folk remedies. Effective measures in this case will be:

• hardening, exercise, active recreation in the fresh air,
• rinsing the nose with a water-salt solution or special sprays based on sea water in order to cleanse it of mucus and bacterial factors,
• the use of vasoconstrictors in the form of drops and sprays,
• from the age of 3, the use of anti-inflammatory hormonal agents in the form of sprays that relieve inflammation in the tonsils and nose.
• taking multivitamin complexes and herbal preparations to boost immunity,
• if necessary, take antihistamines,
• inhalations with essential oils of eucalyptus or thuja,
• Physiotherapeutic procedures: inhalation treatment, magnetic and laser therapy.

Let us dwell in more detail on the innovative method of conservative treatment of adenoids at the early stages of their development – treatment with a laser. In this case, the laser beam helps to effectively relieve swelling in the nasopharynx, and also has a bactericidal effect, which prevents the development of inflammatory reactions affecting the mucous membrane of the upper and lower respiratory tract. The result will be a gradual, safe and painless reduction in the size of the adenoids and normalization of nasal breathing.

The procedures should be done every day for 1.5-2 weeks. Since adenoids tend to relapse (even after removal), it is recommended to undergo a preventive course of laser therapy once every 6 months. In case of weakened immunity, such treatment is indicated until the child reaches the age when lymphoid tissue begins to atrophy.

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Adenoids 2 degrees

The second degree of adenoids in children is said to occur if certain problems with nasal breathing in a child occur not only during sleep, but also during wakefulness. Anatomically, this degree of the disease is manifested by the lymphoid tissue blocking half the length of the vomer. In this case, the lumen of the nasal passages at the entrance from the nasopharynx is blocked by half.

In addition to the symptoms characteristic of stage 1 pathology, there are also other, more serious ones:

• the child constantly breathes with an open mouth (both at night and during the day), which causes infection to penetrate into the lower respiratory tract, which is no longer retained in the nose, cases of respiratory diseases, including inflammation of the lower respiratory tract, become more frequent, the disease lasts longer and is more severe;

The nasal passages should be used to moisturize and cleanse the air entering the body, but the air is now going around,

• in his sleep the child not only snores, but also snores clearly, since the adenoids block the airways,
• the swelling of the nose increases, so the baby breathes through the mouth, leaving it constantly open for convenience (this gives the face a specific shape and expression),
• the timbre of the voice changes, it becomes muffled or slightly hoarse, nasal,
• as a result of lack of oxygen and disruption of night sleep due to breathing problems, the child's general well-being deteriorates, which makes him capricious,
• constant problems with the ears begin: blocked ears, hearing loss, frequent relapses of otitis,
• problems with food intake begin; due to lack of appetite, the baby either refuses to eat at all, or eats little and reluctantly.

Symptoms of the disease may vary in different children, but in any case, they do not have the best effect on the health and development of the child. Therefore, it is very important for parents to pay attention to the slightest manifestations of grade 2 adenoids in children, until the disease has progressed to a stage requiring immediate surgical treatment.

As in the case of adenoids of the 1st degree, it is quite difficult to determine the hyperplasia of lymphoid tissue at the next stage of the disease. This is the reason why the pathology remains unnoticed when it can still be treated conservatively, without resorting to surgery.

The treatment regimen for conservative therapy includes the following measures:

• thorough rinsing of the tonsils and nose with saline solutions (these can be either pharmaceutical preparations or self-prepared compositions),
• inhalation treatment using essential oils, herbal decoctions, saline solution (inhalations are best done using a special inhaler device called a nebulizer),
• instillation of drops into the nose and irrigation of the mucous membrane with sprays with anti-inflammatory, antibacterial and drying effects,
• homeopathic treatment aimed at relieving swelling and inflammation of the tonsils, as well as increasing general and local immunity,
• vitamin therapy to stimulate the immune system,
• taking herbal immunostimulants
• physiotherapy.

As we can see, conservative treatment of stage 2 adenoids in children is practically no different from treatment of the initial stage of the disease. The same are used:

• saline solutions (homemade and pharmacy "Salin", "Aqualor", "Humer"),
• glucocorticosteroids in the form of sprays: Nasonex, Flixonase, Avamis, etc.,
• antibacterial drops: "Isofra", "Polydexa", etc.,
• homeopathic remedies: Sinupret, Tonsilgon, IOV Malysh, etc.,
• antihistamines: Diazolin, Zyrtec, Loratidine, Fenistil, etc.,
• drops based on medicinal plants of home preparation (aloe leaf juice, chamomile and calendula flower decoction, sea buckthorn oil, thuja oil ),
• drops with a drying effect: "Protargol", "Collargol", etc.

Surgical treatment for grade 2 adenoids in children is prescribed only under the following conditions:

• ineffectiveness of the course of conservative therapy,
• noticeably impaired nasal breathing, which causes a decrease in academic performance, developmental delays, disruption of the formation of the chest, as well as the appearance of anomalies in the structure of the jaws, changes in bite, changes in the shape of the face to adenoid,
• hearing loss due to swelling of the auditory tube and inflammatory processes developing inside it,
• transition of the inflammatory process in the tonsils into a chronic form, enlargement of both tonsils, frequent relapses of colds (more than 5 times a year).

In this case, surgical removal of the tonsils remains the only way to give the child the opportunity to fully breathe through the nose.

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Adenoids 3 and 4 degrees

Despite all the unpleasant and threatening symptoms, adenoids of 1 and 2 degrees are considered a mild form of pathology, which in the vast majority of cases is treated conservatively. This cannot be said about adenoids of 3 degrees.

The picture that the doctor sees is terrifying. Stage 3 adenoids in a child almost completely block the vomer bone, leaving only a small gap for breathing through the nose. Sometimes they even partially block the ear canal, causing congestion and inflammation of the inner ear.

Externally, the disease manifests itself as a virtually complete inability to breathe through the nose. Attempts to inhale or exhale air through the nose end with a strong flaring of the wings of the nose and loud wheezing. Very little oxygen enters the body, the baby suffocates and stops painful but fruitless attempts to restore normal breathing.

The child begins to breathe only through the mouth in any weather, bacteria and viruses freely penetrating into the nasopharynx and even deeper provoke constant respiratory infectious and inflammatory diseases. Due to constant illnesses and the presence of an invariable source of bacterial reproduction in the nasopharynx, the child's immunity is greatly reduced. The diseases are very severe, difficult to treat and prone to frequent relapses.

In this case, strong proliferation of lymphoid tissue is necessarily accompanied by inflammatory reactions in the tonsil area. Lack of oxygen due to inadequate breathing affects the development of speech and mental abilities of the baby. The child is very absent-minded, it is difficult for him to concentrate, problems with memorizing information begin.

Due to incorrect breathing, the chest is deformed, the contours of the face change, and the nasolabial triangle is smoothed out. Unpleasant changes in the child's appearance and nasal voice become the subject of ridicule by peers, which cannot but affect the psyche of the little patient.

The picture is not pleasant. And if we consider that all of the above is a consequence of the parents' carelessness or inaction, it becomes even sadder. But adenoids cannot suddenly grow to critical sizes. Their growth was gradual, accompanied by a violation of nasal breathing to varying degrees with all the ensuing consequences. And only the carelessness of the parents could allow the disease to reach such sizes.

At the 3rd degree of adenoids in children, the only effective method of treatment is considered to be adenotomy. This is the name of the surgical excision of adenoids, which is often carried out in parallel with the removal of part of the modified tonsil (tonsillotomy).

Traditionally, adenoids are removed using a special knife - an adenotome. The operation can be performed under local or short-term general anesthesia. The latter is practiced in small children who do not yet understand what is happening to them, may be frightened and interfere with the operation.

A significant disadvantage of surgical removal of adenoids is considered to be quite severe bleeding due to cutting of hypertrophied tissues. Despite the fact that the bleeding does not last long, the child may still get scared and prevent the operation from continuing.

Another drawback is the lack of the ability to visually control the progress of the operation and the completeness of the removal of the overgrown lymphoid tissue, which may subsequently cause a relapse of the disease.

Endoscopic surgery is considered a more modern and effective method of removing adenoids. In principle, adenotomy can be performed using the same adenotome, but the course of the operation and all the nuances associated with it can be observed on the computer screen. In this case, the endoscope acts as both a diagnostic and therapeutic device, i.e. the operation, according to indications, can be performed directly during the examination, without removing the tube with the camera from the child's nose.

Another type of surgery that is considered the least traumatic, but at the same time the safest and virtually bloodless, is laser adenoid removal. The surgery is performed using a beam of greater power than that used in laser therapy. The laser beam cauterizes and removes the overgrown tissue completely. Complications after the surgery usually do not occur.

But despite all the advantages of the above-described method, laser removal of adenoids has not yet found wide application. Doctors still tend to the endoscopic version of the operation, and the laser is used to cauterize tissue to stop bleeding and prevent infectious complications.

As for the questionable 4th degree of adenoids in children, here we are talking more about a complication of the strong growth of lymphoid tissue by an inflammatory process, as a result of which nasal breathing stops completely. In fact, this is a complicated course of the 3rd degree of adenoids (adenoiditis). In this case, there is nowhere to drag it out, so the child is prescribed an urgent operation to remove the adenoids and part of the hypertrophied tonsils, followed by anti-inflammatory therapy.

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