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

Adenoids - this word is constantly on the lips of many parents, especially in winter, when the problem of respiratory diseases is so urgent. Increased adenoids in the baby and the need to remove them as a dangerous source for the propagation of pathogenic microorganisms can not but worry caring mom and dad. However, different degrees of adenoids in children require a different approach to their treatment, and not always have to resort to a surgical procedure.

So, let us consider what adenoids are, why they are needed, what degree of adenoids occur in children and what are the approaches to their treatment.

These terrible adenoids

In fact, there is nothing terrible in them. Adenoids are natural physiologically conditioned formations in the human body, consisting of lymphoid tissue. They are located in the area of the pharynx and nose in the oral cavity. It is these formulations that help to maintain at an altitude children's immunity, delaying the infiltration of the infectious factor further into the body through the airway.

Alas, frequent miscarried respiratory infections of an infectious and inflammatory nature (ARI, flu, tonsillitis, etc.) lead to the proliferation of adenoid tissues, which now do not protect the body, but on the contrary, are an internal source of problems for it, contributing to the multiplication of viruses and bacteria in mouth. As a result of inflammation, the blood supply and lymph flow are disturbed, stagnant processes in the body occur, leading to a weakening of the already not fully formed immune system of the child.

In other words, what is meant to protect becomes a source of danger to the baby's body. You can see such changes by the following symptoms:

• the baby sleeps with his mouth open because his nose is not breathing well,
• the child becomes listless and apathetic, complains of headaches,
• his hearing is deteriorating,
• the baby feels tired even after awakening,
• there are changes in the voice (it becomes more deaf, sometimes hoarse) or difficulty with speech,
• the child begins to suffer more respiratory diseases.

As the number of adenoids increases, the number of problems caused by it is added. This change in the shape of the face due to the need to breathe through the open mouth, disruption of the digestive system, the development of anemia, enuresis, asthmatic attacks, an increase in body temperature of more than 39 degrees, disruptions in the work of the central nervous system, impaired progress, etc.

Most often, the increase in adenoids in children is diagnosed at the age of 3-5 years. However, in recent times there have been cases of significant growth of lymphoid tissue and in children about 1 year. Children who have not been to the kindergarten and have been sick a little earlier may suffer from adenoids at an older age (6-8 years) when they go to school, where due to the accumulation of children, any infection gets widespread.

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

But in children this happens quite often. At the same time inflamed lymphoid formations are associated with a number of unpleasant symptoms that increase as the disease develops.

In the medical literature it is customary to distinguish 3 degrees of adenoids in children. Nevertheless, some sources extend this classification to 4 degrees. You can, of course, argue about the fairness of a classification, blame the doctors who diagnosed "adenoids of grade 4" in the child's incompetence, but this is unlikely to solve the problem itself. In the end, the last word still remains with the attending physician, who at one time gave the oath of Hippocrates and is unlikely to violate it, harming the child's health with an incorrect approach to diagnosis and treatment of the disease.

Let us dwell on the opinion that there are still 4 degrees of adenoids in children. But the adenoids of the 5th degree in the child - this is more a phenomenon from the realm of fantasy. Such a diagnosis would be clearly incorrect.

The final diagnosis of whether the child has hypertrophy of adenoids and what it has reached a degree is made by an otolaryngologist (or in the traditional ENT). To diagnose a doctor, of course you will have to conduct a certain examination of the patient.

The simplest and most affordable method for detecting enlarged adenoids is palpation of the tonsils. The doctor in a sterile glove finger penetrates the oral cavity, reaching the posterior lower nasopharynx, and groping to determine the nature and extent of adenoids. The disadvantage of this method is the impossibility of visually observing the picture of the process of palpation of the tonsils, as well as the negative attitude of the children to this procedure due to a certain discomfort during it.

In parallel with palpation, a procedure for posterior rhinoscopy can be performed. Deep in the patient's mouth is introduced a special mirror, which makes it possible to visually assess the appearance and size of the adenoids, as well as the degree of overlapping of the respiratory tract.

More modern methods of research are:

• radiography of the nose and nasopharynx (a drawback is a certain dose of radiation, so this study is not always appointed),
• endoscopic examination that allows you to see the full picture of enlarged adenoids in all details with the help of a fibroscope with a mini-camera inserted through the nose, information from which is displayed on the monitor screen (disadvantage: slight discomfort during the introduction of the endoscopic tube into the nasal passages).

The last method of investigation is considered the most accurate and preferred. It allows you to establish an accurate diagnosis when you see a doctor about the violation of nasal breathing associated with the proliferation of adenoids.

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

Adenoides of 1 degree

As is customary in medical terminology, the severity of the disease increases as the number that indicates it increases. This means that the  adenoids of the 1st degree in the child  - this is the easiest stage of the pathology. In principle, this stage is still difficult to call a disease. This is more about the borderline, the need for treatment which is a lot of disputes among doctors.

As a rule, the increase in adenoids at this stage is not easy to notice. But for an experienced physician with the appropriate instrument, it will not be difficult to note some hypertrophy of the tonsils, indicating a proliferation of lymphoid tissue. In this case, a pediatrician or an ENT does not always talk about a pathological increase in adenoids.

Much depends on the time of visiting the doctor. If a child has a cold or has recently suffered one of the infectious inflammatory diseases of the upper respiratory tract, an increase in tonsils is not considered a pathology. This is a normal reaction, and the size of the tonsils should eventually return to normal.

Another thing, if a small increase in the volume of lymphoid tissue the doctor notes against the background of the absolute health of the baby. This is already an alarming symptom for a specialist. And what symptoms should parents worry about?

So, adenoids of the 1st degree can manifest as follows:

• First of all, disturbance of nasal breathing is noted. For this reason, the child begins to breathe with his mouth in a dream, although during the waking period the child's breathing seems normal. Parents should always alert the slightly open mouth of the baby during a night or day rest.
• Even if the mouth is closed, the child's breathing becomes noisy and he periodically opens his mouth for inhaling or exhaling.
• The mucus begins to appear in the nose, which, due to the swelling of the tissues, is either released to the outside (runny nose), or flows into the nasopharynx, and the baby swallows it.
• Unaccustomed sniffing during sleep, which had not previously been observed.

In principle, with adenoids 1 degree there is only a slight increase in tonsils. All the above symptoms are associated with the fact that the adenoids increase somewhat and overlap from about ¼ of the lumen of the nasal passages in the vomer region (bone of the posterior nasal region). In the horizontal position, the adenoids occupy an even larger area, considerably hindering the breathing of the child in a dream.

Violation of nasal breathing in a dream makes the night rest inferior, as a result of which the kid feels tired and broken, his cognitive processes are slowing down, his progress is deteriorating.

The methods of treatment of the first degree of adenoids in children chosen by the doctor depend on the age of the small patient. If a child of 10-11 years old can take a wait-and-see attitude, as some doctors advise, and do not take any medical measures. As we have already mentioned, by the age of 12 the problem of adenoids is usually resolved naturally, so one can wait a year or two, if there is no further growth of tonsil tissue.

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

In the case of an increase in adenoids in young children, doctors recommend conservative treatment, which involves the use of both medicamental and alternative means. Effective measures in this case will be:

• hardening, charging, outdoor activities,
• washing of the spout with water-salt solution or special sprays based on sea water in order to cleanse it of mucus and bacterial factor,
• the use of vasoconstrictor in the form of drops and sprays,
• with 3 years use of anti-inflammatory hormonal agents in the form of sprays, which stop the inflammation in the glands and nose.
• the use of multivitamin complexes and herbal preparations to enhance immunity,
• if necessary, taking antihistamines,
• Inhalation with essential oils of eucalyptus or thuja,
• physiotherapeutic procedures: inhalation treatment, magneto- and laser therapy.

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

Procedures should be taken every day for 1.5-2 weeks. Since adenoids have a tendency to relapse (even after removal), a preventative course of laser therapy is recommended to be performed once every 6 months. With weakened immunity such treatment is shown before the child reaches the age when the lymphoid tissue starts to atrophy.

[1], [2]

Adenoides of the 2nd degree

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

To the symptoms, characteristic for 1 degree of pathology, other more serious ones are added:

• the child constantly breathes with his mouth open (both at night and in the day), which causes infection in the lower respiratory tract, which now does not stay in the nose, more frequent cases of respiratory diseases including inflammation of the lower respiratory tract, the illness lasts longer and is more severe;

In the nasal passages, there must be a moistening and cleansing of the air that enters the body, however the air now goes around,

• in a dream the child not only snorts, but also snores clearly, as the adenoids block the airways,
• the swelling of the nose becomes worse, so the baby breathes through the mouth, for convenience, leaving it constantly open (this gives the person specific forms and expression),
• the timbre of the voice changes, it becomes deaf or slightly hoarse, nasal,
• as a result of lack of oxygen and disturbance of night sleep because of problems with breathing, the general well-being of the child worsens, which makes it moody,
• permanent problems with the ears begin: ears are blocked, hearing worsens, frequent relapses of otitis,
• begin to have problems with eating, because of a lack of appetite, the baby either refuses to eat at all, or eats little and reluctantly.

Symptoms of the disease in different children may differ, 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  adenoids of the 2nd degree in children, until the disease has passed into a stage requiring immediate surgical treatment.

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

The curative scheme of conservative therapy includes the following activities:

• thorough washing of the tonsils and nose with saline solutions (this can be both pharmaceutical preparations and self-prepared formulations),
• inhalation treatment with the use of essential oils, herbal decoctions, saline solution (inhalation is best done with a special inhaler device called a nebulizer),
• instillation into the nose drops and irrigation of mucous sprays with anti-inflammatory, antibacterial and drying effect,
• homeopathic treatment aimed at removing the edema and inflammation of the tonsils, as well as increasing the general and local immunity,
• vitamin therapy to stimulate the immune system,
• reception of immunostimulating preparations on a plant basis
• physiotherapy.

As you can see, conservative treatment of grade 2 adenoids in children practically does not differ from treatment of the initial stage of the disease. Used the same:

• Saline solutions (home-made preparations and pharmacy "Salin", "Akvalor", "Humer"),
• glucocorticosteroids in the form of sprays: "Nazonex", "Fliksonase", "Avamis", etc.,
• antibacterial drops: "Isofra", "Polidex", etc.,
• homeopathic remedies: Sinupret, Tonzilgon, IOV Malysh, etc.,
• antihistamines: "Diazolin", "Zirtek", "Loratidine", "Fenistil", etc.,
• drops on the basis of medicinal plants of home preparation (juice of leaves of an aloe, broth of flowers of a camomile and calendula, sea buckthorn oil, oil of a thuja ),
• drops with a drying effect: Protargol, Collargol, etc.

Surgical treatment for adenoids of grade 2 in children is prescribed only if:

• inefficiency of the course of conservative therapy,
• markedly impaired nasal breathing, which causes a decline in academic performance, developmental lag, a breach of the formation of the chest, as well as the appearance of anomalies in the structure of the jaw, a change in the occlusion, a change in the shape of the face to the adenoid,
• hearing impairment due to the swelling of the auditory tube and the inflammatory processes developing within it,
• the transition of the inflammatory process in the tonsils into a chronic form, an increase in 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 breathe fully with the help of the nose.

[3], [4]

Adenoids 3 and 4 degrees

Despite all the unpleasant and menacing symptoms, adenoids of 1 and 2 degrees are considered an easy form of pathology, which in the overwhelming majority of cases is treated conservatively. About adenoids of the third degree this can not be said. 

The picture that the doctor sees is terrifying. Adenoides of the third degree in the child almost completely overlap the opener bone, leaving only a small lumen for breathing with the nose. Sometimes they even partially cover the ear canal, causing stagnant phenomena and inflammation of the inner ear.

Outwardly, the disease manifests itself in a virtual absence of the ability to breathe through the nose. Attempts to inhale or exhale the air with a nose end with a strong swelling of the wings of the nose and a loud wheezing. Oxygen at the same time enters the body very little, the baby suffocates and stops the painful, but unsuccessful attempts to restore normal breathing.

The child begins to breathe only the mouth in any weather, freely penetrating into the nasopharynx and even deeper the bacteria and viruses provoke permanent respiratory infections and inflammatory diseases. Due to persistent illnesses and the presence in the nasopharynx of an unchanged focus for the reproduction of bacteria, the immunity of the child is greatly reduced. Diseases are very difficult, poorly treatable and prone to frequent relapses.

The strong growth of lymphoid tissue in this case is necessarily accompanied by inflammatory reactions in the tonsils. Lack of oxygen due to inferior breathing affects the development of speech and mental abilities of the baby. The child is very scattered, it is difficult for him to concentrate attention, problems with remembering information begin.

Due to improper breathing, the thorax deforms, the contours of the face change, the nasolabial triangle is smoothed. Unpleasant changes in the appearance of the child and the nasal voice become the subject of ridicule of peers, which can not but affect the psyche of a small patient.

The picture does not come from pleasant. And if you consider that all of the above is a consequence of inattention or inaction of parents, it becomes even sadder. But adenoids can not grow at a critical size. Their growth was carried out gradually, accompanied by a violation of nasal breathing to varying degrees, with all the ensuing consequences. And only the carelessness of parents could allow the disease to reach such proportions.

With 3 degrees of adenoids in children, the only effective treatment is considered to be adenotomy. This is what surgical excision of adenoids is called, which is often performed in parallel with the removal of a portion of the modified tonsil (tonsillotomy).

Traditionally, adenoids are usually removed with a special knife - an adenotome. The operation can take place under both local and 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 course of the operation.

An important drawback of surgical removal of adenoids is a rather severe bleeding due to the cutting of hypertrophied tissues. Despite the fact that the blood goes for a short time, the child can still be frightened and prevent the operation from continuing.

Another drawback is the lack of the ability to visually monitor the progress of the operation and the complete removal of the enlarged lymphoid tissue, which can subsequently lead to a relapse of the disease.

Endoscopic surgery is considered a more modern and effective method of adenoid removal. In principle, adenotomy can be performed with the same adenotome, but the progress of the operation and all the nuances associated with it can be observed on the computer screen. The endoscope in this case acts as a diagnostic as well as a therapeutic device, i.e. Operation on the indications can be carried out directly during the examination, without removing the tube with the camera from the nose of the child.

Another type of operation, which is considered the least traumatic, but at the same time the safest and almost bloodless, is the removal of adenoids by means of a laser. Surgery is performed using a beam of greater power than the one used for laser therapy. The laser beam cauterizes and removes the overgrown tissues completely. Complications after surgery usually does not occur.

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

As for the questionable grade 4 adenoids in children, here it is rather a complication of a strong proliferation of lymphoid tissue inflammatory process, as a result of which nasal breathing completely stops. In fact, this is a complicated course of the 3rd degree of adenoids (adenoiditis). To pull in this case there is no place, therefore to the child the urgent operation on excision of adenoids and a part of the hypertrophied tonsils with the subsequent anti-inflammatory therapy is appointed.

[5], [6], [7], [8], [9], [10], [11]