Adenoids and adenoiditis: what is the difference
Adenoids are the enlarged pharyngeal tonsil itself, and adenoiditis is its inflammation. The increase occurs without inflammation: the child simply breathes poorly through his nose. In acute adenoiditis, fever, copious discharge, and pain in the depths of the nose and behind the palate are added. Chronic adenoiditis occurs in waves: almost constant runny nose, night cough from mucus drainage, fatigue. The degree of enlargement is assessed by how much the tissue blocks the lumen of the nasopharynx, but the decision about treatment is made based on symptoms, and not on the number.
- I degree - approximately a third of the lumen is blocked
- II degree - about half blocked
- III degree - the lumen is blocked almost completely
- Acute adenoiditis - with fever and purulent discharge
- Chronic adenoiditis - prolonged runny nose and night cough
Symptoms
The most noticeable sign is that the child breathes through his mouth during the day and especially at night: the mouth is slightly open, the lips are dry, and snoring with pauses can be heard during sleep. The voice becomes nasal, a night or morning cough appears from draining mucus. Due to impaired ventilation of the auditory tube, the ears often become blocked and otitis media recurs, and the child begins to ask questions. Chronic lack of oxygen at night explains morning lethargy, moodiness and difficulty paying attention in the garden and school.
- Mouth breathing and open mouth
- Snoring and restless sleep
- nasal voice
- Persistent runny nose and night cough
- Frequent otitis media and hearing loss
- Morning lethargy and irritability
Diagnostics
The main method is endoscopy of the nasopharynx: a thin endoscope allows you to directly see the size of the adenoids, the presence of pus and whether the mouth of the auditory tube is blocked. The procedure is quick and well tolerated by children. A lateral X-ray of the nasopharynx is used as a simpler alternative, but it only shows the size. An ear examination and, if necessary, a hearing test are required. If the runny nose is year-round and there are other manifestations of allergies, the child is referred to an allergist.
- Endoscopy of the nasopharynx
- X-ray of the nasopharynx in lateral projection
- Otoscopy and tympanometry
- Hearing test if hearing loss is suspected
- Allergological examination for year-round rhinitis
- Assessment of sleep and snoring according to parents
Conservative treatment
They start with regular cleansing of the nose with saline solutions and a nasal shower: this reduces swelling and flushes out mucus. If there is a significant increase in tissue, the doctor may prescribe a course of intranasal hormonal spray - it acts locally and often allows you to postpone or cancel the operation. Concomitant allergic rhinitis and sinusitis must be treated. Antibiotics are used only for bacterial exacerbations, and not in courses “for prevention”. Ventilation, air humidification and the absence of tobacco smoke at home are also important.
- Nasal rinsing with saline and nasal shower
- Intranasal hormonal sprays as prescribed by a doctor
- Treatment of allergic rhinitis
- Antibiotics only for bacterial exacerbation
- Humidification and ventilation of the room
- Quitting smoking in the home
When is surgery needed?
Adenotomy is considered not according to the degree in the image, but in case of persistent consequences: respiratory arrest during sleep, constant mouth breathing with sleep disturbance, repeated purulent otitis media, lingering fluid in the middle ear with hearing loss and persistent chronic adenoiditis that cannot be treated. Today, the operation is performed endoscopically, under general anesthesia: the doctor sees the entire nasopharynx and removes the tissue completely, which reduces the risk of re-growth. The child usually returns home the same or the next day and begins breathing through his nose almost immediately.
- Breathing pauses during sleep
- Constant mouth breathing and snoring with sleep disturbance
- Repeated purulent otitis
- Exudative otitis media longer than three months with hearing loss
- Ineffectiveness of conservative treatment
- Emerging malocclusion due to mouth breathing
