How do they manifest themselves?
- Difficulty nasal breathing, the child breathes through the mouth, especially during sleep
- Snoring, restless sleep, unusual sleeping positions with the head thrown back
- Nasal tone of voice
- Persistent runny nose or mucus running down the back of the throat
- Frequent otitis media, hearing loss
- Morning fatigue, irritability, decreased attention and performance
- Frequent ARVI, prolonged bronchitis
Degrees
- I степень: аденоиды перекрывают до трети просвета носоглотки. Ребёнок дышит носом днём, затруднение только во сне.
- II степень: перекрыто примерно до половины–двух третей. Дыхание носом затруднено и днём, появляется храп.
- III степень: просвет перекрыт почти полностью. Носовое дыхание практически отсутствует, ребёнок постоянно с открытым ртом.
An important disclaimer: a degree is not a death sentence or an automatic indication for surgery. There is a II degree with apnea and hearing loss, requiring intervention, and a III degree without significant consequences, which can be monitored. They look at the child, not at the number.
Diagnostics
- Эндоскопия носоглотки — золотой стандарт: тонкий эндоскоп позволяет увидеть аденоиды, их размер и состояние слуховых труб. Процедура быстрая и переносится детьми хорошо.
- Отоскопия и тимпанометрия — оценка состояния среднего уха и наличия жидкости за барабанной перепонкой.
- Аудиометрия — при подозрении на снижение слуха.
- Рентген носоглотки — менее точен, даёт лучевую нагрузку; используется реже.
- Консультация аллерголога при круглогодичном насморке.
Conservative treatment
- Intranasal glucocorticosteroids in a course - a method with the best evidence, reduces the volume of adenoid tissue
- Rinse your nose regularly with saline solution
- Treatment of concomitant allergic rhinitis
- Elimination of foci of infection: caries, chronic tonsillitis, sinusitis
- Breathing exercises and training in nasal breathing
- Sufficient air humidity, walks, limiting contacts during epidemics
When is surgery needed?
- Obstructive sleep apnea syndrome - stopping breathing during sleep
- Persistent absence of nasal breathing that does not respond to conservative treatment
- Exudative otitis media with fluid in the ear and hearing loss
- Recurrent otitis - more than 3-4 times a year
- Emerging malocclusion and facial skeleton
- Delayed growth and development associated with chronic hypoxia
Modern adenotomy is performed under anesthesia with endoscopic control - this is fundamentally different from the “blind” removal of previous years, it provides complete tissue removal and fewer relapses. The child usually returns home the same or the next day.
The issue of relapse
Adenoids can regrow, especially if the operation is performed at an early age, as well as with persistent allergies and constant inflammation. Endoscopic monitoring during surgery and treatment of allergic rhinitis after surgery help reduce the likelihood.
After 7–8 years, the pharyngeal tonsil begins to naturally shrink, so relapses are rare in older children.
