What are adenoids and why are they harmful to your child?

A child’s local immunity is undeveloped during the first 3–4 years of life. Its final formation occurs only by the age of 14. During this time the throat amygdala begins its reverse development, and during the period of active sexual development, it gradually decreases in size.

The throat amygdala is lymphatic tissue associated with the mucous membrane of the nasal cavity, paranasal sinuses, auditory tubes, throat, trachea, and bronchi. It acts as a barrier and protects the body from harm.

From a medical point of view, adenoids are an excessive increase in the pharyngeal (nasopharyngeal) tonsil. The risk of chronic inflammation and the development of hypertrophy is increased with the following:

• Frequent acute respiratory viral infection (8 times a year or more), when the tissue of the tonsil does not have time to recover from a previous infection.
• Chronic infection with herpes viruses, adeno, rhinitis, enteroviruses.
• Atypical respiratory tract infections (mycoplasmosis, chlamydia).
• Violation of the integrity (chronic burn) of the tonsils’ and pharynx’s mucous membrane due to the reflux of the contents of the stomach (gastroesophageal reflux), followed by the addition of bacterial or fungal infection.
• Constant contact with carriers of pathogenic microorganisms (i.e. in schools).
• Inadequate treatment of infectious diseases (for example, excessive use of medicines, which leads to disruption of the microbiota and destruction of the surface layer of the nasopharyngeal mucosa.
• Allergic rhinitis, which leads to a violation of the protective mechanisms of the nasopharynx’s mucous and lymphoid tissue.

Household allergens (dust mites, mold fungi, endotoxin of Staphylococcus aureus) are the most dangerous when it comes to the development of hypertrophy of the pharyngeal tonsil. Addiction to sweets and junk food contributes to the formation of an environment ideal for the growth of Staphylococcus aureus both in the oral cavity and the nasopharynx.

Enlarged adenoids in children may cause mucus and pus in the nose, sniffing, snoring while sleeping, nasalism, rapid fatigue and weakness, hearing loss, restless sleep with night scare, temperature rising to 100 ℉, headaches, enuresis, and reduced appetite.

Chronic inflammation in the throat amygdala leads to sinusitis, tonsillitis, otitis, lesions of the bronchopulmonary system, cardiovascular disease, and other diseases.

The reversible complications include such health problems as:

• Obstruction of the auditory tube, with the development of chronic otitis. In the absence of proper treatment, inflammation of the auditory tube quite quickly leads to acute inflammation of the middle ear.
• Inflammation of the paranasal sinuses (sinusitis, frontitis, ethmoiditis, sphenoiditis).
• Pneumonia, bronchitis.
• Episodes of short-term respiratory failure during sleep (obstructive sleep apnoea syndrome).

Irreversible complications are not frequent and, as a rule, are associated with improper treatment and disregard for medical advice. These include:

• Adhesive and chronic otitis media.
• Change in the shape of the facial skeleton ("adenoid face").
• Lagging in development due to chronic hypoxia of the brain.

In some cases, chronic adenoiditis can provoke epileptic seizures.

Surgery to remove adenoids in children: is it worth it?

Years ago, the surgery to remove adenoids, an adenotomy, was very common. However, it should only be done with caution after surgery, when lymphatic tissue begins to grow again, and when adenoids often appear again in the child! This happens especially often in children who suffer from allergies.

Modern medicine suggests that surgery does not help with most problems associated with adenoids. Removing only one of the structures involved in the inflammatory process without therapeutic intervention will not stop the chronic inflammation or help the child to recover. Therefore, doctors do not currently recommend adenotomies.

One exception to this is when there is no effect from conservative therapy for six months, with repeated episodes of apnea and obstruction of nasal breathing. However, this can happen in cases where children who have been ill for a long time have not received adequate treatment. In this case, an adenotomy is a necessary emergency measure.

Options for non-surgical treatment

To date, doctors recommend using salt solutions of different concentrations of adenoids, depending on the stage of inflammation. Irrigation of the nasal cavity and nasopharynx reduces swelling of the mucous membrane.

In the acute stage, it is necessary to use hypertensive solutions (with a high content of salt) for 3–5 days and then switch to isotonic (physiological solution). Compared to salt solutions, seawater-based preparations perform much better in treatment.

Spray solutions are prescribed while taking into account the sensitivity of pathogens revealed in a patient, especially in the presence of chronic adenoiditis. In some cases, antibiotics can be prescribed in doses suitable for the age of the child for at least 10 days.

In chronic adenoiditis, bacterial immunomodulators (lysates of local and systemic application) are prescribed as immunotherapy. These are split bacteria that activate the functions of the body's congenital immunity when viruses enter.

However, the fact that vasoconstrictor drops are widely advertised and easily available in pharmacies has led to usage when it is not advisable. They interfere with the regulation of vascular plexuses in the nose, leading to the development of vascular and tissue changes that are often irreversible.

Therefore, these drops are prescribed for a short period of 3 days (or 5 days in the case of an emergency). Independent, uncontrolled use of vasoconstrictor droplets often leads to complications.

What do doctors advise preventing adenoids in children?

Parents should help their child to overcome the period of the natural formation of the immune system. They should realize that, as a rule, frequent colds and runny noses are not a manifestation of immune deficiency, they are simply the immaturity of the immune system and the "price" for its strengthening.

What do doctors recommend for qualitative prevention of adenoids?

First, moisturize and purify the air in rooms where a child spends a lot of time (including kindergarten and school).

Wash hands after being in crowded places, as well as after any cough and sneezing. Clean the nasal cavity and nasopharynx 2 times a day, and treat each episode of ODS.

It is also important for the child to drink a sufficient amount of clean water and have a large number of fruits, vegetables, and vitamins in their diet.

Also, the allergy must be diagnosed correctly and treated promptly—especially allergic rhinitis. For prevention, it is important to do respiratory (breathing) exercises with your child. Additionally, keep an eye on whether your child is having biting problems, which can cause them to breathe through their mouths.

This leads to insufficient hydration, warmth, and purification of the air entering the lungs, which in turn leads to the development of infectious and allergic lung diseases. If this is the case, you should contact an orthodontist.

Additionally, make sure your child does not spend too much time using electronic devices, which can restrict blood circulation in the neck and head area. Children should play outside and be physically active with peers to avoid hypodynamia (decreased strength and power). Long walks in the fresh air will improve the health of the child.

23 March 2021