WHAT IS ADENOID ?
ADENOID is nothing but hypertrophied lymphoid tissue giving rise to symptoms.The symptoms may be mechanical causing obstruction or due to infection.
This is disease of infancy or childhood.After the age of 12 years the nasopharyngeal lymphoid tissue undergoes atrophy so ADENOID are not found in adults.
NAKED EYE APPEARANCE OF ADENOID.
It is pink mass of tissue with longitudinal furrows. There is no capsule.It is just attached to the mucous membrane.It is present at the junction of roof and posterior wall.
AETIOLOGY OF ADENOID:-
Repeated nasal infection i.e. Rhinitis.
WHAT ARE THE SIGNS AND SYMPTOMS OF ADENOID?
1) NASAL SYMPTOMS AND SIGNS :- MOST MARKED
a) The main symptom is increasing bilateral nasal obstruction because of partial or complete blockage of posterior nares. The child can not breath through nose and he is forced to breath from the mouth.
b) In long standing cases( 2-4 years duration) the child stops nose breathing and becomes constant mouth breather.As a result of that the anterior nares becomes pinched, tip and alae of nose undergoes disuse atrophy.
c) As a result of obstruction of posterior nares there is collection of mucous which gets infected and keeps on flowing out of the nose constantly,so much so that there is ulceration of external nose.
d) Because of chronic infection and hyperaemia there is Epistaxis.
e) There may be associated sinusitis in some cases.
2) AURAL SIGNS AND SYMPTOMS:- COMMON.
Adenoid tissue encroaches upon the eustachian tube, blocking the tube partially or completely. The following Signs and Symptoms will occur.
a) Deafness which is bilateral and as a result of this the child becomes Dull, mentally retarded, inattentive in the class.
b) When infection occurs, it causes Otitis media, Ear ache, Middle ear infection and perforation of tympanic membrane which leads to pusy discharge through ear.
c) In some cases there may be collection of fluid ( thick mucus ) in middle ear called GLUE leading to deafness.
3) OROPHARENGEAL SIGNS AND SYMPTOMS:-
These symptoms are mainly due to mouth breathing.
a) As a result of constant mouth breathing, Lips are dry and development of incisor teeth becomes defective.
b) Normally when the mouth is closed the tip of tongue touches the premaxilla and assume a particular shape. When mouth is opened there is no pressure behind, the teeth become overcrowded, the premaxilla become narrow and hard palate becomes arched.
c) There is mild dysphagia. Due to mouth breathing child takes much longer time to eat.
4) LOWER RESPIRATORY TRACT SIGNS AND SYMPTOMS :-
Due to constant mouth breathing air is not properly purified so there are repeated attacks of lower respiratory tract infection, Bronchitis and Bronchopneumonia.
B) GENERAL SIGNS AND SYMPTOMS :-
1) General health of child is poor because of repeated chest infection and dysphagia.
2) General development of face, chest and body as a whole is defective. The nose is pinched, mouth is open, pus coming out of nose gives the child an idiotic look.
3) Mental symptoms:- During the phase of acquiring mouth breathing,the sleep is disturbed, there is Snoring and voice is changed. As a result of disturbed sleep there are episodes of nocturnal enuresis ,this is because of poor oxygenation of blood and oxygen supply of brain cells is defficient. There are nocturanal terrors.
Once the child becomes used to mouth breathing these symptoms disappear.
1) History of nasal obstruction, mouth breathing in nasal cavity.
2) Digital palpation. Put a finger in the nasopharynx and feel. This will be like a bag of worms.
3) X-Ray of nasopnarynx Lateral View. ( A soft tissue shadow is found ).
A) CONSERVATIVE TREATMENT :- IT IS POSSIBLE ONLY :-
a) If the ADENOID is small.
b) If the symptoms are very mild i.e. mild nasal obstruction and no symptom pertaining to ear.
THE TREATMENT CONSISTS OF :-
1) Educating the child to breath through nose.
2) Mild nasal decongestant drops like 1/2 % Ephidrine in normal saline.
3) Antibiotic drops in infection in the nasal cavity.
B) SURGICAL TREATMENT :-
It is indicated if the symptoms are present specially ear symptoms.
The treatment is removal of Adenoid. This is always done under G.A. It may be removal of adenoid exclusively or combined with Tonsillectomy. The operation is called "ADENOIDECTOMY OR ADENOID CURRETTAGE".
COMPLICATIONS OF THE OPERATION:-
1) Profuse bleeding ( very serious ). If instrument is sharp, it may cut the prevertibral fascia. Treatment is to insert post nasal packing immediately, before the child loses lot of blood.
2) During lateral sweeps, the eustachian tube can be injured.
3) If pack is not removed properly or left behind the child may bleed.