The intern I took with me at PACU in January recently transferred to the Department of Otolaryngology and suddenly sent a message asking me: "Teacher, in January, there were a lot of children who had adenoidectomy surgery. Why do I rarely see such children in the ENT department now? Is this disease still divided into seasons? I replied to her, "Yes." Today we take this question and simply learn about adenoid hypertrophy.
First, let's look at the anatomy of the adenoids, also known as pharyngeal tonsils, which grow in the back of the nasal cavity, and excessive hypertrophy will cause corresponding clinical symptoms. Under normal physiological conditions, children aged 6 to 7 years have the largest adenoids and gradually atrophy after puberty.
What is adenoid hypertrophy?
Children with adenoidal hypertrophy are more common and often have chronic tonsillitis. Pathological hyperplasia of the adenoids occurs when the nasopharynx and adjacent sites, or when the adenoids themselves are repeatedly stimulated. Common causes include recurrent episodes of acute and chronic nasopharyngeal inflammation, and acute and chronic rhinosal and sinusitis in children. Cold and humidity are the triggers, which is one of the important reasons why there are more children who come to the operating room for adenoid resection in winter.
In the first case, the adenoids grow too hypertrophied behind the nasal cavity, blocking the back nostrils, and the children are not ventilated, hindering nasal ventilation, and they have to open their mouths to breathe. Poor nasal ventilation, resulting in open mouth breathing, especially in the early stage of sleep open mouth breathing, and even at night when sleeping breathing there will be a certain period of complete blockage, breathing interruption or cessation, sleep apnea occurs. This condition is called adenoid hypertrophy.
In the second case, after the adenoids are overgrown, there is also a tube in the ear tympanic chamber that communicates with the outside world through the nasopharynx and nasal cavity, called the Eustachian tube. After the Eustachian tube is passed, we can climb the mountain or adjust the tympanic pressure balance when the air pressure changes. If the adenoids grow too large, they will block the nasopharyngeal opening of the Eustachian tube. The child loses the ability to regulate, the things in the tympanic cavity cannot be discharged, and a negative pressure is formed inside, resulting in a fluid effusion, and the eardrum cannot vibrate. Conductive deafness is produced, and sounds are not heard. For example, when the plane suddenly lands or takes off, everyone feels that the ears are uncomfortable, and often swallows to let the Eustachian tube open. If there is a large clump of adenoids blocked here, it is not good to do all kinds of movements, and the Eustachian tube is blocked with hearing. This is also known as adenoid hypertrophy.
Another point is that there are many sinuses in the nasal cavity of the pharynx: the maxillary sinuses, sphenoid sinuses, sieve sinuses, and frontal sinuses are all open in the nasal cavity, and if the back of the nasal cavity is blocked, especially some of the sinus openings in the back of the nasal cavity are also easily blocked. This can also cause recurrent episodes of sinusitis due to adenoidal hypertrophy. This is also a clinical manifestation of adenoidal hypertrophy.
In short, the adenoids are too long, blocking the respiratory tract, nasal cavity, Eustachian tube, sinus opening, causing some diseases, such as what we often call adenoidal face, developmental delay, lack of concentration, etc. These conditions are called adenoid hypertrophy.
Does adenoid hypertrophy require surgical removal?
Mild or short-term disease can be treated conservatively, paying attention to nutrition, preventing colds, improving immunity, and actively treating the primary disease. It resolves on its own with age. However, conservative treatment is ineffective or symptoms are repeated, and resection should be performed as early as possible.
Indications for adenoid resection surgery: 1. pathological open-mouth breathing, atresia nasal congestion, infant lactation difficulties; 2. obstructive sleep apnea hypopnea syndrome; 3. secretory otitis media, chronic sinusitis; 4. Recurrent upper respiratory tract infection; 5. Sinus bronchitis; 6. Nocturia, night terrors and inattention caused by adenoid hypertrophy.
Author: Yan Sha Liu Zhenxing
Unit: Wuhan Fourth Hospital