When it comes to adenoid hypertrophy, many parents are familiar with the term.
Breathe with your mouth open, snore while sleeping; nasal congestion is easy to sleep and wake up, and sleep is not steady; The gums are exposed, the lips are upturned, the longer the uglier... These symptoms in children may all be related to adenoid hypertrophy.
However, does surgery need to be removed? What are the consequences of delaying treatment? How does surgery affect your child? The reporter interviewed relevant otolaryngologists.
Adenoids are at their peak of growth around the age of 3-7 and shrink after the age of 10
The reporter learned from the otolaryngology department of many hospitals that at least 1/3 of the children in the outpatient clinic were troubled by adenoid hypertrophy.
Adenoid hypertrophy is a common occurrence in children aged 3 to 10 years, ranging from 9.9% to 29.9%. With the attention of parents in recent years, the rate of medical visits has increased year by year.
According to Yang Youxiong, vice president of the Second Hospital of Yinzhou District of Ningbo City and chief physician of the Department of Otorhinolaryngology-Head and Neck Surgery, adenoids are human immune organs, located at the junction of the nasopharyngeal parietal wall and the posterior wall at the back of the nasal cavity, and belong to lymphoid tissue. Adenoids begin to develop around 1 year of age, usually at the peak of growth at the age of 3-7, which is also the common age when adenoid hypertrophy occurs.
Adenoid hypertrophy is divided into physiological and pathological, physiological adenoid hypertrophy will not affect the child's physical health, nor does it need treatment, can be ignored. Most children will shrink and disappear after the age of 10, and there will be little or no residual adenoids in adulthood.
Adenoids, as members of the immune system, become inflamed and swollen when pathogens invade, and become more hypertrophied, similar to inflammation of tonsils. Normally, this transient hypertrophy recovers when the pathogen is cleared.
Some children have repeated inflammation, adenoids continue to proliferate, hypertrophy, can not be eliminated, that is, pathological adenoid hypertrophy, must not be allowed to develop.
Yang Youxiong is examining the patient.
A 3-year-old boy wakes up five or six times a night with slow development
In general, repeated attacks of diseases such as tracheal inflammation, rhinitis, chronic sinusitis, tonsil inflammation, and otitis media may cause adenoid hypertrophy, leading to nocturnal snoring and mouth breathing.
As the child grows, the effects of adenoid hypertrophy on breathing and sleep are more pronounced.
About 10% of children habitually snore when they sleep. Babies before 3 months, the nasal passages are relatively narrow, the cartilage in the nasal cavity and larynx has not yet fully developed, and it is inevitable that there will be sounds when sleeping, so there is generally no need to worry about it.
As children develop day by day, many children still have sleep snoring. Snoring during sleep is usually caused by the vibration of the airflow caused by a partial blockage of the throat, and the louder the airflow, the louder the snoring. Snoring means that gas exchange is restricted when breathing and the child cannot breathe in enough oxygen.
Adenoids are located in the main communication artery of the nasopharynx, and pathological hypertrophy may lead to airway obstruction. This can cause your child to have symptoms of disturbed sleep, mouth breathing, coughing, and even night terrors, which seriously affects the quality of your child's sleep. "Clinically, 80% of children with adenoid hypertrophy have symptoms of mouth breathing."
Yang Youxiong once saw a 3-year-old boy who came to the hospital because of severe sleep problems.
According to the child's mother, the child went to bed every night with his mouth open to breathe and snoring pronouncedly. After falling asleep, he will suddenly stop snoring and sit up on his butt, shouting uncomfortable in his mouth, but he always wants to sleep. I finally lay down and coaxed myself to sleep, and after a while I sat up again. In severe cases, it is necessary to get up five or six times a night, and adults and children cannot sleep well.
In the long run, the child's daytime energy is not guaranteed, and his life and diet are affected, resulting in the boy being particularly thin and lagging behind children of the same age in development and abilities. After sleep monitoring, the boy was diagnosed with sleep-disordered breathing in children.
According to the American Academy of Pediatrics, sleep apnea causes about 1.2%-5.7% of American children's health to be affected to varying degrees. When the airways are narrowed or blocked, the pressure on your child's ventilation increases, which may cause a brief respiratory arrest and, in severe cases, suffocation.
However, the appearance of nocturnal snoring and mouth breathing symptoms is not all the responsibility of adenoid hypertrophy, "From my outpatient clinic, 1/3 of the children are caused by rhinitis and sinusitis, and these children can be treated with drugs first, not rushing surgery." Yang Youxiong said.
Chief Physician Yang Youxiong led the team to perform surgery on the patient.
Not doing sleep breathing screening requires attention to these details
As early as 2002, the American Academy of Pediatrics recommended that sleep breathing screening be necessary for all children in order to troubleshoot sleep apnea. Starting from the actual situation in China, although it is impossible to do sleep breathing screening for every child, if the child has the following conditions, parents should pay attention to it and seek medical attention in time:
1. Snore while sleeping at least 3 nights a week;
2. Snoring loudly, breathing very hard, mouth breathing;
3. The neck must be clearly straight when sleeping;
4. Restless sleep, night terrors, night walking, sweating;
5. Difficulty concentrating, such as: hyperactive, impulsive, rebellious, and aggressive;
6. Tiredness, listlessness, lack of concentration, excessive sleepiness during the day;
7. There is also a habit of breathing with the mouth open during the day;
8. Irritability;
9. Very thin or visibly obese.
Once the child is diagnosed with pathological adenoid hypertrophy, the hospital will determine the degree of impact of adenoid hypertrophy on the body through various means such as the child's symptoms, sleep testing, and nasopharyngeal endoscopy.
Given that there is more than one cause of sleep-disordered breathing, the examination needs to be judged in conjunction with the results of nasopharyngeal lateral radiographs and nasal endoscopy.
Yang Xiyun, chief physician of the Department of Otolaryngology-Head and Neck Surgery of Li Huili Hospital of Ningbo Medical Center, introduced that lateral radiographs can check the thickness of adenoids, and nasal endoscopy is used to check the degree of nostril occlusion after adenoids. The ratio of adenoid thickness to nasopharyngeal channel width greater than 0.7 is pathological hypertrophy, and surgical resection should be considered for nostril area exceeding 2/3 after adenoid blockage. According to statistics, the hospital performed a total of 1,800 adenoidectomy surgeries last year.
Yang is performing surgery on the patient.
Worried about anesthesia and "appearance anxiety", parents tend to two extremes
When it comes to whether surgery is needed, Yang Youxiong often hears two very different ideas during consultations.
Some families are reluctant to undergo surgery because they are concerned about the adverse effects of having their children undergoing adenoid surgery. Some families have "appearance anxiety", fearing the "sequelae" of adenoid hypertrophy, and insist on surgery, even if the child's symptoms do not meet the indications for surgery.
Parents who resist surgery are often concerned about the risks of surgical anesthesia. In fact, adenoid resection surgery is already a very mature operation, now most doctors through endoscope, the use of low-temperature plasma radio frequency precise excision, will not damage the face, and almost no bleeding, the operation is fast, from the beginning of the resection to stop bleeding to complete about 20 minutes. In such a short time, the occasional anesthesia is not very harmful, but if the child is not treated in time because of fear of anesthesia, long-term pathological adenoid hypertrophy will be more harmful to the brain.
Parents with "appearance anxiety" are worried about the adenoid face, afraid that the child will open the mouth for a long time, and the air flow will continue to impact the hard palate and then cause abnormal maxillofacial development, buck teeth, uneven tooth alignment, poor bite, thick and upturned lips, etc. "In fact, only 1/3 of all the children who come to the clinic actually need surgery." Yang Youxiong said.
If the tonsils are often enlarged and inflamed, removal is recommended
The reporter learned in the interview that the tonsils, as the "twin brothers" of the adenoids, should also be removed together if they are often swollen and inflamed, so as not to cause adenoid hyperplasia. Some parents worry that removing so many immune organs at once will affect their children's immunity.
"There are also strict criteria for determining whether to remove tonsils." Yang Youxiong introduced that tonsil enlargement is divided into four degrees, and the fourth degree is the most serious. Regardless of how much swelling there is, as long as inflammation of the tonsils appears, consider total incision. He said that tonsil surgery is generally more suitable after the age of 4, that is, after the body's immune function is fully developed.
Some parents want to remove part of their children's tonsils to retain their immune function, Yang said that this immune function will not only not be significantly preserved, but also increase the amount of intraoperative bleeding, which is not conducive to postoperative recovery, and even recurrence.
After surgical treatment, the patient's immunity temporarily decreases, and it is necessary to pay attention to the diet that is rich in nutrients, should not be too hot, ensure rest, should not exercise vigorously, and cannot take a hot bath within a week. If you still have the habit of breathing with your mouth open, you can correct it with adhesive tape.
Source | Ningbo Evening News
Responsible Editor | Li Kexin
Editor: Li Kexin