Adenoid vegetations

Adenoid vegetation

The term adenoid vegetation (AV) refers to the pathological enlargement of the nasopharyngeal tonsil (tonsilla pharyngea), which occurs most often as a result of chronic rhinosinusitis. It is a childhood disease affecting both sexes.

The nasopharyngeal tonsil is also referred to as the so-called third tonsil (next to the palatine tonsils). It is part of Waldeyer's lymphoepithelial circuit. Its function is to participate in the body's defense against infection . It is most developed in children aged 4–7 years, after which it gradually involves.

• If it is pure hyperplasia , the tonsil is uniformly enlarged and there is no secretion in the nasopharynx.
• As for the enlargement caused by infection , the enlargement is irregular, the surface of the tonsil is furrowed and covered with secretion, which is also present in the nasopharynx and the nose.

Meaning and development of AV

• Lymphatic tissue rich in secretory glands;
• Meaning: participation in the formation of immunity, production of immunoglobulins and lymphocytes, part of the lymphoepithelial barrier;
• Hyperplasia corresponds to the immunobiological activity of childhood (natural hypertrophy from the activity of lymph tissue and the secretory apparatus);
• Hyperplasia is stimulated by stress on the immunological system, poor nutrition, repeated inflammation of the upper respiratory tract, hormonal influences (inflammatory hypertrophy with proliferation of fibrous stroma);
• Greatest between 3 and 5 years of age;
• From the age of 7 it involutes and disappears, but it can persist;
• For the formation of overall immunity, the importance of the nasal tonsil is marginal and it can be replaced by other organs of the Waldeyer circuit;
• The most common infectious focus in children in the ENT area.

Clinical signs

• nasal obstruction - children breathe through their mouths (especially during sleep), night snoring, rhinolalia clausa;
• sleep apnea syndrome
• facies adenoidea – characteristic facial expression (open mouth, indistinct nasolabial fold, upper lip retraction, exposed upper incisors, flattened cheeks, arched and narrow hard palate – Gothic palate);
• recurrent diseases from colds , rhinosinusitis ;
• recurrent mesotitis ;
• hearing loss – an enlarged tonsil covers the mouth of the Eustachian tube, a negative pressure will be created in the middle ear, the eardrum will be pushed in and there will be catarrhal inflammation with exudation;
• may be bedwetting
• mechanical dysphagia and failure to thrive.

Diagnostics

• anterior rhinoscopy ;
• posterior rhinoscopy;
• endoscopy of the nose;
• audiometry;
• tympanometry.

Differential diagnosis

Benign tumors and cysts of the epipharynx, especially juvenile angiofibroma and antrochoanal polyp, must be differentiated in terms of differential diagnosis .

Treatment

• adenotomy - curettage of the nasopharynx with a curette under general inhalation or intubation general anesthesia; endoscopic adenotomy;
• remediation of HCD inflammations ;
• nose breathing rehabilitation .

Links

Related Articles

• Examination methods in ENT/overview
• Secretory otitis
• Acute tubotympanic catarrh

Source

• BENEŠ, Jiří. Studijní materiály [online]. ©2007. [cit. 2009]. <http://jirben2.chytrak.cz/materialy/orl_jb.doc>.

References

• KLOZAR, Jan, et al. Speciální otorinolaryngologie. 1. edition. Prague : Galén, 2005. 224 pp. ISBN 80-7262-346-X.

• HAHN, Aleš, et al. Otorinolaryngologie a foniatrie v současné praxi. 1. edition. Prague : Grada, 2007. 390 pp. ISBN 978-80-247-0529-3.

• KOŇÁKOVÁ, Blanka. „Třetí mandle“ neboli adenoidní vegetace. Zdravotnické noviny [online]. 2009, vol. 11, p. 69, Available from <https://zdravi.euro.cz/clanek/sestra/treti-mandle-neboli-adenoidni-vegetace-448196>. ISSN ISSN 1214-7664.