Adenoids, inflamed tonsils. Be removed or treated? Expert advice.

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Life often puts a question to the parents if the children suffer from chronic tonsillitis or adenoids in children enlarged. Of course, testimony about any operation is determined by the doctor, but it is the removal of enlarged tonsils and adenoids in the largest extent depends on the parents ‘ consent.

On the one hand, it is probably tempting to immediately do away with the reason of frequent illnesses of the child, but she, like any operation, it is alarming in its outcome, and for the future of a child deprived of albeit small, but still the desired body. How can that be?

To remove inflamed tonsils and adenoids, or not?

Readers who have to solve this problem, I want to give us some basic information about the structure and function of the Palatine and nasopharyngeal tonsils.

The Palatine tonsils are located deep in the oral cavity on the side walls. Inflammation of the tonsils often causes a person pain when swallowing, and sharp increase may hamper not only the swallowing, but speech.

Nasopharyngeal tonsil located on the roof of the nasopharynx, on the way inhale through the nose the air. Increasing, they close the internal opening of the nasal canal, causing breathing difficulties. A pathological increase of nasopharyngeal tonsil and is called “adenology”. Another unpleasant consequence of the adenoids, doctors consider narrowing the mouths evstafievich tubes connecting the middle ear cavity with the nasopharynx, which facilitates penetration of infection and leads to development of otitis.

At first glance it seems strange that nature has chosen for tonsils such inconvenient places that inflammation or increase leads to very unpleasant consequences. But even the most ardent opponents point of view of the infallibility of nature cannot deny the appropriateness of the location of these formations, which play a critical role in protecting the body from infection.

Functions of the tonsils

The tonsils constitute a lymphoid organ, similar to the lymph node tissue which is the formation and maturation of lymphocytes are the main cellular elements of the immune system. Cells emerging at the surface of the tonsils, recognize microorganisms that enter through the nose or mouth, and pass this information to the protective cells that produce antibodies. Most of the antibodies into the bloodstream, but part comes into the fight on the spot, contributing to the immobilization of microorganisms and their subsequent destruction by white blood cells. The body “beneficial” to the protective bodies are as close as possible to the site of infection, which is why the tonsils are located so “uncomfortable.”

The nasal cavity, mouth and throat right after the birth of a child colonized with microorganisms, many of them can cause the penetration of a barrier pharyngeal lymphoid ring of a serious illness. Nasopharyngeal lymphoid apparatus lying in the path of the air stream, performs its protective role very successfully. Formed new clones of lymphocytes, and this leads to an increase in lymphoid organs and in the first place — Palatine and nasopharyngeal tonsils. Hypertrophy of the tonsils is common in children of early age, the immune system which have not yet reached full maturity.

However, the adolescent period of the tonsils and lymph nodes gradually decrease and acquire the characteristic adult form.

The fact that the tonsils and lymph nodes are enlarged not all children, due to genetic conditioning. Until now, this condition called lymphatic diathesis, children in medical jargon is quite dissonant referred to as “lymphatique”. It has been proven that chronic tonsillitis most often affects children whose parents the child is also sick with the same disease.

And all-taki: whether the enlarged tonsils pathology, if to a certain limit, even a sizeable tonsils do not cause any serious deviations in health? However, I think established the fact that children with enlarged tonsils often suffer acute respiratory diseases, however, the question of what is the cause and what the consequence, consensus has not been reached. Removing the tonsils does not always lead to reduction of respiratory diseases.

Symptoms of enlarged tonsils

However, the hypertrophy of Palatine and nasopharyngeal tonsils do not appear only from time to time. First becomes noticeable violation of nasal breathing. The child begins to speak “in the nose”, his mouth is always open, the nose he breathes only in dreams and snores unmercifully. But it is not important. Violation of nasal breathing leads to stagnation of blood in the nasal mucosa, increased mucus secretion and inflammation of the stagnant mucus in the paranasal sinuses. Breathing with the mouth causes dryness in the throat followed by a cough. Violation of nasal breathing can adversely affect mental development of the child.

Enlarged Palatine tonsils may obstruct breathing and lead to disruption of pulmonary blood flow due to sudden pressure changes in the thorax during inspiration and expiration. Some children have tonsils so enlarged that they contact each other. Many children with impaired speech, decreased appetite, difficult to swallow foods, often during food causes nausea.

Increased and altered after many diseases tonsil — foci of chronic inflammation. And yet their status — although the most common, but not the only cause of diseases. It is well known angina can be caused by different viruses — most commonly by adenoviruses and enteroviruses. The causative agent it may be bacteria, such as hemolytic Streptococcus. Angina the tonsils are enlarged, acquire a bright red color on their surface you can often see white Islands — festering follicles or plaque white or gray.

Inflammation of the Palatine and nasopharyngeal tonsils (adenoids) is usually accompanied by enlargement and tenderness of lymph nodes, located under the angle of the mandible and on the neck.

Many children repeated inflammation of the tonsils do not go unnoticed, leaving behind scars and patches of chronic inflammation; often this chronic process occurs in the lymph nodes. Changed diseases the tonsils are much worse perform their protective role and potential foci of chronic inflammation becomes a source of intoxication of the whole organism.

The main question: “to Treat or to remove tonsils?”

Now, perhaps it’s time to answer the question posed in the title of the article is to treat or remove? I must say that this is one of the most hotly debated by doctors for nearly 100 years, although the technique of removal of tonsils and adenoids by itself a long time ago allows to carry out operations without much risk.

Indeed, it’s tempting to remove the child a small piece of cloth, gives him so much trouble, especially because function of it are important but can be done in other parts of the pharyngeal lymphatic ring. And that’s one time in the Western countries remove the child’s tonsils began to be practiced so widely that the retention of them was considered almost a departure from fashion. In our country in the postwar years also increased the number of operations. Currently, the enthusiasm for the removal of the tonsils cooled down all over the world. This is due to several reasons. First of all, meticulous long-term observations have shown that most patients with chronic tonsillitis conservative treatment gives the same results as removing the tonsils: gradually decreasing the frequency of respiratory diseases, stop the aggravation.

However, a significant number of operated patients have unpleasant consequences, such as hypertrophy and chronic inflammation neudenau lymphoid tissue of the pharynx, dryness and atrophic changes of the mucosa.

But perhaps the most convincing argument against surgical intervention was the fact that repeated respiratory infections, bronchitis, asthma attacks, cardiac murmurs, abdominal pain and some other conditions that were previously associated with chronic tonsillitis, as a rule, does not cease after removal of the tonsils. Moreover, it was noted that asthma attacks and bronchitis after surgery in many patients, even more frequent. Recently they found new explanations for some common changes in the heart (functional murmurs, mitral valve handicap, etc.), which previously was considered a result of chronic tonsillitis.

What patients is it appropriate to operate? Absolute indications for removal of tonsils and adenoids is a sharp hypertrophy of a violation of nasal breathing, swallowing. Persistent runny nose, sinusitis (inflammation of the sinuses), repeated ear infections — also good reason for surgery.

Difficult to decide on surgery unless there is an extreme degree of increase of the tonsils. Even in children with frequent aggravation of chronic tonsillitis and could bring it to an end after an energetic therapeutic and physiotherapy treatment. So before you decide on surgery, it is necessary to treat the child and only after making sure the ineffectiveness of the treatment, you can put the question of the removal of tonsils and adenoids. However, many chronic tonsillitis flows almost without exacerbations, and treatment with antibiotics, local treatment (rinsing, ultrasound, lubrication of the tonsils) gives good results.

Now, I think the reader will agree with the following rules for resolving the dilemma: to delete or not to delete.

To remove, if enlarged adenoids or tonsils create mechanical obstruction to breathing or swallowing.

Removeif chronic inflammation of the adenoids or the tonsils accompanied by repeated ear infections, sinusitis, tonsillitis, which do not disappear after two or three courses of conservative treatment.

To remove, if the status is dramatically altered, inflammation of the tonsils does not improve after conservative treatment.

Do not deleteif the tonsils are just enlarged, but do not cause any disorders.

Do not removewithout making vigorous and persistent attempts of conservative treatment of chronic tonsillitis.

Not remove, if the primary reason for the surgery is not so much the condition of the tonsils, or frequent sore throats how many other diseases: respiratory infections, bronchitis, asthma, heart murmur, abdominal pain, and others, the occurrence of which is presumably associated with chronic tonsillitis.

How to cure chronic tonsillitis?

Conservative treatment.
Usually carried out physiotherapy treatments, such as irradiation of tonsils with ultraviolet light (blue light therapy), the impact on the area of the tonsils and lymph nodes by high-frequency currents (UHF, SHF, etc.) or by ultrasound. At home a highly effective regular (two to three times a day) rinsing the throat of the soda-salt solution (in a glass of water half a teaspoon of salt and baking soda), to which you can add one drop of tincture of iodine in a glass or single crystal of manganese-acid potassium (the solution is slightly pink). The physician can lubricate the tonsils Lugol solution with glycerin, produced by prescription at the pharmacy, but it should be remembered that many of the children have increased sensitivity to iodine; in these cases no iodine or Lugol’s iodine should not be used.

Children with adenoids often suffer from rhinitis, which is treated with vasoconstrictor drops (ephedrine sanorin, gasolin). But these drops can be applied only for two or three days, until the liquid liberally from his nose. In the days that followed better to bury the nose in large quantities (one to three pipettes in each nostril) physiological (0.9%) sodium chloride solution or 1-2% solution of baking soda (such a solution is easy to prepare at home, resting on the tip of a knife salt and baking soda in a glass of water). The best effect is obtained by instillation of a solution into the nose when the child is lying on his back with a nodding head.

Surgical treatment.
Surgical removal of adenoids is usually performed on an outpatient basis, and it is traditionally considered desirable to quickly stop bleeding to give the child ice cream. And although the hemostatic effect of ice cream can hardly be taken seriously nowadays (to stop bleeding that are very rare, there is a more efficient means), I think that this practice should be preserved, as a reward the child for good behaviour with this in General painful, yet almost instant operation.

The operation of removing tonsils is more complicated, it is performed in the hospital where the baby is on average seven days.

In rare cases, relapses observed — growth of adenoids lymphoid tissue that remain in the nasopharynx after surgery, and sometimes have to be removed again.

The tonsils are usually removed completely, but often after the operation increase of lymphoid follicles on the back of the throat.

At what age to perform the operation?
It depends on the course of disease. Usually, the question of surgical treatment arises (primarily about the adenoidectomy) when children older than two to three years. Some time conducted conservative treatment of chronic tonsillitis, so the operation is rarely held children under the age of four to five years.

With modern technology surgery and anesthesia any serious complications are very rare. It is also shown that a significant negative impact on the development of the child, his physical and mental abilities, these operations do not have, so our reserved attitude to them is primarily due to the fact that more physiological conservative methods of treatment often give a good result.

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