ADENOIDITIS (adenoiditis; Greek aden — gland, eidos — a look + - itis) — an inflammation of a giperplazirovanny pharyngeal almond. Can be acute and chronic.
Etiology. Acute And. can develop owing to acute infectious diseases of the upper respiratory tracts caused by streptococci, stafilokokka, viruses (adenoviruses) at children frequent pneumococci.
Pathological anatomy. At acute And. the hyperemia, puffiness, places formation of infiltrates both in surface layers of an almond, and in crypts is found (see. Quinsy ).
Clinical picture. In essence it is so-called pozadinosovy, or retronasal, quinsy, but as it proceeds in giperplazirovanny fabric, apply the term «acute adenoiditis» to its definition. Regarding cases acute And. proceeds as catarral quinsy. The disease is observed preferential at children of early age, begins usually with high temperature (to 39 — 40 °). The mortgaging of a nose, ear pain, pristupoobrazny cough is at the same time noted at night. On 2 — the 3rd day against the background of moderately reddened back wall of a throat it is possible to see a hyperemia of palatopharyngeal handles and the characteristic mucopurulent discharge which is flowing down from a nasopharynx. At a back rinoskopiya if she works well, the swelled up a little and sharply hyperemic pharyngeal almond with the grooves covered mucopurulent separated is usually visible. Submandibular and cervical limf. nodes are increased and painful. Existence in children's age of shorter with a wide gleam of acoustical pipes facilitates bystry penetration of an infection into more akin ear, and it leads to emergence obviously or latentno the proceeding acute otitis. Acute And., as usual quinsy, comes to an end on 3 — the 5th day with recovery. In addition to the acute Ampere-second a usual current which is coming to an end in 3 — 5 days, fr. authors allocated a form of acute Ampere-second with longer current. It also begins sharply, often after quinsy, however duration of a disease reaches 15 — 20 days. At the occurred recovery temperature with the wrong fluctuations remains within 38 ° above, cervical and submandibular limf. nodes swelled up a little and painful at palpation. The general state is usually broken a little.
Diagnosis. Diagnosis acute And. at babies happens sometimes difficult — the disease is often mixed with flu, quinsy and even with intestinal frustration of an alimentary origin. At the differential diagnosis it is necessary to remember also retropharyngeal abscess.
Treatment: injection through a nose in a nasopharynx of vasoconstrictive and antiseptic (protargol) drops; purpose of acetylsalicylic acid and antibiotics.
Treatment of Ampere-second by the long current, in addition to use of vasoconstrictors and antibiotics, according to Moore's proposal and Kanyui (Moure, Canuyt) and A. G. Likhacheva, it is possible to make easy massaging of the edematous inflamed pharyngeal almond the finger entered into a nasopharynx on 3 — 5 sec. This reception usually leads to bystry recovery (probably, pathological products from an almond are squeezed out and blood circulation improves). Several weeks later after elimination acute And. it is necessary to make an adenotomy (see Adenoides).
Etiology. Chronic And. develops as a result of repeated acute inflammations of upper respiratory tracts.
Pathological anatomy. At chronic And. the superficial, lacunary or parenchymatous inflammation of lymphadenoid fabric can be noted. The long chronic inflammation of a giperplazirovanny pharyngeal almond (fig. 1 and 2) conducts to its sklerozirovaniye, but with preservation of considerable sites with inflammatory infiltrates.
Infection and suppuration can also develop and in grooves of a giperplazirovanny pharyngeal almond (it becomes similar to the sponge impregnated with pus).
Clinical picture. Chronic And., resulting from infection of a hypertrophied pharyngeal almond, complicates symptomatology of a disease. Inflammatory process of a nasopharynx easily extends to a throat, a throat and bronchial tubes, especially at acute katara and frequent is long the proceeding aggravations of inflammatory process of upper respiratory tracts. Flowing mucopurulent separated in a throat causes persistent reflex cough, especially at night. Submandibular, cervical and occipital limf. nodes quite often are considerably increased. Each aggravation of inflammatory process in a nasopharynx can be followed by long subfebrile temperature. The general condition of such patients is usually broken, the child becomes sluggish, loses appetite, often during meal there is vomiting.
Diagnosis it is put on the basis of a clinical picture and data of a back rinoskopiya.
For an exception of tuberculosis as possible reason of long subfebrile condition, in addition to the general inspection, it is necessary to do reactions of the Tuberculine test and Manta.
Treatment the same, as at acute A. Inogda if it is established that subfebrile temperature depends from And., it is necessary to remove adenoides, but expecting decrease in temperature. especially against the background of treatment by antibiotics. In some cases, at the long inflammatory process leading to a sklerozirovaniye of lymphadenoid tissue of nasopharynx there is a formation of commissures and crossing points in a nasopharynx — infection of a nasopharynx, a partial or full atresia of a postnaris (chronic sclerosing And.). Last form A. it is more often observed at adults at the age of 25 — 40 years. In such cases the nasopharynx happens the sclerosed cicatricial fabric executed brittle. Vigorous crush of this fabric by means of the finger entered into a nasopharynx possible to release more or less easily a postnaris and to recover nasal breath, there is a need for surgical treatment less often (removal of cicatricial membranes in the field of a postnaris and recovery of nasal breath) or radiation therapy.
Bibliography: see to St. Adenoides .
A. G. Likhachev.