Adenoids

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Adenoid or adenoid vegetations are enlargements (hypertrophies) of the lymphoepithelial tissue, i.e. the pharyngeal tonsil and the neighboring adenoid tissue, in the nasopharynx ( epipharynx ). They are the upper part of the so-called lymphatic throat ring, also called Waldeyer throat ring . The palatine tonsils ( tonsil ) and tongue tonsils also belong to it . Defense functions against bacteria and viruses are ascribed to the Waldeyer's throat ring. However, both the removal of the adenoids and the palatine tonsils have shown that the defense function is not reduced because other parts of the lymphatic ring of the pharynx that remain probably take over this function. The adenoids are popularly known as enlarged tonsils or "polyps". They have nothing to do with the polyp of the nasal passage, which usually occurs in plural.

Adenoids usually regress on their own at the end of childhood.

Symptoms

If adenoids are not enlarged, they do not cause any symptoms. If they are enlarged, they cause a variety of symptoms:

1. Impaired nasal breathing due to obstruction of the choane (rear openings of the nasal passages)

2. Mouth breathing

3. Snoring

4. Constant cold

5. Nasal ( hyponasal ) language

6. Audible noises when inhaling and exhaling

7. Infections of the upper respiratory tract with rhinitis and sinusitis ( sinusitis ) and of the lower respiratory tract with cough ( bronchitis )

8.Facial expression typical for adenoids, so-called facies adenoides with open mouth, visible tip of the tongue (popularly called stupid facial expression, which has been associated with low mental activity, aprosexia nasalis)

9. Sometimes tapering, high arched palate

10. Relocation of the mouth of the auditory tuba ( Eustachian tube ) with tympanic effusion ( serotympanum , mucotympanum ) and associated middle ear hearing loss

11. Delayed speech development associated with middle ear hearing loss

12. Breathing stops (apnea phases) during sleep

diagnosis

During a medical examination by an ENT doctor, they can be seen with a small round mirror inserted into the oral cavity that is held behind the uvula , or seen with an endoscope. To confirm the diagnosis, especially if the medical examination is difficult or impossible due to pronounced gagging, the size of the adenoids can be assessed on a lateral x-ray of the paranasal sinuses . There may also be bilateral serous or putrid nasal secretion .

surgery

By adenoidectomy , also called out peeling of the tonsils, the adenoids with a special annular knife through the oral cavity through surgically removed. It is a short, 5 to 10 minute operation under general anesthesia. In connection with this operation, a bilateral drum incision ( paracentesis ) is often made to eliminate the middle ear hearing loss , or a drum tube is placed. The operation is usually performed from the 2nd to 3rd year of life.

Risks and possible complications

  • Rarely, secondary bleeding, which may have to be stopped under anesthesia by placing a so-called Bellocq tamponade .
  • Injury to or breaking out of a tooth by the jaw spreader , which must be used to open the mouth.
  • Temporarily open nasalism.
  • Sometimes reoperation under anesthesia is necessary if the adenoids have not been completely removed and the result is profuse bleeding.

supporting documents

  • Witte: Lexicon of diseases and examinations. Georg Thieme Verlag, 2006, ISBN 3-13-142961-5 .
  • Rudolf Probst u. a .: ear, nose and throat medicine. 2nd Edition. Thieme, Stuttgart 2004.
  • T. Wilhelm, G. Hilger, K. Begall, J. Lautermann, O. Kaschke, P. Mir-Salim, T. Zahnert: S1 guideline “Adenoid vegetations / pharyngeal tonsil hyperplasia.” In: ENT. Volume 60, 2012, pp. 746-752, DOI: 10.1007 / s00106-012-2555-5 .

Textbooks

  • AK Lalwani (Ed.): Current Diagnosis & Treatment in Otolaryngology - Head & Neck Surgery. Lange Medical Books, 2004, ISBN 0-07-140237-3 , p. 574 ff.

Guidelines