Lymphatic pharyngeal ring(Waldeyer-Pirogov ring), consisting

consisting of pharyngeal, 2 tubal, 2 palatine, lingual tonsils and lymphoid

tissue of the posterior pharyngeal wall, before birth and in the first months after birth

poorly developed. In the postnatal period, the tonsils undergo a number of changes

In newborns tonsils are underdeveloped and functionally inactive. Sky

tonsils are not yet fully developed, they reveal emerging

follicles, and development takes a long time.

The main part of the lymphoid ring of the pharynx consists of 2-4 thin folds

mucous membrane of the anterior part of the tonsils, running in the sagittal plane

bones, and 6 in the back, shorter and slightly curved anteriorly,

located in the frontal plane. Presented at birth in

in the form of small spherical clusters of lymphocytes. "Reactive Centers"

CHILDREN'S ENTRY AND LARYNGOLOGY

Chapter 4

they occur in the first 2-3 months of life. Final development of the follicle

fishing ends in the first 6 months of a child’s life, and sometimes by the end of the 1st year.

The normal average size of the pharyngeal tonsil in newborns is

7x4x2 mm.

In infants active development of the lymphoid ring begins.

Differentiation of the follicles of the palatine tonsils occurs earlier, at the 5th-6th

month of life, since after birth the body immediately begins to undergo

protect against the action of bacteria and toxic substances that stimulate the formation of

tion of follicles.

Adenoids are formed more actively than other tonsils. Folds of mucous membrane

the lobes thicken, lengthen, taking on the appearance of rollers, between which

the grooves are clearly visible. Average size of tonsil: after 3 months 10x7x4 mm

and after 1 year 11x8x5 mm, the tonsil reaches full development by 2 - 3 years.

In children of the 1st year of life, the nasopharyngeal cavity is low and acute-angled, in

due to which even a slight increase in the pharyngeal tonsil can significantly

significantly disrupt nasal breathing.

Microscopic structure of the tonsils in fetuses, newborns and children

infancy is different.

U fruits cover epithelium of the mucous membrane multirow cylinder

ric. IN subepithelial layer, lymphoid tissue is located in the form

a thin strip consisting mainly of lymphoblasts, small and medium

lymphocytes. The reticular stroma is quite well defined. Krovenos

These vessels are filled with blood.

U newborns cover epithelium multirow cylindrical. Bo

There are few spores, they are shallow. IN underlying tissue diffusely located

lymphatic cellular elements such as small and medium lymphocytes, many

blood vessels and mucous glands.

Development tonsil begins with the formation of folds of the mucosa

membranes that are penetrated by lymphatic tissue.

Lingual tonsil develops due to the accumulation of lymphatic tissue in

root of the tongue.

After birth, the tonsil tissue is in a state of constant

irritation.

U children in the first half of life well-defined

follicles with clear boundaries; covering epithelium of the tonsils multilayered

ny flat, with sections of multi-row cylindrical.

U children over 6 months in subepithelial tissue is observed relatively

many mature lymphoid follicles of various sizes and shapes with good

sho pronounced “reactive centers”. They are usually located about

circle of furrows Among lymphatic cells and in connective tissue tissue

many blood vessels.

IN At an early age, the pharyngeal tonsil is covered with multi-row cylinders

ciliated epithelium, in older children and adults -

flat epithelium.

Palatine tonsils reach full development in the 2nd year of life. Lakush

palatine tonsils in young children are deep, narrow at the mouth, dense in

curly, often extending to the capsule. Lacunae do not always guide -

V

no

Diseases of the pharynx

extending into the depths of the tonsils, sometimes they turn sharply and go under the cover

ny epithelium; the narrow passages of individual lacunae end in expansions.

All this contributes to the occurrence of the inflammatory process.

In children over 5 years of age, hyperplasia of the follicles is observed, which often

they appear to be separated from the surrounding lymphatic tissue.

Tubal tonsils reach their greatest development in childhood.

Children have less lymphatic tissue in the area of ​​the tongue root than adults;

crypts lingual tonsil smaller and less branched.

In young children, between the prevertebral aponeurosis and the muscle

from the pharynx from the roof of the nasopharynx to the entrance to the esophagus between the two layers

aponeurosis arranged in a chain retropharyngeal lymph nodes And

loose connective tissue on both sides of the spine. These nodes are

are regional for the posterior parts of the nose, nasopharynx and tympanic

loss. Their suppuration leads to the formation of a retropharyngeal abscess.

In the area of ​​the nasopharynx, the retropharyngeal space is divided into two by a ligament

half, so retropharyngeal abscesses in the upper parts of the pharynx are more common

Ut one-way.

After 4-5 years, these lymph nodes atrophy, and therefore in children

In older age and adults, retropharyngeal lymphadenitis does not occur.

Young children are characterized by hypertrophy (age evolution

tion) lymphatic tissue. Enlarged tonsils are caused by hypertrophy

lymphoid follicles, as well as an increase in their number.

Tonsils reach their greatest size by 5-7 years. At this age

Children have the highest infectious morbidity and increased

need for protection against infections. IN At the same age, children spend the most

a greater number of preventive vaccinations that mobilize the entire lymphatic system

foid tissue for the production of immunity. Hypertrophy of lymphatic tissue

due to the intensive formation of active immunity with local

production of antibodies during the endo- or exogenous route of infection

tion agent into the lymphoid tissue of the pharynx.

As antibodies accumulate in the body and the immune system improves,

system after 9-10 years the child begins age-related involution of lymphoid

fabrics with its partial degeneration and replacement with fibrous, connective.

The size of the tonsils decreases, and by the age of 16-20 they are usually not retained.

large remnants, sometimes they completely disappear due to lymphoid atrophy

fabrics. During this period, a thin peripheral belt of mature ligaments appears

phocytes, the number of reticular cells in the center of the tonsils increases.

CONGENAL ANOMALIES OF THE PHARYNGE

Etiology. If fetal development is disrupted, individual elements form

that connect the pharynx and face, fuse incompletely or do not fuse at all. Possible

We have a partial absence of the soft or hard palate, clefts in the palatine arches

or soft palate, splitting of the uvula in the midline. In the pear area

prominent pockets; less commonly, diverti may develop in the area of ​​the palatine tonsils

lumps and cysts.

CHILDREN'S ENTRY AND LARYNGOLOGY

Chapter 4

Classification.

1. Congenital choanal atresia.

2. Cleft lip (“cleft lip”):

Defect one- And bilateral (on both sides of the embryonic intermaxillary

thin bone);

Defect partial (incomplete cleft of the upper lip in the form of a notch)

or full (a gap in the entire thickness of the upper lip to the nose on the side of the middle lip

Research Institute), isolated or in combination with a cleft palate (“cleft palate”).

3. Double upper lip (ridge in the middle part of the upper lip).

4. Hypertrophy of the lips due to the proliferation of connective tissue and lymph

fovenous stasis.

5. Microstoma (narrowing of the mouth opening).

6. Language anomalies:

Small or large tongue (microglossia, macroglossia);

Cleft tongue (double or additional tongue);

Bridle that is too short or long;

Complete absence of language;

Retention of the ectopic lobule of the thyroid gland in the root area

7. Congenital cysts and fistulas of the neck:

- midline cysts and neck swishes are located along the midline of the neck on

level of the hyoid bone, closely connected with its periosteum;

- lateral cysts located anterior to the sternocleidomastoid

Clinical characteristic. At congenital atresia Joan maybe so

closing the mouth of the auditory tube. This developmental anomaly is usually accompanied

there is a high palate, a short tongue, often fused from the back wall

what a throat.

The most common anomalies include congenital deformity of the upper

lips (“cleft lip”). This is the result of a non-closure of the nasal sulcus.

(went between the middle nasal and maxillary processes of the embryo!.

Unilateral clefts are more common on the left and are more common

bilateral.

Usually, at the same time as a cleft lip, a cleft forms between

lateral incisor and canine, which may be limited to the edge of the alveolar

process or spread to the hard and soft palate, forming ""<шм

fall." This pathology has the following clinical manifestations.

Dysphagia syndrome causes choking and reflux of food into the cavity

nose when swallowing, a pronounced nasal sound subsequently leads to

speech formation disorder.

Difficulties arise when the baby sucks the breast. Usually when sucking

the soft palate descends and closes the oral cavity at the back, and the cavity at the front

mouth closed action t. orbicularis oris, lengthening baby's lips, coverage

sucking nipple. With a “cleft lip” the integrity t. orbicularis oris is violated

sucking becomes difficult or impossible. Children are spoon fed

or using a zoid. Aspiration syndrome leads to the development of reciprocal

dilapidated pneumonia.

Diseases of the pharynx

During puberty ectopic part of the thyroid gland V

area of ​​the root of the tongue can cause swallowing problems (dysphagia) and

breathing (stenosis).

The child may develop articulation abnormalities due to protrusion

her (prognathia) or lower (progenia) jaw. Reasons affecting ano

The human body is unique, each organ has its own function, the failure of one of them leads to disruption of the functions of most, and in some cases, all anatomical structures. The work of organs can be compared to the mechanism of a watch; one tiny part breaks and the watch stops running, which is why the human body works on the same principle. One of the organs responsible for two vital processes in the body at once is the pharynx. Its main functions are respiratory and digestive functions.

Structure of the pharynx

The pharynx has a simple structure; it is a funnel-shaped tube that originates from the cervical vertebra and descends down to the esophagus to the 5-7 vertebrae. The size of the pharynx varies from 12 to 16 centimeters. The organ consists of muscles, mucous membrane and lymphoid tissue. The cylindrical tube is separated from the vertebra by soft tissue, which allows the organ to be mobile. The main features of the structure of the pharynx are that until the swallowing function is activated, the airways are open, and at the moment of swallowing food, the larynx blocks breathing so that the food is directed into the esophagus and not the lungs.

In addition, the pharynx has a lot of lymphoid tissue, which allowed it to form tonsils in the mouth. The tonsils serve as so-called guardians at the entrance to the pharynx; they have immune cells that block the entry of microbes into the larynx and down the respiratory tract.

The structure of the pharynx has three sections:

• The nasopharynx is the section that is connected between the nose, mouth and larynx;
• The oropharynx is a continuation of the nasopharynx. This section is separated from the oral cavity by the soft palate, palatine arches and dorsum of the tongue;
• laryngopharynx, this department originates approximately in the area of ​​4 vertebrae (age-related features may be noted). The larynx is located in this section, consists almost entirely of muscles and is a conductor of food to the esophagus.

The structure of the organ implies age-related changes. So, in an infant, the length of the pharynx is about three centimeters; in the first two years of life, the size doubles, and in an adult this parameter is 12-16 centimeters. Also, the lower edge of the organ, due to the increase in size, moves downward. In a newborn, the end of the pharynx is located in the region of the 3-4 cervical vertebrae, and by adolescence, the lower edge is located at the level of 6-7 vertebrae. Age-related changes also occur in the pharyngeal opening of the auditory tube. In childhood it has the shape of a slit, and during the period of growing up it acquires an oval shape. Due to this age-related feature, children are more susceptible to stenosis and the development of asphyxia, since the lumen of their larynx is very narrow; any inflammatory process in the organ leads to swelling and blockage of the lumen, which is accompanied by impaired respiratory function.

Tonsils also undergo age-related changes, with their peak growth occurring before the age of two years. In the period of 12-14 years, reverse development occurs, that is, the lymphoid tissue decreases slightly in size. After this period, age-related changes in the tonsils no longer occur.

Functions

So, respiratory and digestive functions have been said, but in addition to these two important processes, there are
more. The speech function, the ability to pronounce sounds in a person, appears thanks to the vocal cords located in the middle part of the larynx, and the soft palate also participates in this process. Due to the muscle layer and mobility, the anatomical structure allows for the correct distribution of air flow, while creating the timbre of the voice. If the soft palate has some anatomical changes in its structure, this leads to impaired vocal function.

And the pharynx has one more function - protective. The process is made possible thanks to lymphoid tissue, which contains immune agents and a specific mucosal coating on the posterior wall. This wall is covered with mucus with tiny villi, which in turn also trap incoming dust and bacteria so that they do not spread to the larynx and further. That is why quite often inflammatory processes occur in the throat; the infection lingers here, without going lower, and causes symptoms of a cold.

Diseases of the pharynx and larynx

There are a number of pathological processes that can cause problems in the functioning of the larynx and pharynx. The main diseases of this organ include:

The pharynx is an important organ in the human body that undergoes age-related changes throughout life and performs its unique and vital functions, such as breathing, swallowing, speech and defense. The organ is susceptible to various diseases that negatively affect its functions, and therefore require attention from medical personnel and appropriate treatment. For any changes in the normal functioning of the larynx or pharynx, you should consult a doctor and not self-medicate, otherwise even a minor illness can cause serious complications.

The cavity that connects the nasal passages and the middle part of the pharynx is the nasopharynx. Anatomists simultaneously attribute it to the upper respiratory tract and the beginning of the digestive tract. Because of this location, it is indispensable in the body and is often susceptible to various diseases.

Human structure

The upper part of the pharynx is conventionally divided into the following subsections:

• upper;
• intermediate;
• lower.

For convenience, anatomists and otorhinolaryngologists distinguish the organs of the oropharynx, nasopharynx and pharynx itself.

Anatomy of the nasopharynx

It is connected to the passages of the nose through small oval openings - the choana. The structure of the nasopharynx is such that the upper wall is in contact with the sphenoid bone and the occipital bone. The back of the nasopharynx borders the vertebrae of the neck (1 and 2). In the lateral ones there are openings of the auditory (Eustachian) tubes. The middle ear connects to the nasopharynx through the auditory tubes.

The muscles of the nasopharynx are represented by small branched bundles. The nasal mucosa contains glands and goblet cells that are responsible for producing mucus and humidifying the inhaled air. The structure also determines that there are many vessels here that help warm the cold air. The mucosa also contains olfactory receptors.

The anatomy of the nasopharynx in newborns differs from that in adults. In a newborn baby, this organ is not fully formed. The sinuses grow quickly and become the usual oval shape by the age of 2 years. All departments have been preserved, but the implementation of some functions is impossible at this moment. The muscles of the nasopharynx in children are less developed.

Oropharynx

The oropharynx is located at the level of the 3rd and 4th vertebrae of the neck, limited only by two walls: the lateral and the posterior. It is designed in such a way that it is at this point that the respiratory and digestive systems intersect. The soft palate is separated from the oral cavity by the root of the tongue and the arches of the soft palate. A special mucous fold serves as a “flap” that isolates the nasopharynx during the act of swallowing and speech.

The pharynx has tonsils on its surfaces (upper and lateral). This accumulation of lymphoid tissue is called: pharyngeal and. Below is a cross-section of the pharynx, which will help you better imagine what it looks like.

Facial sinuses

The structure of the skull is such that in the front part there are sinuses (special cavities filled with air). The mucous membrane differs little in structure from the mucous cavity, but it is thinner. Histological examination does not reveal cavernous tissue, while the nasal cavity contains it. The average person's sinuses are filled with air. Highlight:

• maxillary (maxillary);
• frontal;
• ethmoid bone (ethmoid sinuses);
• sphenoid sinuses.

At birth, not all sinuses are formed. By 12 months, the last sinuses, the frontal ones, finish forming. The maxillary sinuses are the largest. These are paired sinuses. They are located in the upper jaw. Their structure is such that they communicate with the passages of the nose through an exit under the lower passage.

The frontal bone has sinuses, the location of which determines their name. The frontal sinuses communicate with the nasal passages through the nasofrontal canal. They are paired. The sinuses of the ethmoid bone are represented by cells that are separated by bone plates. Vascular bundles and nerves pass through these cells. There are 2 such sinuses. Behind the superior concha of the nose, the sphenoid sinus is located. It is also called the main one. It opens into a wedge-ethmoid recess. She is not a couple. The table shows the functions performed by the paranasal sinuses.

Functions

The function of the nasopharynx is to bring air from the environment to the lungs.

The structure of the nasopharynx determines its functions:

1. The main function of the nasopharynx is to conduct air from the environment to the lungs.
2. Performs an olfactory function. It generates a signal about the arrival of the smell in the nasal part, the formation of an impulse and its conduction to the brain thanks to the receptors that are localized here.
3. It performs a protective function due to the structural features of the mucous membrane. The presence of mucus, hairs and a rich blood network helps clean and warm the air, protecting the lower respiratory tract. Tonsils play an important role in protecting the body from pathogenic bacteria and viruses.
4. It also implements a resonator function. The sinuses and vocal cords, located in the pharynx, create sound with a different timbre, which makes each individual special.
5. Maintaining pressure in the cranium. By connecting the ear to the external environment, the nasopharynx allows you to maintain the necessary pressure.

Possible diseases

It is susceptible to various diseases due to its location and its functions. All diseases can be divided into groups:

• inflammatory;
• allergic;
• oncological;
• injuries.

Table of diseases.

Diseases	Symptoms	Predisposing factors
Inflammatory	1. Deterioration of general condition, malaise, weakness, fever.	1. Hypothermia.
	2. Sore throat.	2. Reduced immunity.
	3. Redness of the throat, enlarged tonsils.	3. Contact with sick people.
	4. Sore throat.	4. Being in a large crowd of people during the high morbidity season.
	5. Congestion, nasal discharge.
Allergic	1. Itching.	1. Contact with an allergen.
	2. Redness.	2. Burdened heredity.
	3. Nasal discharge.	3. History of allergic reactions.
	4. Sore throat.	4. Flowering season.
	5. Watery eyes.
Oncological	1. Presence of a neoplasm.	1. Burdened heredity.
	2. Difficulty breathing.	2 Smoking.
	3. Difficulty swallowing.	3. Contact with a source of gamma radiation (work in an X-ray room, etc.).
	4. Drastic weight loss of more than 7-10 kg per month.
	5. General malaise, weakness, enlarged tonsils and lymph nodes.
	6. Temperature around 37°C for more than 2 weeks.
Injury	1. Sharp pain.	1. History of trauma.
	2. Bleeding.
	3. Crepitation of bones.
	4. Swelling of the affected area.
	5. Redness of the affected area.

ENT > Children's ENT diseases > How to remove snot from a child's nasopharynx: basic methods

Quite often, snot accumulates in the nasopharynx in children, which causes difficulty breathing, moodiness, etc. In any case, no matter what caused their appearance, the snot needs to be removed.

Causes of snot in the nasopharynx

There are many reasons why a child suddenly begins to accumulate snot in the nasopharynx.

These include:

• Infection. In this case, pathogenic bacteria and microbes enter the body, which begin their destructive effect. And the body’s defensive reaction is precisely snot, which begins to be released more and more in order to protect the mucous membrane.
• Unsuitable conditions. Sometimes children, if the room is very dry or, conversely, very humid, may develop snot. Moreover, it will be transparent in color and flow constantly. Or it may simply stagnate somewhere inside, causing nasal congestion.
• Vascular reaction. Some children have a peculiar vascular reaction to certain stimuli. So, for example, if we talk about infants who eat formula, then sometimes mucus comes out of their nose during feeding.
• Allergy. Today, many children suffer from allergies. The reason for this is poor environmental conditions, as well as heredity. For allergies. The child has clear and slightly runny mucus flowing from his nose. At the same time, the baby scratches his nose, constantly sneezes, and his eyes may become swollen.
• The child hit his nose. Sometimes, due to injury, the nasopharyngeal mucosa swells a little, causing mucus to be released.
• A foreign object has entered the nose, and the body thus tries to push it out and defend itself.
• Deviated septum. For certain reasons, some children have a deviated septum from birth. This can only be detected by a specialist after conducting an examination, during which he will notice that one nasal passage is narrower than the other.
• Persistent runny nose. namely, the constant use of vasoconstrictor drops. Most medications of this type are highly addictive, which is why mucus begins to be released.

Read also: Conservative treatment of adenoids in children: symptoms of the disease and basic principles of treatment

There are many reasons for the appearance of mucus in the nasopharynx. But the main thing is to remove it in time, as it causes great discomfort to the baby.

The frequent appearance of mucus in the baby's nasopharynx forces parents to think about how to remove it without constantly resorting to medications and antibiotics. In the event that the appearance of mucus is caused by a simple runny nose (not bacterial) or simply by pollen getting into the nose, then in this case you can resort to rinsing the nose.

It is believed that for children it is best to use medicines made from sea water, such as Aqua Maris and Aqua Lor. But their cost sometimes prevents some parents from purchasing drugs frequently.

In the case of Aqua Lor and Aqua Maris, there are different types that differ from each other in the intensity of the jet flow. Depending on the age of the child, one type or another should be selected. Washing should be done at least four to five times a day. If you do it more, then on the contrary it will be better.

Salt water, in addition to promoting the removal of mucus, moisturizes the mucous membrane and also slightly disinfects it.

If it is not possible to go and buy one of these drugs at the pharmacy, then you can buy Essentuki 17 mineral water, which is approximately the same in composition as Aqua Maris. Before flushing, you need to release the gases. After this, take a pipette, fill it with mineral water, and drop it into the baby’s nose. After a few minutes, water will flow from the nose, and the mucus will come out with it.

Useful video on how to properly apply nose drops to a baby.

For those who do not have the physical opportunity to go to the pharmacy (for example, you are alone at home with a child), you can take a teaspoon of salt and mix it with a glass of boiled water. Rinse with this solution. It is believed that rinsing the nose with salt water contributes not only to better removal of mucus, but also to a speedy recovery.

Read also: Acute pharyngitis in children: developmental features and various treatment methods

Inhalations in the fight against snot

Another very good method to remove mucus from the nasopharynx is inhalation. It is advisable to do this only if you have an inhaler and saline solution at home.

It is best to inhale three times a day (after sleep, before naps and at night). If the child does not resist and likes this procedure, then it is better to do it one or two more times. There will be no harm, but there will be a lot of benefit.

Some doctors say to do inhalations with interferon, but only when it is a viral disease, and in addition to removing mucus, you also need to help the body fight the infection.

If the accumulation of mucus is caused by a bacterial infection, then inhalation is not recommended.

Allergic rhinitis: causes and treatment

One of the most common reasons why mucus accumulates in a child's nose is an allergic reaction. Some children react to dust mites. It sounds a little scary, but this only happens if the bed has not been changed for a long time. In children, the nose immediately begins to become stuffy and runny.

Also, mucus appears when flowers bloom and from simple dust.

Whatever causes the mucus, it must be removed urgently, as the swelling can spread further. It is best not to resort to vasoconstrictor drugs, since their frequent use can be addictive.

First of all, you need to remove the allergen, and then give the child an antihistamine.

At the same time, rinse the baby’s nose with salt water to remove allergen particles. Typically, these activities help remove mucus from the nasopharynx.

Drug treatment of snot in the nasopharynx

Treatment with drugs

Read also: How to treat a very red throat in a child - medicines and folk remedies

If we are talking about a common runny nose, then it will not be possible to remove mucus from the nasopharynx in the first days. Sometimes a runny nose in children begins with simple congestion, and during an examination by a doctor it turns out that mucus is flowing down the nasopharynx.

In this situation, it is necessary to carry out the same treatment as if mucus is leaking from the nose, because the infection needs to be treated. The child is allowed to drip vasoconstrictor drops twice a day for three days (to make the effect of other medications better and make breathing easier), antiviral drops or antibiotics (in some cases it is better to immediately start dripping with antibiotics, especially when the snot is thick and cannot be blown out ).

Before using any drops, you should rinse your nose with salt water to remove mucus and germs. This should be done as often as possible.

After three days of intensive treatment, the amount of mucus will decrease, but now you need to blow your nose.

How and how to treat inflammation of the nasopharynx?

If the child does not know how to do this, then you need to buy Otrivin Baby and do it for him. It is also better to rinse your nose with water before blowing your nose.

Quite often, mucus accumulates in the nose of infants. And since they cannot breathe through their mouths, this can be very dangerous. To clean the nose, you need to take cotton wool, smoke a flagellum from it and lubricate it with oil, and then clean it with light and not strong rotational movements. Experienced parents very quickly remove mucus from the baby’s nasopharynx, since they know exactly in which case which drug or method should be used.

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There are 8 tonsils in the human body, which are located in the mouth, nose and pharynx. The tonsils are “stuffed” with immune cells, so their main role is to create a barrier to pathogenic bacteria trying to enter the body. One of the tonsils (the third pair) is nasopharyngeal and is a collection of lymphoid tissue, which is located behind the nose behind the tongue hanging from the palate, passes a stream of air through it when inhaling and cleanses it of germs, allergens, viruses and other foreign agents.

Adenoids are a pathological hypertrophy (proliferation) of the nasopharyngeal tonsil. The third pair of tonsils is very well developed in childhood, and with age, from about 12 years old, it begins to decrease. In some adults, the nasopharyngeal tonsil is completely atrophied. The high percentage of adenoids in children aged 3-10 years is associated with age-related characteristics. But adenoids are possible both in adolescents, during puberty, and in adults.

Reasons

There are 5 main reasons that lead to the development of adenoids in childhood:

Frequent ARVI
Typically, a child living in a large city and attending child care facilities suffers from colds no more than 6-8 times a year.

When pathological microflora enters the nasopharynx, the upper respiratory tract is affected (rhinitis, tracheitis, pharyngitis). In response to this, the nasopharyngeal tonsils enlarge, as they begin to actively produce protective immune cells.

After ARVI subsides, the tonsils return to their previous size. But if a child gets sick often, then the tonsils do not have time to shrink. A new infection is the proliferation of lymphoid tissue.

Weakened immunity
Outwardly, the child looks healthy, and parents may not be aware of the presence of a persistent “walking” infection in his body. These can be herpes or Epstein-Bar viruses, chlamydia, mycoplasma, lamblia and others.

All of these infections often occur hidden and undermine the body’s defenses, which provokes hypertrophy of the nasopharyngeal tonsils.

Photo: localization of adenoids

Allergy
Currently, there is a tendency towards an increase in children with allergies. This is due to the disturbed environment, potentially dangerous compounds contained in household chemicals, preservatives, and so on.

Allergens, as well as pathogenic microbes, cause the proliferation of adenoids.

Heredity
Polylymphoadenopathy - the proliferation of lymphoid tissue in many parts of the body is a constitutional feature and is inherited.

Degrees

There are three degrees of severity of adenoids depending on the percentage of proliferation of lymphoid tissue and the clinical picture:

• first degree - proliferation of the third pair of tonsils and blocking of 33% of the opening communicating with the nasopharynx;
• second degree - covering 66% of the opening by adenoids;
• third degree - almost the entire hole is closed, about 99%.

Symptoms of adenoids

The first characteristic sign of adenoids is difficulty breathing through the nose, which is completely unrelated to ARVI or trauma to the nose.

• In the first (mild) degree, difficulty in nasal breathing during sleep is especially noticeable when the child takes a horizontal position. He begins to sniffle in his sleep.
• In the second degree, the child begins to snore at night, breathes through his mouth, and mucus from the nose flows into the throat.

  The child's nasopharynx is swollen

  Sleep is disturbed, the baby does not get enough sleep, becomes irritable and capricious. It is possible to stop breathing during sleep (apnea).

• In the third degree, the nose does not completely allow air flow, as a result of which the child is forced to breathe through the mouth not only at night, but also during the day. He develops an “adenoid” face: the nasolabial folds are smoothed out, the mouth is slightly open, the gaze becomes uninformed, the lower jaw droops.

In severe cases, the constant flow of mucus under the baby's nose causes the skin to become irritated and inflamed, which later forms eczema. Hearing problems appear, infection from the adenoids spreads to the middle ear, and children hear poorly.

The child begins to study worse, perceives the material poorly, and is unable to concentrate. And, of course, a child with adenoids often has colds, from which he does not “climb out.”

Diagnostics

Diagnosis of adenoids is carried out on the basis of characteristic complaints, examination of the posterior wall of the oropharynx with a special mirror and additional methods:

• Finger method. Currently not applicable. The doctor touches the nasopharyngeal tonsils with a finger through the mouth, based on which he makes a conclusion about their enlargement.
• X-ray of the nasopharynx. It provides information only about the enlargement of the tonsils, but does not allow us to judge the presence of an inflammatory process in them.
• Endoscopy. A small diameter tube with a video camera at the end is inserted through the nose, and the adenoids are displayed on the monitor. The endoscopic method makes it possible to determine their size, location, and overlap of the openings of the auditory tubes. This is the most informative, safe and painless examination.

Examination before surgery (adenotomy):

• general blood and urine tests;
• biochemical blood test;
• blood for clotting;
• pediatrician consultation.

Treatment of adenoids

Adenoids are treated by an otorhinolaryngologist (ENT). Treatment can be conservative and surgical. The decision on surgical intervention is made taking into account the severity, severity of symptoms, the presence of concomitant pathology and contraindications.

Conservative therapy

Conservative treatment of adenoids consists of regularly washing the nasopharynx with decoctions of medicinal herbs (infusion of calendula, chamomile, celandine, mint, St. John's wort, eucalyptus leaves and others) or saline solutions (sea salt is used).

After rinsing, it is necessary to instill medicinal preparations into the nose that have anti-inflammatory and drying effects (solutions of protargol, collargol, albucid).

Glucocorticoids (dexamethasone) are also prescribed, which help relieve swelling and shrink the adenoids.

It is necessary to take vitamins: ascorbic acid, ascorutin, vitamin D.

Physiotherapy is carried out (UV irradiation of the nasopharynx, electrophoresis with drugs, laser therapy).

Aromatherapy has a good effect. If there are no results from conservative treatment, the issue of surgery is decided.

Adenoid removal surgery

Indications:

• lack of effect from conservative therapy;
• relapse of the disease 4 or more times a year;
• development of complications;
• apnea;
• frequent otitis and ARVI.

Contraindications to adenotomy:

• blood diseases;
• infectious diseases 4 weeks before surgery;
• influenza epidemic;
• severe cardiovascular pathology.

Surgical removal of adenoids is currently performed endoscopically under general anesthesia.

Not so long ago, adenotomy was performed blindly, which led to relapse of the disease in half of the cases. Under the control of a video camera inserted into the nasopharynx, growths of lymphoid tissue are cut off, and bleeding vessels are cauterized with a laser, liquid nitrogen or electric current.

After surgery

The child is in the hospital for 1-3 days, and then at home for 10-14 days.

On the first or second day, a rise in temperature and abdominal pain is possible. This is a reaction to surgery.

Vomiting blood clots once or twice is not a dangerous symptom (the child may have swallowed blood clots during surgery).

Consequences and prognosis

The prognosis for adequate and timely treatment of adenoids is favorable.

However, the consequences of adenoids in children are terrible, and are observed in advanced cases (at the third stage):

Chronic inflammatory diseases of the upper respiratory tract

As a result of the fact that unpurified air enters the body plus the constant ingestion of infected mucus and pus from adenoids, the child develops

The listed diseases can become a trigger point in the development of bronchial asthma.

Hearing impairment

The nasal cavity communicates with the middle ear cavity through the auditory tube. The overgrown lymphoid tissue of the adenoids blocks the opening of the auditory tube in the nose, which makes it difficult for air to penetrate into the middle ear. Because of this, the eardrum loses elasticity and becomes immobile—hearing decreases. Cases of otitis media (inflammation of the middle ear) are also common.

Decline in school performance

Difficult nasal breathing leads to a lack of oxygen, as a result of which cerebral circulation suffers. The child becomes inattentive, absent-minded, has difficulty concentrating and remembering. Sleep disturbance (drowsiness during the day, constant fatigue) also plays an important role in this. Possible mental retardation, enuresis (bedwetting).

Changes in the facial skeleton and chest

Due to impaired breathing, a “chicken” breast is formed - a chest that is flattened from the sides and a protruding sternum. The skull has a dolichocephalic shape, the lower jaw elongates and droops. A sloping chin is characteristic. An incorrect bite is formed, the teeth begin to grow crookedly, which also contributes to their caries.

Digestive tract problems

Constant ingestion of infected mucus leads to inflammation of the gastric and intestinal mucosa (gastritis and enteritis).

Speech disorders

Changes in the bones of the facial skull lead to a decrease in the mobility of the soft palate, and, as a result, to the formation of incorrect and incomprehensible sounds.

Other chronic diseases

Against the background of adenoids, the palatine tonsils are often affected (chronic tonsillitis), hypertrophied nasopharyngeal tonsils become inflamed (adenoiditis), the process can also involve joints, kidneys, blood vessels (vasculitis), the cardiovascular system, and anemia usually develops.

Adenoiditis

Adenoid growths (vegetations) are a pathological enlargement of the nasopharyngeal tonsil.

Occurs mainly in childhood. In children with enlarged adenoids, nasal breathing is difficult, which is caused by mechanical obstruction and chronic inflammation of the nasal mucosa. Characteristic signs of adenoiditis in a child are a constantly half-open mouth, snoring during sleep, and frequent headaches. Such children quickly tire under physical and mental stress and lag behind in physical development. The face becomes puffy, the lower lip droops. “Adenoid” children are absent-minded, often suffer from urinary incontinence, tongue-tiedness, and their sense of smell is reduced.

Adenoiditis: acute and chronic

Adenoiditis is an inflammatory disease of an enlarged pharyngeal tonsil. Most often occurs in children of preschool and primary school age. Inflammation proceeds similarly to the inflammatory process in the tonsils during tonsillitis. Long-term chronic adenoiditis, like tonsillitis, can lead to severe complications and spread of infection to the kidneys, heart, blood vessels, joints and other organs.

Causes of adenoiditis

The following factors predispose to the development of adenoiditis: artificial feeding of a child, monotonous, predominantly carbohydrate diet, the presence of rickets (vitamin D deficiency), diathesis, allergies, hypothermia, environmental factors, for example, prolonged exposure to places with dry, polluted air. Acute adenoiditis develops in young children due to activation of the microbial flora of the nasopharynx under the influence of hypothermia or as a complication of any infectious disease.

Adenoiditis in children.

Snot in the nasopharynx: in children and adults. Causes and treatment

Symptoms

The clinical picture of acute adenoiditis is characterized by the appearance of mucopurulent discharge from the nasopharynx - it flows down the back wall of the pharynx and is visible upon examination, increased body temperature, and difficulty in nasal breathing. Very often, with acute adenoiditis, the eustachian (auditory) tube is involved in the inflammatory process, which is manifested by congestion, ear pain and hearing loss.

Chronic adenoiditis is a consequence of acute inflammation of the adenoids. Manifestations of the disease: slight increase in body temperature (low-grade fever), retardation of the child in mental and physical development, increased fatigue, poor performance at school, impaired attention, drowsiness along with poor sleep, headache, decreased appetite, night cough in a child (due to purulent discharge from the inflamed tonsil draining down the back wall of the pharynx). Chronic adenoiditis is often accompanied by chronic eustachitis, which is accompanied by progressive hearing impairment.

Diagnostics

The diagnosis of acute and chronic adenoiditis is made by an otorhinolaryngologist!

Adenoiditis in children treatment

To remove infectious pathogens from the surface of the nasopharyngeal tonsil and reduce the volume of the adenoids, it is necessary to rinse both halves of the nose with sterile sea water (Aqualor Baby, Aqualor Soft, Aqualor Norm, Aqualor Mini) daily 3 times a day.

After rinsing, if there is severe nasal congestion and severe disruption of nasal breathing, you can drop vasoconstrictor drops into the child’s nose (they relieve swelling of the mucous membrane and restore nasal breathing). Place 1-2 drops in each nostril. Treatment with vasoconstrictor drugs should not last longer than 5-7 days, since their longer use can lead to the development of serious complications (one of them is the development of a “medicated” runny nose in a child, which is very difficult to get rid of in the future). The decision to prescribe vasoconstrictor drops is made by an ENT doctor!

For chronic adenoiditis, antiallergic drugs are prescribed. The dosage of drugs depends on the age of the child and is determined by the doctor.

It is mandatory for chronic adenoiditis to take children's vitamin-mineral complexes, which help strengthen general immunity and reduce the number of exacerbations.

An important component of adequate treatment of adenoiditis is a balanced diet. It is necessary to exclude from the patient’s diet all foods that are potential allergens: chocolate, cocoa, etc. It is recommended to increase the consumption of fresh fruits, vegetables, berries, and exclude easily digestible carbohydrates from the diet (semolina, fresh baked goods, confectionery).

Outdoor games, swimming in the pool and open water, as well as breathing exercises are recommended. In acute adenoiditis, it prevents the disease from becoming chronic; in chronic adenoiditis, it helps maintain nasal breathing and prevent the development of hypertrophy of the pharyngeal tonsil (adenoids). In case of an acute process, breathing exercises should be started during the recovery period, in a chronic case - in the interval between exacerbations of the disease.

Exercise 1. Starting position: sitting or standing. Inhale and exhale slowly through one nostril, then inhale and exhale through both nostrils, then inhale through the right nostril, exhale through the left, then inhale through the left nostril, exhale through the right, then inhale through the nose, exhale through the mouth. When performing the exercise, the child either closes one nostril one by one, or is helped by an adult. After performing this exercise, the child sits (stands) quietly for some time, and the adult massages his nostrils - while inhaling, runs his index finger along the nostrils, while exhaling, taps his nostrils with his index fingers.
Exercise 2. Inflate balloons or inflatable toys.
Exercise 3. Exercise "gurgling". Take a bottle or deep plate, immerse a rubber tube about 40 cm long with a hole 1 cm in diameter into it, and put the other end of the tube in the child’s mouth. The child should inhale through his nose and exhale through his mouth (“gurgle”). The duration of the exercise is 5 minutes. It is performed daily for several months.

Sore throat in a child: how to treat it

Nasopharyngeal tonsil: adenoids, adenoiditis, allergic rhinitis Clinic. The first and main signs of adenoids (hyperplasia of the nasopharyngeal tonsil) are difficulty in nasal breathing and sleeping with your mouth open. The degree of nasal breathing impairment depends on the size, shape and structure of the adenoids, the ratio of their volume to the size of the nasopharyngeal cavity, as well as accompanying inflammatory changes - adenoiditis. Significant difficulty in nasal breathing leads to mouth breathing, insufficient hydration, warming and purification of inhaled air, constant cooling of the mouth, pharynx and lower respiratory tract. The mass of microbes and dust particles inhaled during mouth breathing settles on the mucous membrane of the larynx and trachea, leading to colds, frequent sore throats, pharyngitis, diseases of the bronchi and lung tissue. Adenoid vegetations (AV) during sleep can increase due to venous stasis and cause severe impairment of respiratory function, including respiratory arrest due to intermittent obstruction of the upper respiratory tract - obstructive sleep apnea syndrome. Therefore, children with adenoids often sleep with their mouths open, restlessly, and often snore; the saliva flowing from the open mouth wets the pillow. Often, in children with adenoids and adenoiditis, mucus flows from the nasopharynx into the oropharynx and laryngopharynx, which leads to a persistent cough. The inflammatory process often spreads into the nasal cavity, forming rhinitis, sinusitis with copious nasal discharge, irritating the skin of the vestibule of the nose and upper lip, which becomes hyperemic, thickened, and covered with cracks. A similar condition can be noted during an exacerbation of allergic rhinitis (AR). Difficult nasal breathing caused by adenoids and adenoiditis often leads to impaired ventilation of the paranasal sinuses with the development of chronic inflammation. Difficulty in nasal breathing with adenoiditis leads to venous congestion in the meninges, memory impairment and decreased intelligence. At the same time, children experience poor sleep with night terrors, dreams, snoring, with episodes of motor restlessness, nocturnal enuresis (due to increased carbon dioxide levels and insufficient oxygen in the blood, which leads to relaxation of the sphincters). Difficulty in nasal breathing and limited mobility of the soft palate due to impaired blood circulation in it, as well as changes in the volume of the upper resonators (nasopharynx, paranasal sinuses) cause a violation of speech function, called rhinolalia clausa posterior. At the same time, children have difficulty pronouncing nasal consonants; their speech is muffled and abrupt. Children with adenoids who breathe through the mouth are in a state of constant oxygen starvation. Their chest is narrower and flattened laterally, the sternum is protruded forward (“chicken breast”). Many authors point to the connection of adenoiditis with diseases of the middle ear. This relationship is based on mechanical blockage of the auditory tube or compression of its pharyngeal opening by adenoid growths. Frequent otitis media, caused by chronic adenoiditis, can lead to hearing loss, which will affect the child’s speech development. Chronic inflammation of the pharyngeal tonsil (adenoiditis) causes intoxication, sensitization of the body, disrupts the protective abilities of the mucous membrane of the upper respiratory tract, and contributes to the emergence and development of local and general diseases. Chronic adenoiditis is characterized by symptoms of intoxication - general weakness, low-grade fever, dysfunction of the cardiovascular system; local changes (impaired nasal breathing, mucopurulent discharge from the nose, a strip of mucus along the back wall of the throat), a disorder of the nervous system (irritability, restless sleep, enuresis). Diagnostics hyperplasia of the nasopharyngeal tonsil (adenoids of degree II–III) is based on the data of the clinical picture (see above) and endoscopic examination of the nasopharynx, in which adenoid tissue of varying degrees of size can be seen with the usual pink color of the surface, lacunae are visible. With adenoiditis, endoscopic examination of the nasopharynx demonstrates lymphoid tissue of the nasopharyngeal tonsil with mucopurulent contents in the lacunae, on the surface of the tonsil and the posterior wall of the pharynx. Diagnosis of allergic rhinitis and adenoiditis is carried out jointly with an allergist. During an otorhinolaryngological endoscopic examination, the nasal mucosa is pale, and there is clear mucous discharge in the nasal passages. The surface of the nasopharyngeal tonsil is pale, swollen, and increased in volume. Immunological blood tests are characterized by an increased content of IgE, both general and type-specific. On the recommendation of an allergist, skin prick tests with antigen can be performed. Before proceeding to the treatment of pathology associated with the nasopharyngeal tonsil, it is necessary to highlight a number of fundamentally important facts: The pharyngeal tonsil is one of the structurally formed accumulations of the so-called lymphoid tissue associated with mucous membranes, and takes part in the mechanisms of immune defense. Just like other formations of the lymphopharyngeal ring, the pharyngeal tonsil, together with nonspecific protective factors (mucociliary transport, production of lysozyme, interferon, etc.) performs the barrier function of the mucous membranes of the upper respiratory tract. Due to the high role of the lymphoid tissue of the pharynx in the formation of the body’s immunological defense, today the indications for surgical treatment of lesions of the palatine and pharyngeal tonsils are significantly narrowed, and priority is given to conservative therapy. In addition, it is necessary to take into account that, according to different authors, the rate of postoperative AV recurrences ranges from 5 to 75%. This is facilitated by insufficiently complete removal of the AV during surgery, features of the anatomical structure of the skull and nasal pharynx, infection of the lymphoid tissue and, most importantly, allergies. Children suffering from allergic diseases of the respiratory tract (allergic rhinitis, bronchitis, bronchial asthma) often experience an increase in the volume of the pharyngeal tonsil due to allergic edema. Surgical treatment gives a very short-term result and leads to a rapid relapse of the disease or, as noted by many authors, can lead to attacks of bronchial asthma if it did not exist before. Adaptive reactions of the immune system are a long-term process that is determined by the gene regulation of its development and interaction with environmental factors. The lymphoid organs of the pharynx of a young child respond to the respiratory antigenic load (viruses, bacteria, etc.) with significant hyperplasia. Pathogens can persist for a long time in lymphoid formations. This is typical for persistent viral infections (intracellular pathogens, herpes viruses, etc.). The presence of intracellular pathogens (viruses) allows secondary bacterial infections to form. The combined pathogenic flora “virus + microbe” determines the recurrent and chronic course of the inflammatory process. Scientific publications show that in conditions of infection of certain types of viruses in the lymphoid formations of the pharynx (palatine tonsils), the immune response has its own characteristics and is characterized by the absence of activation of humoral defense. On the mucous membrane of the upper respiratory tract, there is no increase in the production of secretory antibodies IgA (slgA), IgA, IgM, IgI, but hyperproduction of IgE (reagin antibodies) occurs. Treatment: Elimination- irrigation therapy is an important component of complex therapy for inflammation in the nasal cavity, sinuses, and nasopharynx. Its goal is the mechanical removal of mucus, which, under conditions of inflammation and disruption of mucociliary transport, allows mucus containing many components of inflammation (microorganisms, destroyed cells with released aggressive components, etc.) to be washed off from the surface of the epithelial layer. All of these mucus components can enhance the destruction of epithelial cells and maintain inflammation. Without restoring mucociliary transport, it is difficult to obtain the full effect of a drug administered to the mucous membrane. The choice of preparations for rinsing with moistening of the mucous membrane of the nose and pharynx is quite wide: Salin 0.65% (NaCl solution), preparations based on sea water Aquamaris, Physiomer, Marimer, Aqualor. A device and composition for rinsing the nose Dolphin has been developed. Antiviral treatment. There are few drugs that directly affect the virus. Basically, targeted etiotropic treatment is possible for herpes viral infections and influenza. The following drugs have been developed and are used for the treatment of diseases caused by herpes viral infection: acyclovir (dose for adults 200 mg every 4 hours, for children under 2 years old - 1/2 adult dose, course duration 7-10 days), valocyclovir (Valtrex ) 500 mg 3 times a day. Antiviral treatment is carried out during the acute period of the disease or during relapse. In a latent state, a persistent virus is inaccessible to medications. In the complex therapy of viral infections, immunomodulatory drugs play an important role. In the acute period of the disease, human leukocyte interferon (IFN) can be used. Of the recombinant IFNs, the most popular is Viferon - recombinant IFN-a2b with antioxidants - vitamins C and E. The drug is highly effective in the acute period of a viral disease. In the treatment of persistent viral infection in a latent state, the use of bacterial lysates on the mucous membrane of the nose (IRS-19), pharynx (Imudon), etc., as well as interferonogen inducer drugs, is indicated. In particular, there is positive experience in the use of systemic immunomodulators - imunorix, bronchomunal, ribomunil, cycloferon, etc. Antibacterial drugs. Their use in classical dosages is indicated for acute adenoiditis with the corresponding clinical picture: severe temperature reaction (more than 38°C), severe limitation of nasal breathing, mucopurulent discharge on the back wall of the pharynx. Aminopenicillins (amoxicillin), cephalosporins (cefuroxime axetil, cefixime, ceftibuten, etc.), macrolides (azithromycin, clindamycin, etc.) are prescribed. In pediatric practice, soluble forms of Solutab drugs, as well as suspensions and syrups, are preferred. Experience is accumulating in the treatment of recurrent and chronic forms of adenoiditis with low doses of macrolides. The explanation for the positive effect of long-term antibiotic therapy lies in the immunomodulatory effects of macrolides, and also in the fact that small doses of macrolides can impair the ability of bacteria to adhere to epithelial cells. Taking into account modern data on the resistance of microbes to any type of antibiotics while they are in an inactive state in biofilms, these treatment regimens are recommended for use in adenoiditis. Anti-inflammatory therapy. In this section there is reason to consider the role of glucocorticosteroids (GCS) in the treatment of all forms of dysfunction of the nasopharyngeal tonsil. GCS (systemic, inhaled, nasal) are widely used to treat respiratory diseases. They are among the drugs with pronounced anti-inflammatory activity (prednisolone, beclomethasone, dexamethasone, budesonide, fluticasone, mometasone, etc.). The use of GCS in the treatment of nasopharyngeal tonsil is one of the effective non-surgical treatment methods. However, it should be noted that the indications for the use of systemic corticosteroids for the treatment of adenoiditis are strictly limited. Currently, there is the possibility of their local use. New forms have been developed - intranasal hormonal drugs (ICS). They are well studied, have a high clinical effect and low systemic bioavailability.

Hurry up to cure nasopharyngitis in a child: about the most important thing

The safety of ICS has been proven in scientific and clinical studies. It has been shown that even long-term use of inhaled corticosteroids (up to 1 year) does not disrupt the function of the child’s endocrine glands and does not have a negative effect on his growth. Of the well-known ICS on the Russian market, mometasone furoate (Nasonex) is approved for use from 2 years of age, fluticasone propionate (Flixonase) from 4 years of age, and budesonide (Tafen) from 6 years of age.