Adenoids

Adenoids usually start to shrink after about age 5. By the teenage years, they are almost completely gone. By then, the body has other ways to fight germs.

ANATOMY AND PHYSIOLOGY:

The nasopharyngeal tonsil, commonly called “adenoids”, is situated at the junction of the roof and posterior wall of the nasopharynx. It is composed of vertical ridges of lymphoid tissue separated by deep clefts. Covering epithelium is of three types: ciliated pseudostratified columnar, stratified squamous and transitional. Unlike palatine tonsils, adenoids have no crypts and no capsule. Adenoid tissue is present at birth, shows physiological enlargement up to the age of 6 years, and then tends to atrophy at puberty and almost completely disappears by the age of 20.

Blood supply. Adenoids receive their blood supply from:

1.  Ascending palatine branch of facial.

2.  Ascending pharyngeal branch of external carotid.
3. Pharyngeal branch of the third part of maxillary artery.
4.  Ascending cervical branch of inferior thyroid artery of thyrocervical trunk.

Lymphatics from the adenoid drain into upper jugular nodes directly or indirectly via retropharyngeal and parapharyngeal nodes.

Nerve supply is through CN IX and X. They carry sensation. Referred pain to ear due to adenoiditis is also mediated through them.[1]

Causes:

Adenoids are subject to physiological enlargement in childhood. Certain children have a tendency to generalized lymphoid hyperplasia in which adenoids also take part. Recurrent attacks of rhinitis, sinusitis or chronic tonsillitis may cause chronic adenoid infection and hyperplasia. Allergy of the upper respiratory tract may also contribute to the enlargement of adenoids.

Study demonstrated some risk factors for severe AH:

• apnoea,
• recurrent respiratory infections, and
• high serum CD163 levels.[4]

Pathophysiology

• Adenoids are on the posterior nasopharynx, posterior to the nasal cavity. Additionally, They are a component of the Waldeyer’s ring of lymphoid tissue, which is a ring of lymphoid tissue and includes adenoids and tonsils.

• Adenoids are developed from lymphocytes infiltration in subendothelium of nasopharynx during the 16th week of gestation.

• After the birth adenoids begin to enlarge.
• By the time children are aged 6 months, lactobacilli, anaerobic streptococci, actinomycosis, Fusobacterium species, and Nocardia species are present in the mucosal flora.

Normal flora found in the mature adenoid tissue consists i.e.:

• • Alpha-hemolytic streptococci
  • Enterococci
  • Corynebacterium species
  • Coagulase-negative staphylococci
  • Neisseria species
  • Haemophilus species
  • Micrococcus species
  • Stomatococcus species
• It is normal to find symptomatic adenoids in children aged 18-24 months.
• They continue their grow until individuals are aged 5-7 years.

• Adenoids start to shrink by the age 6-7.
• By the time children reach 10-12, the adenoids are usually small enough for the child to become asymptomatic.[4]

Symptoms and signs depend not merely on the absolute size of the adenoid mass but are relative to the available space in the nasopharynx. Enlarged also infected adenoids may cause nasal, aural or general symptoms.[1]

1. NASAL SYMPTOMS

(a) Firstly, Nasal obstruction is the commonest symptom. This leads to mouth breathing. Nasal obstruction also interferes with feeding or suckling in a child. As respiration and feeding cannot take place simultaneously therefore a child with adenoid enlargement fails to thrive.

(b) Secondly, Nasal discharge. It is partly due to choanal obstruction, as the normal nasal secretions cannot drain into nasopharynx and partly due to associated chronic rhinitis. The child often has a wet bubbly nose.

(c) Thirdly, Sinusitis. Chronic maxillary sinusitis is commonly associated with adenoids. It is due to persistence of nasal discharge and infection. Reverse is also true that a primary maxillary sinusitis may lead to infected and enlarged adenoids. [1]

(d) Fourthly, Epistaxis. When adenoids are acutely inflamed, epistaxis can occur with nose blowing.

(e) Lastly, Voice change. Voice is toneless also loses nasal quality due to nasal obstruction.

2. AURAL SYMPTOMS

(a) Firstly, Tubal obstruction. In other words, Adenoid mass blocks the eustachian tube leading to retracted tympanic membrane also conductive hearing loss.

(b) Secondly, Recurrent attacks of acute otitis media may occur due to spread of infection via the eustachian tube.

(c) Thirdly, Chronic suppurative otitis media may fail to resolve in the presence of infected adenoids.

(d) Fourthly, Serous otitis media. Adenoids form an important cause of serous otitis media in children. The waxing also waning size of adenoids causes intermittent eustachian tube obstruction with fluctuating hearing loss. At last, Impedance audiometry helps to identify the condition. [1]

3. GENERAL SYMPTOMS

(a) Adenoid facies. Chronic nasal obstruction and mouth breathing lead to characteristic facial appearance called adenoid facies. Additionally, The child has an elongated face with dull expression, open mouth, prominent also crowded upper teeth and hitched up upper lip. Nose gives a pinchedin appearance due to disuse atrophy of alaenasi. Hard palate in these cases is highly arched as the moulding action of the tongue on palate is lost.

(b) Pulmonary hypertension. Long-standing nasal obstruction due to adenoid hypertrophy can cause pulmonary hypertension and cor pulmonale.

(c) Aprosexia, i.e. lack of concentration.[1]

Clinical Examination

Investigation

Depending on what your doctor finds, your child may need a blood test to check for infection. Besides this, In some cases, an X-ray exam of the throat may be necessary.

In severe cases, your child may need to undergo a sleep study.[5]

Diagnosis

Examination of postnasal space is possible in some young children and an adenoid mass can be seen with a mirror. A rigid or a flexible nasopharynx go scope is also useful to see details of the nasopharynx in a cooperative child. Soft tissue lateral radiograph of nasopharynx will reveal the size of adenoids and also the extent to which nasopharyngeal air space has been compromised. Detailed nasal examination should always be conducted to exclude other causes of nasal obstruction.

Differential Diagnosis

• Choanal atresia
• Pyriform aperture stenosis
• Allergic rhinitis
• Acute or chronic sinusitis
• Nasal polyposis
• Intranasal encephalocele
• Nasal dermoid
• Nasopharyngeal neoplasm
• Acute otitis media
• Chronic serous otitis media
• Cholesteatoma
• Nasopharyngeal malignancy
• Inverting papilloma
• HIV[6]

Eating healthful foods, getting enough sleep, and drinking plenty of water can keep the immune system functioning well and help reduce the risk of enlarged adenoids.

Also, good hygiene can help prevent infections. In some cases, children need their adenoids removed.[7]

Homeopathic Treatment of Adenoids

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Homeopathic Medicines for Adenoids:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Homeopathic Medicines for Adenoid i.e.:

ARSENICUM ALBUM:

Swollen edematous, constricted burning, unable to swallow. additionally, thin watery excoriating discharge from nose. Sneezing. After that, Worse – wet weather after midnight from cold, cold drinks after food. seashore. right side. Better – heat, head elevated, also warm drinks.

BELLADONNA:

Dry as if glazed, angry looking congestion. Red < on right side. Most importantly, Tonsils enlarged, throat feels constricted, difficult deglutition, worse liquids, sensation of a lump. Moreover, Esophagus dry; feels contracted. Spasm in throat. Continual inclination to swallow. Scraping sensation. Muscles of deglutition very sensitive, otitis media with tearing pain in ear. Coryza, Worse – touch, noise, draught afternoon, lying down. On the other hand, Better – semi-erect.[2]

CHAMOMILLA:

Parotid and submaxillary glands swollen. Constriction and pain as from a plug. Furthermore, Earache with soreness, stitching pain. Irritable cough. Worse – by heat, open air, wind, night. whereas, Better – warm wet weather.[2]

CALCAREA CARBONICA:

Swelling of tonsils, and submaxillary glands, stitches on swallowing. Difficult swallowing. Particularly, Throbbing in ears with pulsating pain. Hardness of hearing. Nostrils sore and obstructed. Coryza Worse – from exertion, cold in every form. Water, moist air, washing, wet weather, standing, but Better by dry climate and weather, sneezing.

LACHESIS:

Sore throat, < left side – swallowing liquids. Dry intensely swollen, pain < by hot drinks, mucus sticks and cannot be forced up or down. Very painful < slightest pressure. Feel as if something is swelled also must be swallowed. Pain into ear – a tearing pain, sneezing and coryza. Worse – after sleep – left side, in the spring, warm bath, pressure or constriction, hot drinks. On the other hand, Better – warm applications.

MERCURIUS:

Bluish-red swelling. Constant desire to swallow. Putrid sore throat. Worse especially right side. In addition, Ulcers and inflammation. Stitches into ear on swallowing. Much sneezing. Worse – at night, wet weather, especially, lying on right side, perspiring, warm room and warm bed.

SULPHUR:

Throat has pressure as from a lump, splinter or a hair. Ball seems to rise also close pharynx, burning redness and dryness. Nose blocked, especially indoors for adenoids and polyps moreover worse – at rest, when standing, warmth in bed. On the other hand, Better – dry warm weather.[2]

• Green vegetables
• Drinks enough water
• Hygiene and importance of washing hands
• Avoid smoking
• Don’t self-medicate