• What you may not know about respiratory infections, sleep obstruction, weak speech and hearing impairments in children

Job Osazuwa

Adenoid is not a disease, but it could, overtime, turn into a major health challenge when it grows out of proportion. Adenoids naturally come with everybody at birth and are expected to start shrinking around age five or six and virtually disappear by the teen years.
However, when Adenoids refuse to shrink, they constitute health hazards and sends fear and panic to the affected child’s parents or guardians. The health setbacks associated with Adenoids are usually respiratory infections, sleep obstruction as weak as speech and hearing impairments.
According to a paediatrician at Abi Health Centre in Lagos State, Rex Ogugu, adenoid , also known as a pharyngeal tonsil or nasopharyngeal tonsil, is situated posterior to the nasal cavity, in the roof of the nasopharynx, where the nose blends into the throat.
He simplified adenoid, which normally forms a soft mound in the roof and posterior wall of the nasopharynx, just above and behind the uvula, as a mouth condition in children. He added that it could degenerate into some sort of deformity if not nipped in the bud.
According to him, “the adenoids are a mass of soft tissue behind the nasal cavity. Like lymph nodes, adenoids are part of the immune system and are made of the same type of tissue (lymphoid tissue). White blood cells circulate through the adenoids and other lymphoid tissue, reacting to foreign invaders in the body.
“Everyone has adenoid at birth and in childhood, but as we grow and become adolescence, they start to shrink. At the level of adulthood, most people’s adenoids have completely disappeared.”
A general practitioner based in Lagos State, David Oluwadare, said adenoids are one of two folds of lymphatic tissue covered by ciliated epithelium.
He said the condition might obstruct normal breathing and make speech difficult when swollen, a condition often called adenitis synonyms.
Said he: “Adenoids with tubal tonsils, the lateral bands, the palatine tonsils, lingual tonsils form a ring of tissues called Waldeyer’s ring after the German anatomist who described them. It is a well vascularised and innervated tissue, and other names of which I will not bother you with for the purpose of simplicity and clarity.
“The adenoids and the tonsils are part of the secondary immune system. Without afferent lymphatic, the lymphoid nodules in these structures are exposed to antigens only in the crypts of the palatine tonsils and the folds of the adenoids, where it is transported through the epithelial layer. These are involved mostly in the production secretory IGA, which is transported to the surface, providing local immune protection.”

Importance of adenoids
These mass tissue, along with one’s tonsils, according to experts, help to keep one healthy by trapping harmful germs that pass through the nose or mouth. Adenoids also produce antibodies to help the body fight infections.
Unlike tonsils, which can be easily seen by opening the mouth, adenoids are hidden inside the mouth. For it to be examined properly, a doctor has to use a small mirror or special instrument with a light. Sometimes x-rays may be taken to see them more clearly.
Although, adenoids play an important role in keeping a person healthy, as the person gets older, they become less important, because the body can at that point, fight infection in other ways.

How adenoids develop
A group of specialists, under the auspices of American Kids Health Monitors (AKHM), in its bulletin released in November 2016 in Maryland, USA, revealed that adenoids develop from a subepithelial infiltration of lymphocytes after the four months of embryonic life.
The report said: ”Usually, after birth, enlargement begins and continues until five to seven years. Symptomatic enlargement between 18 and 24 months of age is not uncommon, meaning that snoring, nasal airway obstruction and obstructed breathing may occur during sleep. However, this may be reasonably expected to decline when children reach school age, and progressive and rapid shrinkage may be experienced thereafter.
“The establishment of the upper respiratory tract is initiated at birth. Species of bacteria, such as lactobacilli, anaerobic streptococci, actinomycosis, fusobacterium, and nocardia are normally present by six months of age.”

Ugly side of adenoids
Ogugu said one of the commonest conditions easily identifiable is the inflammation of adenoids, often from infection, which is called adenoiditis. He added that some certain bacteria or viruses might cause adenoiditis.
It was gathered that even though adenoids help filter out germs from the body, sometimes they could get overwhelmed by bacteria and become infected. It is most commonly seen in children, but sometimes affects adults.
The expert told Daily Sun that in children, the adenoids could get larger because of infection and some other unknown reasons, stressing that some very large adenoids could interfere with breathing or with the flow of mucus, consequently causing the child discomfort.
On obstructive sleep, the doctor said while sleeping, enlarged adenoids may intermittently block the flow of air through the throat. This, he added, could cause a person to stop breathing for a few seconds – apnea – and could occur several times each night.
“It also causes ear infections (otitis). In children, enlarged adenoids may block the eustachian tubes, which drain fluid from the ears into the throat. If these tubes are unable to drain, it can lead to repeated ear infections,” he enlightened.
On his part, Oluwadare said recurrent acute adenoididtis could be four or more episodes of adenoididtis in a period of about six months, in which there could be wellness breaks in between this period.
He said: ”Beyond this period of the acute window is called chronic adenoididtis and symptoms include: malodorous breath (bad breath), persistent nasal discharge, post nasal drip, extra oesophageal reflux lasting at least three months.
“Other problems that can happen to the adenoids include: Exceptional increase in size, which obstructs the airway (obstructive adenoid hyperplasia) and this manifests as symptoms of chronic nasal obstruction, nasal discharge, snoring, mouth breathing, and hypo nasal voice.”

Common symptoms
According to Ear, Nose and Throat (ENT) specialists, symptoms of adenoiditis could vary depending on what is causing the infection, but may include: sore throat, stuffy nose, swollen glands in the neck, ear pain and other ear problems.
When the nose is stuffy, breathing through usually becomes a difficult task. Other symptoms of adenoiditis related to nasal congestion include: breathing through the mouth, speaking with a nasal sound, as if one is speaking with a pinched nose and difficulty sleeping.
Similarly, Oluwadare added: “ln children, there could be daytime drowsiness (somnolence), because the child could not sleep well at night, behavioural problems and urinary incontinence (enuresis).
“Children having problems of enlarged adenoids have certain appearances called ‘adenoid facies’ and these include: Long face with mouth opened almost all the time because the upper airway is blocked. This could be life threatening in format of cessation of breath during sleep (sleep apnea).
“Other presentations of this appearance include: Underdeveloped thin nostrils, short upper lip, prominent upper teeth (other conditions like sickle cell disease patient also have this); crowded teeth, narrow upper alveolar, high arched palate, and so on.”

Diagnosis
Endoscopy: A small, flexible tube with a lighted camera on the end is inserted into the nose or throat of the patient. A doctor can also view the nasal passages and adenoids on a video screen during endoscopy.

Computed tomography (CT): A CT scanner takes multiple x-rays, and a computer constructs detailed images of the sinuses, nasal cavities, and adenoids.

Magnetic resonance imaging (MRI): A MRI scanner uses a high-powered magnet and a computer to create highly detailed images of the nasal passages, sinuses, and adenoids.

Treatments
Surgery (adenoidectomy): Surgery to remove the adenoids is often required when the adenoids are large enough to cause other health problems. Children’s adenoids may be removed surgically with no apparent ill effects.

Antibiotics: Antibiotics kill bacteria, usually curing sinus or ear infections caused by bacteria. However, if the child has frequent infections, including ear and sinus infections, or antibiotics do not help. If the patient has ongoing breathing problems, surgery may be needed to remove the adenoids through adenoidectomy procedure.
The child’s doctor might also recommend that the tonsils be removed at the same time since adenoiditis and tonsillitis often go hand in hand. Surgery to remove the tonsils is called a tonsillectomy.
An adenoidectomy is performed by a doctor who specialises in ear, nose, and throat surgery. It occurs in a hospital or outpatient surgical centre under general anesthesia. This means the child is put to sleep. The tonsils and/or adenoids can be removed through the mouth, so no additional incisions are made, except for where the tissues are removed.
Most patients could go home after the procedure, but should be expected to be in the surgical centre for around four or five hours after the surgery in order to be carefully monitored.
Oluwadare said secondary infection could be given antibiotics, but quickly added that some condition could be corrected by surgery, especially in cases where there are recurrent purulent nasal discharge of four or more episodes in prior 12 months in a child less than age12.
Other instances, according to him, are persistent symptoms of adenoiditis after two courses of antibiotics, sleep disturbance, hypno nasal speech or nasal speech etc. He revealed there are contra-indications to the surgery which your doctor will discuss with you.
He, however, warned patients and relatives against patronising quacks who deceive people that they can perfectly cut adenoids. He recommended proper diagnosis and investigation at a clinic, and submitted that wisdom is profitable to direct.

Recovery from Adenoidectomy
As soon as adenoidectomy is performed, the child may have a low fever several days after. If the fever gets higher and resisting drugs, call the doctor. Also, seek medical attention if fever is accompanied by other symptoms, such as lethargy, nausea, vomiting, headache, or stiff neck.

Mouth breathing: Mouth breathing and snoring may occur following the surgery, due to swelling in the throat. Breathing should return to normal once swelling goes down, which is usually 10 to 14 days after surgery. Don’t hesitate to seek medical attention if there is difficulty breathing.

Pain: Some throat and ear pain is normal for a few weeks following surgery. The doctor should prescribe medicine to help control pain.

Scabs in the mouth: Thick, white scabs will develop where the tonsils and/or adenoids were removed. This is normal and most scabs fall off in small pieces within 10 days after surgery. Do not allow the child pick at the scabs. These scabs may also cause bad breath.

Tips to quick recovery after adenoidectomy
Feed the child soft foods, such as scrambled eggs, soup, and popsicles. However, do not let your child eat or drink milk products for the first 24 hours following surgery.
Make sure the patient drinks plenty of fluids to avoid dehydration. Have the child rest as much as possible for the first few days following surgery. The patient should be able to return to school once he or she can eat regular foods again, is no longer on pain medication, and is able to sleep soundly through the night.