What are adenoids called?
The adenoids – better known by the shortened term of “vegetations” – designate the lymphoid tissue located at the back of the nose, in the nasopharynx, where the nasal cavities meet. “This sheet of lymphoid tissue under the mucous membrane of the nasopharynx helps the body defend itself against viruses and bacteria, explains Pr. Nicolas Leboulanger, otolaryngologist. However, in some children, it happens that the vegetation increases in volume and cause a chronic nasal obstruction – with some snoringa mouth breathingfrom surinfections, etc – which may require surgery”.
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What is their role ?
The role of vegetations is of defend the body against the viral and bacterial infections. “This lymphoid tissue – the same as that of tonsils – provides a first line of defense against pathogens, confirms the specialist. However, when the vegetations are too voluminous, for example after repeated infections, and they bother the child on a daily basis, it may be necessary to reduce their size”. Let the parents be reassured: the intervention on the vegetations does not generate immune deficiency or of increased susceptibility to infections.
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Adenoidectomy: why should the adenoids be removed?
Widespread twenty years ago, the operation of vegetation is less systematic today. ” In some cases moderate hypertrophya medical treatment with topical corticosteroids can be prescribed, confirms Pr. Leboulanger. It is also recommended to do daily nose washes with saline to help decrease inflammation and increase the comfort of the child ».
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AdenoidectomyWhere reduction in the volume of vegetationis today recommended :
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- especially in cases of chronic nasal obstruction with an impact on the general condition of the child: mouth breathing, snoring, impaired sleep qualityetc.
- sometimes as part of a serous otitis (also called seromucosa) which is prolonged over time and when the adenoids are increased in volume and symptomatic. “The increase in volume of the vegetations can block the lower orifice of the Eustachian tube and lead to a lack of ventilation of the middle ear conducive to the formation of serous otitis”, explains the specialist.
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What are the symptoms of enlarged adenoids?
The hypertrophy of the vegetations is generally manifested by:
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- a chronic nasal obstruction with flows
- a mouth breathingi.e., by mouth, diurnal and nocturnal
- from snoringa agitated sleepwhich can sometimes go as far as a syndrome obstructive sleep apnea (OSAS).
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« The hypertrophy of the vegetations also promotes nasopharyngeal infections and recurrent ear infections. It can, for example, be associated with a serous otitis, says Prof. Nicolas Leboulanger. This is why the reduction of vegetation is sometimes coupled with the installation oftympanic aerators also called yoyos ».
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What are the causes of enlarged adenoids?
The hypertrophy of the vegetations often results from a persistent inflammation in time. “It occurs in a context of repeated ENT infections, confirms the specialist. Too stressed on the immune level, the adenoids will increase in volume and cause chronic nasal obstruction”.
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What are the risk factors?
Several factors can promote the occurrence of hypertrophy of the vegetations: for example, community life (nursery mode) which accentuates the spread of viruses during epidemics or even the passive smoking which will tend to irritate the baby’s respiratory mucous membranes.
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When should adenoids be operated on in children?
In fgeneral, surgery (adenoidectomy) is performed in children from 18 months to 4/5 years old. Then, the adenoids decrease in volume which often allows a resolution of the symptoms associated with them. In general, the young patient is referred to the ENT by the pediatrician or the general practitioner.
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During the appointment, in addition to the clinical examination, the specialist performs a nasofibroscopie to explore the nasal cavities. “This examination carried out with a small fibroscope adapted to children is not painful, specifies Prof. Leboulanger. The sensation can be a little unpleasant but it only lasts a few seconds. This makes it possible to visualize the vegetations, to check their volume and to confirm or not the indication to intervene surgically”.
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Removal of vegetation takes place under General anaesthesiamost often in ambulatory (day hospitalization). “The gesture is now very well mastered,” says the specialist. We remove part of the lymphoid tissue by curettage to reduce its size. It also happens that vegetation grows back. It is rare, but if these again have a functional impact on the child (nasal obstruction, etc.), a second operation may be considered”. Sometimes, the surgical intervention is also coupled with a gesture on the tonsils (tonsillectomy) or installation of a tympanic ventilator in the context of serous otitis.
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What are the postoperative consequences of removal of adenoids?
The postoperative course is simple. “For a few days, there sometimes persists a slight pain easy to swallow relieved by painkillers like paracetamol, reassures the ENT. Rare bleeding may also occur. The specialist recommends not eating foods that are too hot or spicy and washing the nasal cavities with saline in the first days after surgery. “The benefits of the operation are very rapid: the child will breathe better and therefore sleep better, which will have an impact on his general condition”, concludes Prof. Leboulanger.
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Tonsils versus adenoids
The operation of the vegetations can be coupled with the ablation of the tonsils. Tonsillectomy is indicated in the context of:
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- excessively large tonsils: hypertrophy of the tonsils can indeed cause permanent mouth breathing in children and the appearance of obstructive sleep apnea syndrome (OSAS).
- recurrent angina or chronic tonsillitis resulting in pharyngeal pain, inflammation of the tonsils and cervical lymph nodes that persist over time.
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And in adults?
As they grow, the vegetations atrophy. “The removal of adenoids in adults is rare, confirms Prof. Leboulanger. When we intervene, it is rather to check that there is not an underlying tumor pathology”.
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