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Vegetations: medical and surgical treatment



The vegetations or adenoiditis is the sustained inflammation of the pharyngeal tonsils (also called adenoids), which are glands of small size located in the upper part of the pharynx, behind the nostrils. In fact meet a defensive function, since they are part of a structure that the immune system has in the vicinity of the airway to protect us from the microorganisms in the environment that we inhale the breath.
There are three types of tonsils in this area: the lingual tonsils (at the mouth), the Palatine tonsils (on the palate, which produced classic tonsillitis or throat infection) and the pharyngeal tonsils or adenoids, which are, as we say, giving place to the vegetations.
Vegetations are common among children aged four to six years of age. Colds and repeated respiratory infections produce an increase in its size (hypertrophy), causing an obstruction to air flow which makes the child to breathe through your mouth. Although typically between one and another episode to return to its normal size, if this does not occur, and inflammation is maintained, there is a vicious circle: the infection keeps hypertrophy, and hypertrophy results in a less aeration of the area, favouring the stagnation of secretions and the growth of germs causing infection, whichin turn, keeps swelling.

Symptoms of vegetations

The symptoms of the vegetations occur as a result of obstruction of the upper airway, since inflammation of the pharyngeal tonsils prevents the normal flow of air through the nostrils, and are:
The child breathe through the mouth: is the classic symptom. In fact, Pediatrics refers adenoid facies to refer to the typical face of the boy who is always open-mouthed because you can not breathe through the nose.
Snoring: the child with vegetations always snores at night. They can even occur pauses in breathing, also called apneas, resulting in the equivalent of the adult (OSA) sleep apnea syndrome. To diagnose sleep apnea should do a more specific test called polysomnography. Children with this problem sleep poorly and are weary and restless during the day, being a secondary cause of school failure.
Nocturnal cough: is very common for the accumulation of secretions dripping back during position in supine (lying) during sleep. This cough is usually dry, irritant and does not improve with cough syrups.
Colds and respiratory repeat infections: to hinder the normal air flow and proper drainage of respiratory secretions is favored the emergence of more infections that perpetuate the process: otitis, pharyngitis, and sinusitis.

Diagnosis and treatment of vegetations

Repeated colds are very common in childhood and not all children have vegetations, not all vegetations will operate. It is normal to have some degree of adenoid hypertrophy, but as the child grows the adenoids are proportionally decreasing in size. To make a specific diagnosis of vegetations or adenoiditis and assess whether they need surgery, ENT is two tests:
Lateral neck x-ray: allows to estimate indirectly is how busy the airway by the growth of vegetations, and can assess its size.
Liveview: through a fibroscopy, the otorrino introduces a small cannula connected to a camera through the nostrils, observing directly what is the size of the adenoids and the degree to obstruct the airway.

Treatment of vegetations

The treatment of vegetations is initially medical, and surgical intervention is not always required:
• Washing with physiological serum: frequent washing of the nose with saline or sea water with enough pressure to drag the accumulated mucus.
• Antihistamines and decongestants: employees on a regular basis can relieve symptoms, although they do not give a definitive solution to the problem.
• Antibiotics: sometimes used when there is an acute infection, with fever associated with abundant nasal mucus. It is often used amoxicillin or clavulanic-amoxi.

When is it necessary to remove the adenoid glands?

Removal of the adenoids is performed under general anesthesia
In the case that with the medical treatment of vegetations not be enough and the diagnostic tests reveal oversizing of the adenoid glands that produce many symptoms, surgical removal of the same shall be indicated. The main indication for this intervention is that its size is such that produce apnea of the dream or deformities in the teeth. Other indications of the most discussed are otitis or adenoiditis of repetition that is not controlled with medical treatment.
Adenoidectomy is the surgical removal of the adenoids. It is a short and simple, intervention in which the specialist makes a curettage or scraping of the gland, accessing it through the mouth or nose. It is a short operation (15 minutes in total) but requires general anesthesia. Typically, the child enter the same morning of the intervention at the hospital and return home the same day or the next. Their effectiveness is almost 100% and it is not often that needed a second intervention.

Tips after the intervention

Although it is a simple intervention, all operation is not free of risks associated with general anesthesia. Especially in the case of children who had sleep apnea before surgery, should watch that after awakening from the anesthesia there is spasm of the larynx, which can be severe.
Another possible complication, but it rare, is bleeding. If it is blood red and abundant, should immediately go to hospital so that the child is assessed by the specialist and get a tamponade. If it is dark blood there isn't much risk, because it tends to be blood that has passed into the stomach during surgery and is digested.
In some cases the specialist prescribed an antibiotic after surgery to prevent infections. Initially it is normal that the child may have sore throat and ears, which can be controlled with routine analgesia and following a diet soft. After a few days a little annoying, in less than a week the small patient can make their normal life.
Article contributed for educational purposes
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