Adenoid disease

Description:

The long inflammation of pharyngeal and palatine tonsils develops after postponed quinsy and other infectious diseases which are followed by an inflammation of a mucous membrane of a pharynx (scarlet fever, measles, diphtheria) or without the previous acute disease. At an adenoid disease the ulceration of a mucous membrane, granulation, pustules in the thickness of almonds, growth of connecting fabric are observed. Only local symptoms are characteristic of a simple form of an adenoid disease (a pharyngalgia, etc.) if the general phenomena (persistent cervical lymphadenitis, the increased body temperature, changes join them from heart etc.), such form is called toksiko-allergic. The adenoid disease can promote emergence or an exacerbation of rheumatism, nephrite, thyrotoxicosis and other diseases.
Historically the adenoid disease is considered as a disease of infectious and allergic genesis for a long time (B. S. Preobrazhensky, 1966).

Symptoms of the Adenoid disease:

Suggests to distinguish three forms of an adenoid disease:
A. Compensated.
B. Subcompensated.
V. Dekompensirovannuyu.

Classification of an adenoid disease of B. S. Preobrazhensky (1964).

I. Simple form. The cases of an adenoid disease proceeding only with local symptoms, subjective complaints and objective symptoms of a disease, with frequent quinsies, and in other cases – without repeated quinsies (a "bezanginny" adenoid disease) concern to her.

II. Toksikoallergichesky form. Results from disturbance of protective and adaptive mechanisms. These or those local changes are followed by the general phenomena. Here the forms of an adenoid disease proceeding with subfebrile condition, with the phenomena of tonzillogenny intoxication belong; the tonzillo-cardial syndrome, etc. is quite often stated. Importance of toksiko-allergic manifestations is not identical and therefore it is reasonable to distinguish 1 degree (with easier phenomena) and the 2nd degree (with considerably the expressed phenomena).

Reasons of the Adenoid disease:

The etiology and pathogeny of an adenoid disease are up to the end not studied today.

The starting moments in development of a disease are the repeated inflammatory processes leading to a local immunosuppression which substantially concerns ability of cells of almonds to antibody formation and the level of cytotoxic activity of immunocompetent cells, decrease in reception and products of tsitokinovy molecules in their fabric. At a chronic inflammation in mindilina there are cells having ability to inhibit natural cytolytic activity of blood cells, and also apparently, and almonds. There is antigenic "overload" of fabric of almonds that leads to the phenomenon of the competition of antigens. An important role is played by toxic substances of microorganisms and the general allergisky reactions.

Development of an adenoid disease is promoted by also permanent disturbance of nasal breath (adenoides at children, a curvature of a nasal partition, increase in the lower nasal sinks, nose polyps, etc.). Quite often the infectious centers in nearby bodies are the reasons of local character: carious teeth, purulent antritises, chronic adenoidites.

Treatment of the Adenoid disease:

Distinguish two main methods of treatment: surgical and conservative.
Conservative treatment is shown at the compensated form, and also at dekompensirovanny, shown repeated quinsies, and in cases when there are contraindications for surgical treatment. Methods of conservative treatment is offered sufficient much.
Shortly and schematically means of conservative treatment can be grouped in the nature of their main action as follows.
1. The means promoting increase in protective forces of an organism: the correct day regimen, a balanced diet with the use of enough natural vitamins, physical exercises, resort climatic factors, biostimulators, gamma-globulin, iron preparations, etc.
2. The hyposensibilizing means: calcium drugs, antihistaminic drugs, ascorbic acid, an epsilon - aminocapronic acid, small doses of allergens, etc.
3. Means of immunocorrection: levamisole, Prodigiosanum, Thymalinum, IRS-19, bronkhomunat, ribomunit, etc.
4. Means of reflex influence: various look novocainic blockade, acupuncture, manual therapy of cervical department of a backbone (it was noticed that at patients with an adenoid disease and frequent quinsies disturbance of mobility in a cranial and cervical joint meets a spasm of short razgibatel of a neck and that blockade at this level increases a susceptibility to the repeating tonsillitis).
5. The means making the sanifying impact on palatine tonsils and their regional lymph nodes (active, medical manipulations).
A. Washing of lacunas of almonds. It is applied for the purpose of removal of pathological contents of almonds (traffic jams, pus). Wash out usually the syringe with a cannula, applying various solutions. Antiseptic agents, antibiotics, enzymes, the antifungal, antiallergic, immunostimulating drugs, biologically active means, etc. can be such solutions. Correctly executed washing promotes reduction of an inflammation in lacunas of almonds, the size of almonds usually decreases.
B. Suction of contents of lacunas of almonds. By means of a suction machine and a cannula it is possible to remove liquid pus from lacunas of almonds. And, having applied a special tip with a vacuum cap and with leading of medicinal solution, it is possible to wash out lacunas at the same time.
B. Introduction to lacunas of medicinal substances. The syringe with a cannula is used to introduction. Enter various emulsions, pastes, ointments, oil suspensions. They are late in lacunas for longer time, from here and more expressed positive effect. Drugs on an action spectrum same what are applied to washing in the form of solutions.
G. Injections in almonds. Shprits with a needle impregnate fabric of almonds or the space surrounding it with various medicines. Some time ago in Kharkiv it was offered to injection to do not by one needle, but a special nozzle with a large number of small needles that was more effective as almond fabric really became impregnated with medicine, unlike an injection only with one needle.
D. Greasing of almonds. For greasing quite large amount of different solutions or mixes is offered (an action spectrum as at drugs for washing). The most often used drugs: solution of Lugol, colloid silver, Solutio oleosa of a hlorofillipt, propolis tincture with oil, etc.
E. Rinsings of a throat. Are carried out by independently sick. The uncountable number of rinsings is offered traditional medicine. Too it is possible to find enough ready solutions or concentrates for rinsing in drugstores.
6. Physiotherapeutic methods of treatment.
Most often appoint ultrasound, microwave therapy, laser therapy, the microwave oven, UVCh, an inductothermy, ultra-violet radiation of almonds, magnetotherapy, an electrophoresis, "Vitaphone" (the device vibroacoustic), mud cure, inhalations. Also techniques with topical administration of immunomodulators, such as levamisole, etc. are offered.
The following technique is of interest. The patient recommends to apply 2 times a day within 10 - 14 days mix to a rassasyvaniye: 2 tablespoons of small polished carrots + 1 tablespoon of honey + 5-10-15 (the quantity depends on age) a thaw of spirit tincture of propolis + 0,5 ml of 5% of solution of ascorbic acid.
Let's consider shortly options of surgical treatment. As a rule, operation is appointed at a dekompensirovanny form of tonsillitis and in cases when the carried-out repeatedly conservative treatment did not improve a condition of almonds.
Contraindications to a tonsilectomy: hemophilia, the expressed cardiovascular and renal failure, a severe form of a diabetes mellitus, an active form of tuberculosis, acute infectious diseases, the last months of pregnancy, the periods period. If the day before there was quinsy, then it is necessary to perform operation in 2-3 weeks.
Adults usually operate under a local anesthesia, applying to terminal anesthesia Dicainum or Pyromecainum, to infiltration – novocaine or Trimecainum.
Make the arc-shaped section on edge of a palatoglossal handle with transition to palatopharyngeal. The raspatory or an elevator through a section get into paratonsillar space, for the almond capsule, otseparovyvat the last from a palatoglossal handle ekstrakapsulyarno from an upper pole to lower. Then take an almond a clip and separate it from a palatopharyngeal handle. The cicatricial unions which are not giving in to stupid separating cut scissors, doing small notches. Having imposed a cutting loop on an almond and having rejected it from top to bottom, cut a loop all almond. The Tonzillyary niche is processed haemo static paste. At department of an almond consider that near its poles there pass internal and outside carotid arteries.
After operation of the patient put to bed usually on the right side, having given sublime situation to his head. In the first day it is allowed to take several sips of water. In the next days the patient receives the wiped and liquid not hot food, to him appoint antibacterial therapy. By 4-5th day of the hospital mode tonsillar niches are cleared of a fibrinous plaque. The patient is written out for outpatient observation at the otorhinolaryngologist.
Also diathermocoagulation of almonds belongs to surgical methods (it is now applied seldom).
In recent years new methods of surgical treatment are developed: a tonsilectomy by means of the surgical laser.
Influence almonds and surgical ultrasound. The cryosurgical method (freezing of almonds) is quite widespread. The method is applied at small almonds, some doctors before freezing sound previously almonds also ultrasound that promotes reduction of reaction of fabrics by freezing and improvement of healing of a wound surface on almonds.