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Snoring with adenoids in children and adults
Last reviewed: 23.11.2021
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Adenoids (adenoid vegetation) are folds-like enlarged pharyngeal or nasopharyngeal tonsil, which is part of the innate immune system - the lymphoepithelial pharyngeal ring. With an increase in these folds, such a symptom of respiratory disturbance as snoring with adenoids occurs.
Epidemiology
According to European pediatricians, snoring occurs in 15-20% of children under the age of 13 (the peak is observed in children from 2 to 8 years old). [1]
And according to the American Academy of Family Physicians, the estimated prevalence of snoring in children is between 3% and 35%. Boys (12.4%) snore more often than girls (8.5%). In most cases, snoring is a consequence of hypertrophy of the adenotonsillar tissues. [2]
Snoring due to adenoids in adults in 60% of cases affects people aged 18-25, and more than two thirds of them are men. [3]
Causes snoring with adenoids
The main causes of snoring with adenoids are vibration of an increased mass of soft lymphatic tissue located in the nasopharynx: on its upper and posterior walls. That is, blockage of the nasopharyngeal canal by adenoids leads to its narrowing and an increase in the resistance of the upper airways to the flow of inhaled (and exhaled) air, and snoring occurs with adenoids in children. [4]
The pharyngeal (adenoid) tonsil is formed during embryonic development by subepithelial infiltration of lymphocytes from the mucous membrane of the distal part of the nasopharyngeal vault. After birth, the amygdala continues to expand and lengthen up to six to seven years - when the lymphoepithelial pharyngeal ring is fully formed, which protects the mucous membranes of the respiratory tract from infections.
Why in childhood the nasopharyngeal tonsil can grow pathologically, in detail in the publications:
Then (from the age of nine to ten) the accumulation of lymphoid tissue in the nasopharynx begins to gradually contract, and in adults its complete involution occurs. Therefore, snoring due to adenoids in adults is very rare. The most common causes of adenoid hypertrophy in adults are chronic infection and allergies (chronic allergic rhinitis). See - Adenoids in adults . [5]
Risk factors
Hypertrophied (enlarged) adenoids can become quite bulky and completely block air flow through the nasal passages, and the child must breathe through the mouth. This is the main risk factor for snoring.
In adults, smoking, air pollution from harmful substances (in industrial premises), as well as malignant neoplasms of nasopharygeal localization and HIV infection are considered to be important predisposing risk factors for adenoid hypertrophy and associated ronchopathy.
Pathogenesis
The snoring mechanism is discussed in detail in the material - Snoring .
The pathogenesis of adenoid hypertrophy is associated with their frequent acute inflammation - adenoiditis caused by viruses. In cases of chronic inflammation, Staphylococcus aureus is the most common infection. Also, adenoids can increase with frequent nasopharyngitis and chronic allergic rhinitis. [6]
The tissues of the hypertrophied nasopharyngeal amygdala consist of cells of pseudo-stratified epithelium, altered by inflammatory processes, with an increased number of overgrown cells of the basal layer, macrophages and interepithelial lymphocytes - in the form of diffuse zones of lymphoid tissue localized among the epithelial cells. In the adenoid lymphoid tissue itself, newly formed lymphoid nodules and larger secondary lymphatic follicles are present. In addition, in some areas of the tonsils there are depressions (crypts) that contain the decay products of epithelial cells and lymphocytes.
Read also - Hyperplasia of the tonsils
Symptoms snoring with adenoids
In addition to nasal congestion, difficulty in nasal breathing and snoring, in the presence of grade 3 adenoids, the child manifests symptoms in the form of dizziness and frequent headaches, nasal voice, swollen cervical lymph nodes, hearing impairment (due to frequent otitis media) and the formation of the so-called "adenoid face "- with an open mouth (due to constant breathing through the mouth) and a lowered lower jaw (an increase in the angle of its plane), which leads to deformation of the dental arch and facial skeleton. [7]
Complications and consequences
Complication of snoring with hypertrophy of the pharyngeal tonsil:
- restless sleep;
- tense or noisy breathing (stridor);
- sleep apnea syndrome (pauses in breathing), which occurs in 2-3.5% of children with adenoids;
- daytime sleepiness. [8]
Difficulties arise when breastfeeding babies in the adenoids. [9]
Diagnostics snoring with adenoids
In addition to collecting anamnesis and physical examination, the diagnosis of adenoid hypertrophy includes general blood and urine tests, bacterial culture of the nasopharyngeal microflora, and in adults (if necessary) - biopsy of adenoid tissues and their histological examination.
Instrumental diagnostics is carried out with the aim of examining the pharynx , for which ENT specialists use rhinoscopy (including endoscopic), pharyngoscopy, lateral nasopharyngeal radiography or CT of the nasopharynx.
Differential diagnosis
To exclude benign tumors of the nasopharynx (Thornvalds cyst or juvenile nasopharyngeal angiofibroma), teratoma or nasopharyngeal carcinoma, differential diagnosis is performed.
Who to contact?
Treatment snoring with adenoids
Adenoids are treated with conservative methods and physiotherapy, all methods are in materials:
How to remove snoring with adenoids 2 and 3 degrees? To date, a real cure for snoring caused by the proliferation of lymphoid tissue of the pharyngeal tonsil is provided only by the removal of adenoids in children - adenoidectomy. If there are appropriate indications, adenoidectomy is performed at any age. [10]
Read also - Operation to remove adenoids with a laser .
According to clinical data, in 19-26% of cases after surgery, the pharyngeal tonsil regrowth with repeated hypertrophy, and in such situations, snoring is possible after removal of the adenoids. [11]
Prevention
Full information in the material - Prevention of adenoids in children .
Forecast
With timely adenoidectomy, the prognosis is positive, since the cause of the snoring is eliminated.