The adenoids or pharyngeal tonsils are lymphoid masses that lie posterior to the nasopharynx (in layman's terms, behind the nose).
They have a predominantly defensive role and block most of the atmospheric microorganisms, so as not to let them pass inside the respiratory tract.
The pathologies affecting this district can be occasional, recurrent, acute or chronic.
Infected / inflamed adenoids swell making nasal ventilation difficult.
The most frequent diseases of the adenoids are:
- Infection: infectious adenoiditis from bacteria, viruses or fungi.
- Hypertrophy: permanently enlarged adenoids due to recurrent infections or allergic reactions.
There are also hereditary / anatomical discomforts to the adenoids (sometimes the hypertrophy begins already inside the womb).
The published material is intended to allow quick access to general advice, suggestions and remedies that doctors and textbooks usually dispense for the treatment of Enlarged Adenoids; such indications must in no way substitute the opinion of the attending physician or other health specialists in the sector who are treating the patient.
What to do
- In the presence of specific symptoms, it is necessary to contact the general practitioner or directly to the otolaryngologist specialist.
Typical symptoms of enlarged adenoids are: - For acute infectious adenoiditis: fever and rhinorrhea with serous or muco-purulent nasal discharge. Sometimes, rhinitis, ear infections and sinusitis are also associated.
- Snoring: snoring is typical of diseases that characterize the upper respiratory tract (rhinitis, pharyngitis, sinusitis, etc.), but in the case of hypertrophic adenoids it is permanent.
- Sleep apnea: ventilation pauses during sleep.
- Daytime sleepiness: typical of sleep disorders. It is no coincidence that adenoids are among the causes of Obstructive Sleep Apnea Syndrome - OSAS.
- Open mouth breathing: Since nasal ventilation is physically impeded, the subject reacts spontaneously by opening the pharynx.
- Nasal voice: caused by reduced communication between the nose and the pharynx.
- Doubt must increase if certain complications occur frequently such as:
- Recurrent catarrhal otitis: caused by tubal occlusion; often causing perforation of the eardrum, with outflow of fluid from the ear.
- Relapsing fever: caused by frequent infections, especially in the winter months.
- Alteration of the palatine structure and dental malocclusion: caused by the respiratory alteration.
- In children, loss of appetite.
- With a diagnosis of adenoiditis, a number of steps need to be taken:
- Blow your nose frequently.
- Clean the inside of the nose with physiological solution to be instilled several times a day. It is especially useful in small children who do not know how to blow it.
- Assume a slightly inclined position, with the head raised, to facilitate nighttime breathing. It may be useful to use a pillow under the mattress at head height.
- Stay hydrated, to keep any nasal secretions fluid and more easily eliminated.
- Use night humidifiers in rooms with a dry atmosphere.
- Use aerosol with physiological solution or Sirmione water while waiting for a therapy.
- To children (preschoolers):
- Facilitate feeding: see below What to Eat.
- Night observation: it is necessary to establish the severity of the disturbance (presence of apneas, duration, etc.).
- Pharmacological therapy: varies according to age; the little ones do not tolerate the same drugs to be administered to adults. Generally, it consists of: anti-inflammatories and / or antibiotics and / or antifungals / or antihistamines. For viral infections, remission is usually spontaneous and occurs in about 48 hours.
- If drug therapy fails, a microbiological culture may be required to detect a specific drug. The bacteria most often involved are: streptococci, moraxella and staphylococci.
- Surgery: to be used only when drug therapy is not conclusive. In children frankly affected by a pathology of the adenoids, some specialists advise to operate before school age (in order to avoid complications in learning and language development).
- Post-surgical rest: used to avoid bleeding and / or infections. It lasts at least 7-14 days. The person can drink liquids almost immediately and is free to counteract the pain by using certain medications.
What NOT to do
- Do not seek medical attention, especially if the infections are recurrent and close together, or if the symptoms of nasal hypertrophy / occlusion become important.
- For parents, do not carefully observe the clinical signs of the child or do not inform the pediatrician.
- Leave the nose blocked with mucus.
- Sleeping in positions that obstruct ventilation.
- Neglecting hydration: in this way the mucus becomes more difficult to expel.
- Sleeping in rooms with air that is too dry (for example in rooms with a stove or fireplace) or too humid.
- To children (preschool age): offer very hot and difficult to chew food.
- Do not comply with drug therapy.
- For allergy sufferers: expose yourself to allergens or fail to prevent allergic crises.
- If the disorder continues to show up several times a year, do not investigate further.
- Exclude surgery even if necessary.
- Do not respect the post surgical rest
What to eat
There is no specific diet to cure adenoid diseases, but by respecting the following principles it is possible to optimize the therapy:
- Ease of chewing and swallowing (especially for children): without the use of the nose it is impossible to chew and breathe at the same time. This requires foods that should not remain in the mouth for long. It is advisable to eat easily chewable foods, preferably liquid or creamy , at medium or room temperature.
- Improvement of the intestinal bacterial flora: it is useful to support the immune system and is often affected by antibiotic therapy.
- Plenty of anti-inflammatory and antioxidant molecules.
- Plenty of nutrients that support the immune system.
Practically:
- Among the first courses, prefer the soupy ones, the vegetable purees, the velvets and the creams
- Among the second courses, prefer soft cheeses, eggs, soft meats and fish.
- Among the side dishes and fruit, prefer those that are not very fibrous, tender, cooked and without peel.
- Promote the consumption of probiotic foods: they enrich the intestinal bacterial flora. Some are: yogurt, buttermilk, kefir, tofu, tempeh, miso, kombucha, sauerkraut, gherkins etc.
- Foods rich in soluble fiber and other prebiotics (vegetables, fruits, cereals, legumes and potatoes, especially cooked): together with carbohydrates (also not available) they nourish the physiological bacteria of the colon.
Anti-inflammatory molecules:
- Omega 3: they are eicosapentaenoic acid (EPA), docosahexaenoic (DHA) and alpha linolenic (ALA). They have an anti-inflammatory role. The first two are biologically very active and are mainly found in: sardines, mackerel, bonito, sardinella, herring , alletterato, belly of tuna, garfish, seaweed, krill etc. The third is less active, but constitutes a precursor of EPA; it is mainly contained in the fat fraction of certain foods of vegetable origin or in the oils of: soy, linseed, kiwi seeds, grape seeds etc.
- Antioxidants:
- Vitamins: the antioxidant vitamins are carotenoids (provitamin A), vitamin C and vitamin E. Carotenoids are contained in vegetables and red or orange fruits (apricots, peppers, melons, peaches, carrots, squash, tomatoes, etc.); they are also present in crustaceans and milk. Vitamin C is typical of sour fruit and some vegetables (lemons, oranges, mandarins, grapefruits, kiwis, peppers, parsley, chicory, lettuce, tomatoes, cabbage, etc.). Vitamin E can be found in the lipid portion of many seeds and related oils (wheat germ, corn germ, sesame, kiwi, grape seeds, etc.).
- Minerals: zinc and selenium. The first is mainly contained in: liver, meat, milk and derivatives, some bivalve molluscs (especially oysters). The second is mainly contained in: meat, fish products, egg yolk, milk and derivatives, enriched foods (potatoes, etc.).
- Polyphenols: simple phenols, flavonoids, tannins. They are very rich: vegetables (onion, garlic, citrus fruits, cherries, etc.), fruit and relative seeds (pomegranate, grapes, berries, etc.), wine, oil seeds, coffee, tea, cocoa, legumes and whole grains, etc.
- Nutrients that support the immune system:
- Vitamin C or ascorbic acid: it is mainly contained in sour fruit and raw vegetables. In particular: peppers, lemon, orange, grapefruit, tangerine, parsley, kiwi, lettuce, apple, chicory, cabbage, broccoli etc.
- Vitamin D or calciferol: it is mainly contained in: fish, fish oil and egg yolk.
- Magnesium: it is mainly contained in: oil seeds, cocoa, bran, vegetables and fruits.
- Iron: it is mainly contained in: meat, fish products and egg yolk.
- Lysine and glycine amino acids: they are mainly contained in: meat, fish products, cheeses and legumes (especially soy).
What NOT to Eat
In addition to respecting the principles dedicated to a healthy and correct diet, avoid:
- Food that is difficult to chew or too hot (especially important for children).
- Beverages containing dehydrating molecules: especially the caffeine in coffee and the ethyl alcohol in alcoholic beverages. Furthermore, alcohol negatively interacts with the metabolism of drugs.
- Spicy foods: they are irritating to the mucous membranes (pepper, chilli, curry, etc.). While they play a bactericidal role, they can make swelling worse.
- Milk and dairy products in the presence of antibiotic therapy; they can inactivate some medications
Natural Cures and Remedies
- Nasal washes with physiological water or Sirmione water.
- Herbalist:
- Herbal teas based on:
- Chamomile (Matricaria recutita L.): gives relief to edematous mucous membranes, thanks to its anti-inflammatory, sedative, bactericidal and antifungal properties.
- Echinacea (Echinacea angustifolia): has antiviral, immunostimulating, antibacterial and anti-inflammatory properties. It can be taken in the form of syrup or tablets).
- Propolis: antimicrobial, antifungal, antiviral activity (also in the form of tablets to suck).
- Spirea (Spirea meadowsweet): shows anti-inflammatory and calming effects (the extract contains antipyretic and analgesic salicylates).
- Suffumigi or fumigation:
- Mint (Mentha piperita): has balsamic, decongestant and anti-catarrhal properties.
- Bitter orange (Citrus aurantium L. var. amara): it has disinfectant, anti-inflammatory and decongestant characteristics.
- Eucalyptus (Eucalyptus globulus Labill): boasts the presence of anti-inflammatory, expectorant and balsamic molecules.
- Balsamic essential oils widespread in the environment: especially menthol, eucalyptol, etc.
Pharmacological treatment
- For viral adenoiditis:
- The administration of analgesics and antipyretics is almost always sufficient:
- Non-steroidal anti-inflammatory drugs (NSAIDs):
- Salicylates: acetylsalicylic acid (e.g. Aspirin ®), contraindicated under 14 years
- Propionic acid derivatives: ibuprofen (eg Moment ®), naproxen (eg Xenar ®), ketoprofen (eg Ketodol ®), dexketoprofen (eg Enantyum ®) and flurbiprofen (eg Benactiv throat ®).
- Acetic acid derivatives: ketorolac (eg Toradol ®), diclofenac (eg Dicloreum ®) and indomethacin (eg Indoxen ®).
- Sulfonylides: nimesulide (for example Aulin ®).
- Derivatives of enolic acid: piroxicam (eg Brexin ®), meloxicam (eg Leutrol ®), tenoxicam and lornoxicam.
- Phenamic acid derivatives: mefenamic acid (for example Lysalgo ®) and flufenamic acid.
- Selective COX-2 inhibitors: celecoxib (eg Artilog ®) and etoricoxib (eg Algix ®).
- Antipyretic analgesics:
- Paracetamol: for example Actigrip ®, Buscopan compositum ®, Codamol ®, Efferalgan ®, Panadol ®, Tachipirina ®, Zerinol ®.
- For bacterial adenoiditis, antibiotic drugs can be used:
- Amoxicillin and clavulanic acid: for example Augmentin ®, Clavulin ®.
- Cephalosporin: for example Cefaclor ®, Cefixoral ®, Cefporex ®.
Prevention
The prevention of diseases of the adenoids can only be applied if one is aware of the predisposition to their development; it consists of a greater attention to respiratory tract diseases. It is not applicable to prenatal or anatomical discomfort.
- Avoid nutritional deficiencies and support the immune system.
- Especially in the winter season, cover yourself carefully and avoid sudden changes in temperature.
- Avoid going to environments at risk of viral, bacterial or fungal infection. If this cannot be avoided, adopt very strict hygiene measures.
- Prevent allergic reactions by reducing exposure and using special vaccines.
- Sometimes it is necessary to give up activities such as: swimming or diving, sports games in the rain (rugby, football) etc.
- At the first symptoms and no later than the third day, seek medical attention.
Medical Treatments
- Aerosol: it is a home insufflation method, generally used for drugs but which can also be used with water and phytotherapeutic extracts (it is advisable to consult a doctor).
- Surgery: it is called adenoidectomy and consists in the removal of the adenoids. It is essential when the disease does not heal and becomes chronic or when the adenoids create an obstruction for the airways (congenital anatomical factor).
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