Chronic diseases of the upper respiratory tract
Most often, a chronic disorder of nasal breathing is observed with hypertrophy of the third or pharyngeal tonsils - adenoids. The pharyngeal tonsil has a rich network of lymphatic vessels leading to the deep lymph nodes in the lower jaw area. Therefore, chronic inflammatory processes of the pharyngeal tonsil can cause a long subfebrile condition. The follicles in the immediate vicinity of the pharyngeal tonsil on the posterior, pharyngeal wall, in the region of the tongue root and at the pharyngeal openings of the Eustachian tubes, together forming the globular lymphatic ring of Pirogov-Valdeier, also react in acute and chronic inflammatory processes with hyperplasia with a decrease in the basic barrier function of the lymphatic ring, ie, the ability to hold bacteria and their toxins.
To determine the causes of difficult nasal breathing, it is of great importance not only to examine a laryngologist, but first of all a detailed questioning and examination by a child's doctor. Chronic hyperplasia of the pharyngeal ring is most often observed in children with lymphatic exudative diathesis;such hypertrophied tonsils at every relapse of catarrhal inflammation create the soil for lymphogenic and bronchogenic spread of the inflammatory reaction.
Laryngologists distinguish: a) chronic inflammation or hyperplasia of the third amygdala, i.e. adenoidal dilations, and b) chronic inflammation of the palatine tonsils, i.e. chronic tonsillitis. In the genesis of disturbances in external respiration, adenoidal dilations are particularly important, because narrowing of the holes makes the khoan predominantly through the mouth, and the breath takes a snoring character, especially during sleep. With significant adenoidal incisions, the child's face takes on a characteristic appearance;it is somewhat compressed laterally as a result of the delay in the development of the facial part of the skeleton and adnexal cavities, and in connection with this the firm sky has an inverted dome, the upper jaw lags behind in growth, so that the lower one is protruding. Half-open mouth with a drooping lower lip, some goggles give the child a characteristic dull look. In addition to frequent colds, the usual complaints are a tendency to cold with a long subfebrile temperature, and often to chronic bronchitis. In the genesis of these catarrhas, a number of points are important: first, inadequate cleansing and warming of the atmospheric air due to difficulty in nasal breathing, which causes mechanical and temperature irritation of the respiratory mucosa, secondly, inflammation of the adenoidal lesions, and, consequently, lymphogenous penetration of the infection inlungs. Finally, the presence of adenoids impairs lung ventilation due to a decrease in the volume of breathing. In children with significant adenoids, most functional tests of external respiration usually show a deviation from normal values. Low ventilation leads to a decrease in gas exchange and hypercapnia;as a result, the lung tissue in a child is structurally altered by the development of perivascular and peribronchial infiltrates.
Chronic interstitial pneumonia is an extremely frequent disease in a child with adenoids. The presence of such pneumonia even more changes the thorax of the child, already deformed due to inadequate respiratory excursions.
It is sometimes enough for a pediatrician to hear an altered naked child( a nasal hue with a difficult pronunciation of words with two consonants, for example "days") to judge the presence of significant adenoids. Often, mothers also complain about child's lethargy, headaches, lag in school hours and memory loss, which is explained by a decrease in gas exchange in the body, which negatively affects higher nervous activity-the child's intellect and behavior.
All the symptoms described above should immediately stop the attention of the child's doctor both in the polyclinic and in the school, especially since more often one of the above symptoms comes to the fore. The final diagnosis is established by the otolaryngologist, but the degree of adenoidal enlargement( I, II, III) often indicated does not coincide with the clinical symptoms. It is connected, obviously, with the nature of the causative agent of the infectious process in adenoids and its ability to spread( and not with the magnitude of adenoidal disruptions), as well as with the characteristics of the reactivity and type of nervous activity of the child.
Therefore, adenoids of all degrees require treatment: climatic with quenching of the body, irradiation with quartz or UHF;significant deletions are deleted promptly. Exceptionally favorable, even with significant adenoids with peripheral lymphadenitis, affects a 2-month stay by the sea for children. From medicines fish oil is recommended, from time to time - iron with phytin, sometimes iodine potassium or iodine iron.
Read more Chronic tonsillitis in childhood