Vegetations or adenoids, when should I operate?

As children we present structures or organs that atrophy or disappear when we get older, such as vegetations, which are located in the back of the nostrils and that, if they give problems, surgery is resorted to.

What are vegetations?

Although they are popularly called this way, the medical name is adenoids or pharyngeal tonsil. It is a lymphatic tissue mass which is located inside the face, just behind the nose, in an area called the rhinopharynx, so we cannot see them by opening our mouths.

Like other organs in the child, they atrophy and disappear with growth and its function is to maintain health, trapping bacteria and viruses that the child inhales or swallows. Their function is similar to that of the tonsils, both being an infantile organ through which the body "learns" to recognize the strange and to defend itself.

Adenoids are part of a larger structure or organ called "Waldeyer's ring", which forms a kind of belt that borders the inside of the mouth and nose, right where we swallow and breathe, and where potentially dangerous microorganisms can enter. East defensive belt consists of:

• Angina or palatine tonsils,
• The lingual tonsil, located far back on the tongue,
• The adenoids or pharyngeal tonsil.

From the 5 years, at the time when the immune system is wiser and more effective in fighting infections, the vegetations shrink or atrophy progressively until they become practically imperceptible in adolescence. This process is called lymphoid involution.

Inflammation: Hypertrophic adenoids

Like any structure in the body, adenoids can cause problems, specifically related to their function. By trapping germs that pass through the airway, lymphatic tissue can become inflamed temporarily while fighting infection. It is characteristic in young children between 3 and 6 years and it is caused by those of the upper respiratory tract (colds and colds) that occur especially at the beginning of the school stage.

1. The adenotonsillar pathology

It represents one of the most frequent reasons for (more than 4 million consultations a year in Spain). Infection and obstruction frequently coexist and a certain degree of adenoid hypertrophy occurs and is considered physiological up to 5 years.

In most cases the inflammation is transient and improves, but sometimes adenoids can become infected causing adenoiditis. Inflamed and / or infected adenoids can make breathing difficult and cause the following derived problems:

• Stuffy nose that forces the child to breathe through the mouth
• Snoring and trouble sleeping at night
• Swollen glands in the neck
• Ear problems, such as serous otitis

Once the vegetations return to their normal size, after the resolution of the infection, these symptoms disappear.

2. Adenoid hypertrophy

It is something similar that lasts longer in time, since we are talking about a chronic nasal obstruction. When we talk about hypertrophy, we mean increase in size. Popularly, this adenoid hypertrophy is said to be a child "has vegetations." By this we mean that your adenoids overgrow and cause problems.

We must not forget that all children have vegetations, and whether they cause problems or not is due to the relationship between their size and cavity in which they are found, the rhinopharynx. The characteristic symptoms They are due to the obstruction of the air passage through the nose, as its posterior outlet is obstructed. We are talking about symptoms lasting more than 6 months:

• The child always breathes with his mouth open, whether or not he has a cold
• Snoring when sleeping
• He speaks with a nasal voice, as if his nose was always stuffed
• Bad breath in the morning
• Persistent nasal mucus and congestion without an accompanying cold
• Recurrent otitis media or serous
• Apneas during sleep: pauses without breathing that do not allow a good rest
• They may have ogival palate

How is adenoid hypertrophy diagnosed?

What adenoids cannot be seen with the naked eye we must confirm the diagnosis by confirming its increase in size. The specialist's assessment is decisive to assess whether we should operate or not.

• The otolaryngologist usually uses a special mirror To see them or a little camera called fiberscope
• A radiography of It can also be used to assess the size of the vegetations
• To assess the impact of adenoid hypertrophy on sleep, a sleep study can be requested to assess the existence and intensity of apnea episodes.

When should vegetations be operated?

Removal of the adenoids is called adenoidectomy and is usually done in children older than 2 years. Removal of adenoids is recommended when medication doesn't resolve symptoms derived from the increase in effect size or if they are making the child very sick.

Vegetations are not a clearly delimited organ, so the operation consists of "Reduce" its size and not in its complete removal. There may be cases in which a second adenoidectomy is required after months or years, especially if the first was performed at an early age.

Removal of tonsils and vegetations at the same time

Sometimes the tonsils and adenoids are removed at the same time, this means that a child undergoes a tonsillectomy and adenoidectomy. Are two very simple operations being able to return home the same day of the operation. In none of these operations is it necessary to put stitches since the operated areas heal themselves. After the operation, the child will have a sore throat and will have to follow a soft diet for several days.

If the operation has been carried out successfully, after a few days the child will breathe well through his nose, he will stop snoring, apnea and the timbre of the voice will be higher and less nasal. In the long term, recurrent otitis should decrease.

What you should know:

• Their function is similar to that of the tonsils, both being an infantile organ through which the body "learns" to recognize the strange and to defend itself.
• By trapping germs that pass through the airway, lymphatic tissue can temporarily become inflamed while fighting infection.
• It is recommended to remove the adenoids when the medication does not resolve the symptoms derived from the increase in size effect or if they are making the child very ill.

Pediatric specialist