• Diagnostics difficulties of adenoid vegetations in children

Diagnostics difficulties of adenoid vegetations in children

SOVREMENNAYA PEDIATRIYA.2018.5(93):11-13; doi 10.15574/SP.2018.93.11

Kosakivska I. A.
Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine

The diagnosis of adenoid vegetations and chronic adenoiditis does not commonly cause any difficulties.
Objective: to improve the quality of adenoid vegetation diagnostics.
Materials and methods. In total 183 children aged from 2 to 15 years with adenoid vegetations were followed-up. In the anterior and posterior rhinoscopy, the adenoid vegetation size and state (signs of inflammation, mucoid or suppurative discharge) were evaluated. In front rhinoscopy, endoscopes with different angles of vision were used (0° and sometimes 30°). Posterior rhinoscopy was performed using a nasopharynx speculum or endoscope with 70° angle of vision. In some cases, digital nasopharynx examination was performed due to the impossibility of visual assessment of the nasopharynx.
Results. In most cases, the diagnosis of adenoid vegetations caused no difficulties. There were adenoid vegetations of grade II in 27.3% of cases, and degree III — in 72.7%. In 2.7% of cases, the lymphoid tissue from the nasopharynx protruded through the choanas into the nasal cavity. In one patient, adenoid vegetations protruded into the nasal cavity by 3 cm, and the lymphoid tissue was covered with mucus and simulated a bilateral choanal polyp. In 6.6% of patients, there was a deviated nasal septum, 0.6% had nasal synechias, 3.8% — hypertrophy of the nasal concha, in 5% of cases there was allergic rhinitis, in 0.6% — the mucocoele of the ethmoidal labyrinth, in 0.6% of cases — Tornwaldt cyst was diagnosed, 1.1% — foreign bodies of the nasal cavity, 1.6% — choanal polyp, which significantly challenged or disabled anterior rhinoscopy and examination of the nasopharynx with endoscope through the nasal cavity. Difficulties in posterior rhinoscopy were connected with the age peculiarities of a child or increased emetic reflex, and in one case, it was stipulated by cicatricial changes in the nasopharynx. In one child, an angiomatous polyp of the nasopharynx was diagnosed, and in one case — the Burkitt's tumour.
Conclusions. Adenoid vegetation is the most common paediatric disease, the diagnosis of which usually does not cause any difficulties. Diagnosis of adenoid vegetations using direct rhinoscopy can be difficult due to diseases of the nasal cavity and paranasal sinuses, and the posterior rhinoscopy can be challenged by tumours or scars in the nasopharynx and the child's age-related anatomic and physiological features. For the purpose of differential diagnosis of adenoid vegetations, CT, MRI and repeated histological examination should be used if considered necessary.
Key words: adenoid vegetation, diagnostics, children.

REFERENCES

1. Antoniv VF, Aksenov VM, Portyanoy MG. (2006). Adenoidyi — adenoidnaya bolezn. Diagnoz stavit mat. Tezisyi 17 s'ezda otorinolaringologov Rossii. Nizhniy Novgorod: 418.

2. Bezshapochnyiy SB, Gasyuk YuA, Smeyanov EV. (2017). Giperplaziya i vospalenie glotochnoy mindalinyi. Kyiv: Lohos: 123.

3. Kosakivska IA. (2016). Pharyngeal tonsil hypertrophy, choanal polyps simulates. Sovremennaya pediatriya. 5(77): 137—138. doi 10.15574/SP.2016.77.137

4. Laiko AA, Zabolotnyi DI, Kosakovskyi AL ta in. (2006). Adenoidni vehetatsii ta adenoidyty. Kyiv: Lohos: 171.

5. Laiko AA, Zabolotnyi DI, Melnykov OF ta in. (2010). Adenoidyt. Kyiv: Lohos: 178.

6. Laiko AA, Zabolotnyi DI, Rautskis PA ta in. (2010). Hipertrofiia hlotkovoho myhdalyka. Kyiv: Lohos: 168.

7. Laiko AA, Kosakovskyi AL, Zabolotna DD ta in. (2013). Dytiacha otorynolarynholohiia: natsionalnyi pidruchnyk. Laiko AA (red.). Kyiv: Lohos: 576.

8. Puhlik SM, Neyvirt EG. (2002). Adenotomiya: istoricheskiy aspekt. Rinologiya. 2: 70—71.

9. Puhlik SM. (2016). Adenotomiya — istoricheskiy ekskurs. Zdorovia Ukrainy. 1: 37—39.

10. Talalaienko IO, Boienko SK, Boienko DS ta in. (2013). Diahnostyka i likuvannia khronichnykh zapalnykh zakhvoriuvan limfadenoidnoho hlotkovoho kiltsia u ditei: navchalnyi posibnyk. Donetsk: DonNMU: 150.

11. Fujioka M, Yooung LW, Girdany BR. (1979). Radiographic Evaluation of Adenoidal Size in Children: Adenoidal-Nasopharyngeal Ratio. AJR. 133; 4: 401—404. https://doi.org/10.2214/ajr.133.3.401; PMid:111497

Article received: Feb 13, 2018. Accepted for publication: Aug 27, 2018.