What are vegetations?
Vegetations or adenoids are tonsil-like glands located in the middle of the nose at the back of the throat where the nasal passages, throat and Eustachian tubes meet. During infancy they are part of the body’s defense system against infections. Their main function is to retain and capture substances that could be harmful to the body (bacteria, viruses or dust). Once captured, they process them and activate the immune response or defenses.
Vegetations cause problems in childhood when they grow more than normal (either naturally or due to repeated airway infections). Vegetations increase in size from birth until the child is 4 years old, and then shrink until they almost disappear in adulthood. The increase in size is a consequence of infections, when the immune system is working. All young children usually suffer from this pathology but it is when symptoms start to appear that it is considered a problem.
Swollen vegetations are always a symptom of an infection.
Prognosis of the disease
The increase in the size of the vegetations is a consequence of successive infections, something that would not be serious if it were not for its location, since the increase in its size generates an increase in mucus, obstructing the child’s nose and blocking air from entering the ears through the Eustachian tubes. This blockage causes otitis (ear infection) and rhinopharyngitis (inflammation of the rhinopharynx). If there is an enlargement of the vegetations there is infection. As the adenoid grows, ventilation is worse, which helps to cause infection. And if the air passes through but contains germs, an infection occurs which, in turn, causes the vegetations to grow.
Symptoms of vegetations
Symptoms of vegetations begin to develop when the upper airway becomes blocked. Some of the symptoms that may appear are:
- Breathing changes: the nose is blocked, so the child is forced to breathe through the mouth.
- Snoring and sleep apnea: children with vegetations snore when they sleep. In addition, depending on the case, they may have pauses in breathing (sleep apnea). This causes them to sleep poorly and be restless and tired during the day.
- Difficulty swallowing. The fact of not being able to sleep makes them breathe with their mouth open, which, in turn, makes the throat dry and painful, making it difficult to swallow food.
- Increased mucus.
- Increased infections. Increased secretions, with the consequent difficulty in draining them and allowing air to circulate normally, can cause cough and infections such as sinusitis, otitis or pharyngitis.
- Nasal obstruction and difficulty breathing through the nose.
- Dry mouth.
- Bad breath when waking up.
- Voice alterations.
- Pain in the ears, and even oozing of the ears.
- Colds with mucus and cough.
- Repeated ear infections (otitis).
Medical tests for vegetations
Vegetations cannot be seen with a simple examination of the throat, so to diagnose them, the specialist must perform a physical examination to assess whether they have increased in size. A lateral x-ray of the pharynx can also be performed to see the size. In severe cases in which sleep apnea is associated, a sleep apnea study should be performed to assess the intensity of the episodes.
What are the causes of vegetations?
Vegetations can appear naturally (usually during fetal development) or develop during the school period as a result of repeated respiratory tract infections (colds or flus).
Some vegetations can be caused by Streptococcus virus or Epstein-Barr virus, among others.
People in whom vegetations have developed from the fetus will be more likely to have symptoms from an early age, including more of the normal symptoms and more respiratory tract infections, as well as an easier time catching colds. Also, people with vegetations are more at risk for tonsillitis, headaches and sore throats.
Can it be prevented?
Vegetations cannot be prevented. However, the consequences that the symptoms may have on the child can be avoided. It is recommended to see an ENT specialist when the child presents the first symptoms: difficulty breathing through the nose or snoring during the night.
Treatments for vegetations
The first thing the specialist will do is to administer antibiotics to lower the infection in the tonsils, adenoids and sinuses. This will reduce the production of mucus and free the nasal passages, but not the inflammation.
However, the most advisable when all other symptoms are associated is the surgical removal of the adenoid glands, usually together with the tonsils, to avoid possible complications. The operation is performed under general anesthesia and orally, and consists of curettage (scraping) of the adenoids or vegetations protruding from the mucosa. It is a very brief intervention that lasts about 40-50 seconds. After this, the child will be 45 minutes in the center and will return to the consultation in a week, for review with the specialist. It is preferable that the operation is performed at 2 years of age but if the child has repeated severe otitis or seromucous (with fluid inside the ear), it is independent of the age at which it is performed. If the child is less than 9 months old, the specialist will study the best way to treat the child, normally without surgery.
Which specialist treats it?
The specialist who treats vegetations is the expert in Otorhinolaryngology. Specifically, vegetations are treated by the specialist in Pediatric Otolaryngology.