Problems of Adenoids and when to remove it

Some problems associated with adenoids
Swollen or enlarged adenoids are common in children. Causes include:
• Infections with viruses or bacteria. Once an infection clears, the swelling often goes down but sometimes the adenoids remain enlarged.
• Allergies.
• Often there is no apparent cause.

Symptoms of swollen enlarged adenoids include the following
• Difficulty breathing through the nose. The child then mainly 'mouth breathes'.
• The nose sounds blocked - that is the child may talk with a nasal voice (as if someone is pinching the nose when they talk).
• A constantly runny nose.
• Breathing through the nose may be noisy.
• Snoring at night. In severe cases sleep may be disrupted by the blocked nose and difficulty breathing.
• Swollen adenoids may block the entrance of the eustachian tube. This is the tube that goes from the back of the nose to the middle ear. It normally allows air to get into the middle ear. If this tube is blocked it may contribute to the formation of 'glue ear' (fluid in the middle ear). See separate leaflet called 'glue ear'.

What is the treatment for enlarged adenoids?
In most cases no treatment is needed. Often the symptoms are mild but may flare up during a cold or throat infection. Adenoids normally gradually shrink in later childhood and usually almost disappear by the teenage years. So symptoms tend to clear in time.
If symptoms are severe then a doctor may consider removing the adenoids. For example, if a child regularly has difficulty sleeping or disrupted nights sleep due to a blocked nose. Also, some children with glue ear may benefit from removing the adenoids.

Tonsils and Adenoids

What are adenoids and tonsils?
Tonsils
Tonsils are made of soft glandular tissue and are part of the immune system. You have two tonsils, one on either side at the back of the mouth. Tonsils vary in size from person to person. A main function of tonsils is to trap bacteria and viruses (germs) which you may breathe in. Antibodies and immune cells in the tonsils help to kill germs and help to prevent throat and lung infections.
You can normally see your tonsils by opening your mouth wide and looking in a mirror. They are the two fleshy lumps that you can see at the sides and back of the mouth.

Adenoids
Adenoids are also made of glandular tissue and are part of the immune system. They hang from the upper part of the back of the nasal cavity. Adenoids get bigger after you are born but usually stop growing between the ages of 3 and 7 years. You cannot see your adenoids. If needed, a doctor can look at the adenoids either by using a light and a small mirror held at the back of the mouth, or by using a small flexible telescope. Occasionally, an x-ray is done to determine the size of the adenoids.
Like tonsils, adenoids help to defend the body from infection. They trap bacteria and viruses which you breathe in through your nose. Like tonsils, they contain cells and antibodies of the immune system to help prevent throat and lung infections.
Although tonsils and adenoids may help to prevent infection, they are not considered to be very important. The body has other means of preventing infection and fighting off bacteria and viruses. In fact, the adenoids tend to shrink after early childhood, and by the teenage years they often almost disappear completely. Generally, you can have your tonsils and adenoids removed without increasing your risk of infection.

What are the treatments for aphthous ulcers?

Treatment aims to ease the pain when ulcers occur, and to help them to heal as quickly as possible. (There is no treatment that prevents aphthous mouth ulcers from recurring.)
• No treatment may be needed. The pain is often mild, particularly with the common 'minor' type of aphthous ulcer. Each bout of ulcers will go without treatment.
• General measures include:
o Avoid spicy foods, acidic fruit drinks, and very salty foods (such as crisps) which can make the pain worse.
o Use a straw to drink, to by-pass ulcers in the front of the mouth. (Note: do not drink hot drinks with a straw, as you may burn your throat. Only cold drinks.)
o Use a very soft toothbrush. See a dentist if you have badly fitting dentures.
o If you suspect a medication is causing the ulcers, then a change may be possible. For example, if you are using oral nicotine replacement therapy (nicotine gum or lozenges), it may help to use a different type instead such as patches or nasal spray.
• Lidocaine paste (gel) for pain control
• A painkilling oral rinse, gel, or mouth spray may help to ease pain. However, the effect of each dose does not last very long.
Other treatments may be tried if the above do not help or where the pain and ulceration are severe.

What causes aphthous mouth ulcers?

The cause is not known. They are not infectious, and you cannot 'catch' aphthous mouth ulcers.
• In most cases, the ulcers develop for no apparent reason in people who are healthy.
• In some cases, the ulcers are related to other factors or diseases. These include:
o Injury - such as badly fitting dentures, a graze from a harsh toothbrush, etc. Increased acidity can cause mouth ulcers too.
o Changes in hormone levels. Some women find that mouth ulcers occur just before their period. In some women, the ulcers only develop after the menopause.
o Some ex-smokers find they develop ulcers only after stopping smoking.
o A lack of iron, or a lack of certain vitamins (such as Vitamin B12 and Folic acid) may be a factor in some cases.
o Rarely, a food allergy may be the cause.
o Mouth ulcers run in some families. So, a genetic factor may play a part in some cases.
o Stress or anxiety is said to trigger aphthous mouth ulcers in some people.
o A reaction to a medication is a rare cause. For example, anti-inflammatory drugs have been reported to cause mouth ulcers in some people.
o Mouth ulcers are more common in people with Crohn's disease, coeliac disease, HIV infection, and Bechet's disease. But the ulcers may not be aphthous type.
Tell your doctor if you have any other symptoms in addition to the mouth ulcers. Sometimes a blood sample or other tests are advised if any of the above conditions are suspected.

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What are aphthous mouth ulcers?

Aphthous mouth ulcers are painful sores that can occur anywhere inside the mouth. They are the most common type of mouth ulcer. At least 1 in 5 people develop aphthous mouth ulcers at some stage in their life. Women are affected more often than men.
There are three types:
• Minor aphthous ulcers are the most common (8 in 10 cases). They are small, round, or oval, and are less than 10 mm across. They look pale yellow, but the area around them may look swollen and red. Only one ulcer may develop, but up to five may appear at the same time. Each ulcer lasts 7-10 days, and then goes without leaving a scar. They are not usually very painful.
• Major aphthous ulcers occur in about 1 in 10 cases. These are 10 mm or larger. Usually only one or two appear at a time. Each ulcer lasts from two weeks to several months, and then goes but leaves a scar. They can be very painful - eating may become difficult.
• Pinpoint aphthous ulcers occur in about 1 in 10 cases. These are tiny, about 1-2 mm across. Many occur at the same time, but some may join together and form irregular shapes. Each ulcer lasts one week to two months. (These are sometimes called 'herpetiform ulcers', but they have nothing to do with herpes or the herpes virus.)
Aphthous ulcers usually first occur between the ages of 10 and 40. They then recur from time to time. There can be days, weeks, months, or years between each bout of ulcers. The ulcers tend to recur less often as you become older. In many cases, they eventually stop coming back. Some people feel a burning in part(s) of the mouth for a day or so before an ulcer appears.

My next blog would be on the causes of Aphthous Ulcer

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