NASO-PHARYNX, DISEASES OF. Post-nasal Adenoid Growths (Adenoid Vegetations).
The recognition of this condition has been of inestimable value to humanity. To Wilhelm Meyer, of Copenhagen, is due the credit of having first brought the subject in its clinical and pathological aspects before the medical world.
Symptoms.—Among the earliest symp toms characterizing post-nasal adenoid hypertrophy is obstruction to nasal res piration. The naso-pharyngeal stenosis inay be partial or complete, this depend ing upon the size and position of the vegetations and upon the accompanying inflammation. Even with partial occlu sion, however, the patient often finds it more comfortable to breathe, at least partially, through the mouth. Dryness of the throat on waking is often com plained of. This is due to the mouth breathing, and forms the source of vari ous pharyngo-laryngeal disturbances.
Among 4080 patients suffering from affections of the nose, throat, or ear, 426 had adenoid tumors in the vault. Of these 69 per cent. had symptoms of nasal obstruction; 37 per cent. suffered with tonsillitis or pharyngitis; 59 per cent. had ear complications, of whom 110 were cases of suppurative otitis and 142 were cases of deafness without suppuration. Y. Arslan (Jour. of Laryn., etc., Dec '95).
Still, cases are sometimes seen that breathe with the mouth closed despite the presence of vegetations.
In infants nursing is often hampered in consequence of the obstruction, and cleansing of the nose is rendered difficult, owing to the fact that the expiratory current is interrupted by occlusion of the upper pharynx.
The voice is usually altered. The im pairment is occasioned by an interference of the passage of the waves of sound through the post-nasal space. Stuttering has also been ascribed in some cases to post-nasal obstruction. The tumor some times causes a sensation suggesting the presence of a foreign body in the naso pharynx or at the back of the throat which cannot be got rid of by any effort on the part of the patient. Headache is sometimes complained of.
Associated with adenoid vegetations is a condition known as aprosexia, or lack of ability to concentrate attention. Sleep is often disturbed and the child grows "nervous" and irritable. Attacks of suf focation during sleep occur occasionally, out of which the patient is aroused ex hausted and in a state of profuse per spiration. The mouth-breathing is usu
ally noisy, and snoring is not infrequent. Night-terrors are sometimes witnessed. Enuresis is often traceable to post-nasal _growths.
As to 1\ hether enlarged tonsils and adenoids produce enuresis the following conclusions are reached: 1. In 350 cases of enlarged tonsils enuresis was present in 104. 2. But only 157 out of these 350 were pure tonsillar cases; the remaining 193 were complicated in some form or other. 3. Of the uncomplicated 157 cases only 26 had enuresis, while in the other 193 eases enuresis was found not less than 78 times. 4. In complicated cases of enlarged tonsils and adenoids, enuresis occurs at the rate of 40 per cent.; in uncomplicated cases at the rate of about 16 per cent.
Notes found of 23 cases in which the tonsils had already been removed and who from five to nine months after the operation developed enuresis, some 5 without any apparent cause, the other 18 during convalescence from acute in fectious diseases. These cases have not been included in this paper. Ludw ig Freyherger (Treatment, Mar. 9, '99).
Cough due to laryngeal irritation brought on by constant buccal breathing usually persists as long. as the naso pharyngeal vault remains occluded.
Children in whom adenoids exist 111T more susceptible to croup, laryngitis, bronchitis, and pneumonia. F. A. Bot tome (N. Y. Med. Jour., May 22, '97).
Deafness or impaired hearing in early life without doubt has its source in post nasal adenoid hypertrophy in the major ity of cases. Normal or perfect ventila tion of the tympanic cavity is impeded, which condition may ultimately lead to retraction of the membrana tympani and induce tinnitus aurium. The cause and course of chronic otorrh(ea to which so many children are subject, especially those of the scrofulous or tuberculous temperament, are very frequently refer able to adenoid vegetations. Inflamma tory states of the lymphoid tissue induced by exposure to temperature-changes or the exanthematous diseases generally pro duce catarrhal affections of the Eusta chian tube or of the mucous membrane lining of the tympanic cavity, which may end in a chronic suppurative process of the middle ear, accompanied, as the case may be, by mastoid complication. Fre arat. he is the result of press \(rcist. Li on the Eustachian cushion r 1,v adenoid growths, causing I,‘ t ,1 and irritation of the tube.