. HYPERPLASIA OF THE PHARNYCEAL TONSIL (Adenoids, adenoid vegetations) vegetations are extremely common during childhood. Kafetnann found that 17 per cent. of school children ex amined by him had adenoids, Schmuckmann 30 per cent., Felix from 28.52 per cent. to 35.1 per cent., and Wilbert found that 62 per cent. of ehildren had adenoids. The condition is most common between the sixth and eleventh years, and fairly uncommon after the age of puberty. Klirner has found adenoids in 313 per cent. of sea-coast dwellers.
symptoms depend largely upon the size of the growth in the nasopharynx, and on the presence or absence of inflam matory complications.
(a) Symptoms Caused by Nasal Obstruction.—The nasal obstruc tion results.in mouth breathing, and this is responsible for the. char acteristic facial expression of children with adenoids. The mouth is kept open, the lips are thy, the nasolabial folds are drawn down, and the eyes are dull and heavy, giving the face a stupid expression. Many of the children are in poor physical and mental condition. This deficient mentality is caused by impairment of hearing, more than two-thirds of the children with adenoids being deaf (Abeles, lialbeis, Hartmann, -Wilbert). This deafness is the result of obstruction of the pharyngeal ostium of the Eustachian tube, lead ing to deficient ventilation of the middle ear, salpindtis, and retraction of the tympanic membrane. The voice lacks resonanee, and children often snore during sleep. Headache is quite common. Deformities of the bones, particularly of the superior maxillary, consisting in a highly arched hard palate and pointed alve olar process, also result from the interference with nasal breathing.
Irregularities of the teeth are also common. Faulty development of the thorax (flattening, chieken breast, Troltsch, Haug, Hopmann), probably occur only in cases of rachitis, and the nasal obstruction can only be considered one of many etiological factors. Spinal curvatures have also been observed (Redard, Zieni).
Exophthalmos is an interesting complication (Holz, Spieler). In stead of attributing this to a function of the hyperplastic tonsil similar to the thyroid (Holz), it is probable that a retroliulliar lymph-stasis (Spieler), or anomalies of the orbit (Escherieh), play the main rifle.
(b) Inflammatory Complications.—Swelling of the cervical glands shows how intiinately adenoids and inflammatory processes are asso ciated, and such involvement of the glands is of great symptomatic and diagnostic importance. The faulty nasal breathing explains the frequent occurrence of catarrhal conditions, which may be mild or severe. They are not limited to the tonsils, but may involve the nose as well as the pharynx (follicular pharyngitis). A stubborn mum purulent rhinitis is a common symptom in children, and often leads to hyperplastic conditions of the nasal mucosa. Complications on the part of the middle ear and respiratory- passages are common.
(c) Effects upon Remote Organs and their Functions.—Catarrhal conditions of the larynx, and collections of tenacious secretion in the pharynx produce severe spasmodic coughs with retelling, vomiting and even spasm of the glottis. Night terror.s are not uncommon. There is no positive proof that asthma, chorea, epilepsy, enuresis and other neuroses are the result of adenoids, but speech disturbances, particularly stain mering, may have some connection with this condition. Adenoids occur so frequently also in stuttering (Kafemann, Berkhan, Karutz, Pinder), that it is wise to beg-in treatment of such cases with an adenotomy.
Importance of Adenoids to the General and mental deficiencies are common symptoms. Children are unable to concentrate the attention, they are indifferent, and tlo not keep up with children of their OW11 age (nasal aprosexia, Gaye). It It of the greatest importance to recognize the symptoms on the part of the ear. Deafness and various other anral diseases are rommon.