Inflammatory pathology of VA
Children with nasal congestion, babies with completely stuffy nose have to breathe through their mouth, fast breathing, irregular rhythm, stop eating, stop feeding
In the throat, there are many lymphocytes scattered throughout the mucosa or concentrated in blocks on the front of the throat called the Waldeyer ring which includes: tap tonsils (Amygdale de Gerlach) and the nasopharyngeal tonsils (Amygdale de Luschka).
When this organ becomes inflamed and overgrowths called adenoids, it can interfere with breathing air.
Normally, when the VA block grows up to 6-7 years old, then atrophy, especially can be seen in adults.
The rate of VA in our country is about 30% of children, the maximum age is 2-5 years old.
Acute VA inflammation
Acute inflammation, exudate or purulent in the tonsils de Lushka at an early age, can also be seen in older children and adults (but very rarely).
Virus: Adenovirus, Mycovirus, Rhinovirus...
Bacteria: Staphylococcus aureus, group A beta-haemolytic streptococcus, Haemophilus Influenzae ...
In the baby, onset suddenly, high fever 40- 41 0 C, often accompanied by the events of a severe reaction such as spasm of the glottis, convulsions. In older children, there may also be a sudden onset of high fever, accompanied by spasm of the larynx, ear pain and sometimes a meningeal reaction, but milder progression in the child.
Children with nasal congestion, babies who can have completely stuffy nose must breathe through their mouths, breathe quickly, have irregular rhythm, stop eating, and stop feeding. Older children do not have a complete stuffy nose but snore, especially at night, voices with closed nose. In adults, if there are still pharyngitis behind the tongue, tinnitus, hearing loss.
Nasal cavity filled with mucus, unable or difficult to examine the nasopharynx through the nose first. In older children, after removing the mucous nose in the nasal cavity, placing the drug to shrink the nasal mucosa can see the VA in the dome covered with pus.
Throat examination shows red mucosa, a white, yellow mucus covering the back of the throat lining flowing down from the arch.
Ear examination: the eardrum loses its shade, becomes Gray, slightly concave due to obstruction of the ear canal, a very valuable symptom to diagnose VA.
Small lymph nodes can be palpable in the corner of the jaw, the carotid groove, sometimes even the posterior sternum, slightly painful, and there is no peri-lymphadenitis.
Indirect rear nose exam with a small mirror in older children and adults will see a swollen, red, swollen nasopharynx, with mucus covering on top of the nasopharynx.
Finger palpation should not be performed during acute inflammation.
Chronic VA inflammation
Saying yes VA means VA is big or inflamed. Chronic VA is an overgrowth or fibrosis of VA after acute multiple infections.
Appears from 18 months to 6-7 years old.
Often mild fever, babies develop slowly for their age, less agile, poor appetite, thin people, blue skin. Children with poor concentration of thoughts often due to slightly distracted ears and lack of oxygen brain due to chronic lack of breathing, often poor learning.
Nasal congestion: at first a little stuffy, then more and more stuffy. Children often open their mouths to breathe, voice closed nose.
The nose is often inflamed, with mucus secreting and a runny nose sticking out of the front nose.
Sleep restless, loud snoring, startled.
Poor or inflamed headphones.
Nasoscopy before: nasal passages are full of mucus, oedema of the nasal mucosa, swelling of the lower nose. Absorb all mucus, shrink the nasal mucosa, you can see a shiny, reddish mass in the posterior nose.
Post-nasal exam is performed in older children and adults and finds that the roof of the arch has a cavity occupying the nasopharynx, covering most of the posterior nose.
Palpation of the palate: with the tip of the index finger, we can assess the mass, the density of the rough mass.
Throat examination: the back of the throat has many large pea-sized lymphocytes and mucous nose flowing from the arch to the throat.
Ear exam: scarred or recessed eardrum, pink due to total congestion in the eardrum or upper posterior angle.
The baby has a VA face: blue skin, open mouth, large teeth, deviated teeth, upper lip pulled up, long lower lip, eyes wide, innocent.
Based on the symptoms of stuffy nose, nasal congestion, cough and mild fever, loud snoring, sleep with mouth open, hearing loss.
Clinical examination: front and posterior nasal examination shows pus mucus fluid and can detect masses, especially when this lymphatic organization is too large and has caused frequent infections in the ears, respiratory tract, and gastrointestinal tract. .
Bronchial laryngitis: VA can cause sudden, intense nocturnal attacks of shortness of breath and accompany asthma attacks that occur more quickly and worse.
Otitis media: bacteria follow the Eustachy tube into the eardrum.
Gastrointestinal inflammation: abdominal pain that goes out of mucus, water.
Lymphadenitis causes abscesses like Gillette's: it is an abscess of the posterior pharynx in a child.
Ocular inflammation: conjunctivitis, eyelid inflammation, watery eyes.
Affect the development of the body: deformed body, flat chest and narrow width, arched back or hunched, belly atrophy. Always tired, lazy, sleepy, poor intelligence, caused by hearing loss and poor breathing, so the body is not normal.
Treatment of acute VA inflammation.
Treatment such as common acute rhinitis with nasal aspiration, nasal discharge to ease breathing and mild antiseptics (Ephedrine 1%, Argyron 1%) is for children.
Nasal nebulization: corticosteroids and antibiotics.
Systemic antibiotics: used for severe and complicated cases.
In cases of prolonged acute inflammation, physicians have to palpate the dome to release pus gathered in the VA or curettage of "hot" VA, provided that high doses of antibiotics are given before and after treatment, but very rarely.
Treatment of chronic VA inflammation: VA curettage is very popular nowadays, but when and when not to curl VA, it is necessary to follow the indications and contraindications.
VA has many episodes of acute inflammation, recurring again (5-6 times / 1 year).
VA causes near complications: ear infections, respiratory tract infections, lymphadenitis.
VA causes distant complications: acute arthritis, acute glomerulonephritis ...
VA is overheating, affecting the airways.
VA curettage is usually carried out for children aged 6 months and older, except in special cases, early curettage.
Haemophilia, blood clotting disorder.
In the presence of acute VA inflammation.
When there are acute viral infections such as flu, measles, whooping cough, dengue fever ...
Patients atopic allergies, bronchial asthma, cleft palate.
Chronic diseases: tuberculosis, syphilis, AIDS ...
The weather is too hot or too cold.
Curettage method VA
VA curettage is a relatively simple, fast, effective procedure that is considered to be both treatment (curettage of the VA organization) and disease prevention (avoiding complications caused by VA).
Scraping can be done with a La Force curette table or with a La Moure scraper.
In children with tonsillectomy under endotracheal anaesthesia, VA curettage can be combined when indicated.