The good old days - Adenoid vegetations

Adenoid vegetations in the vault of the pharynx are common in childhood. They are produced by hypertrophy of the adenoid tissue, which is abundant in this situation, where it forms a mass known as Luschka's tonsil.

Adenoids may occur in an infant shortly after birth and may seriously interfere with suckling, but more commonly they manifest themselves between the ages of 3 and 10 years.

In the large majority of cases they tend to wither and disappear at the age of puberty.

When the adenoid growths are sufficiently definite to cause symptoms it is not justifiable, however, to wait for a possible natural cure, as by doing so irreparable damage may occur.

The chief symptoms are impaired hearing, snoring, and a vacant expression of countenance from the child breathing with the mouth half open.

Children who are mouth-breathers do not sleep peacefully; they snore and may suffer from nightmares and night terrors. As a consequence of the disturbance of their sleep, they become nervous and suffer in general health.

Another important effect of adenoidal vegetations is on the voice. A nasal or 'dead' tone is often imparted, and this can have significant consequences, such as in a young chorister.

If adenoids remain untreated for several years, the child acquires a characteristic appearance. The nose looks pinched, the lower jaw hangs down, the mouth is always open, and the upper front teeth become prominent, like those of a rabbit.

Treatment consists of removing the tonsils, under the influence of nitrous oxide gas with a little ether, followed if necessary with some chloroform blown in.

Soft vegetations can be scraped away with the nail behind the palate and having long fingernails can be of assistance in this technique.

Extirpation with Meyer's ring knife or Loewenberg's forceps is needed for larger specimens.

Taken from 'Surgery, its Theory and Practice', by William Johnson Walsham, FRCS (Eng) MB and CM (Aberdeen), published in 1887 by J & A Churchill of London.

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