Symptoms.—Children breathe chiefly or wholly through the mouth. They are apt to breathe noisily, especially when they eat and drink. They sleep with their mouth open, breathe hard and snore. They have attacks of slight suffocation sometimes, especially seen in young children. There may be difficulty in nursing in infants; they sleep poorly, toss about in bed, moan, talk, and night terrors are common. They may also sweat very much during sleep. A constant hacking or barking cough is a common symptom and this cough is often troublesome for some hours before going to bed. Troubles with the larynx and pharynx are common and spasmodic laryngitis appears to be often dependent upon adenoids. Bronchial asthma and sneezing in paroxysms are sometimes connected with them. The chest becomes deformed. The prolonged mouth-breathing imparts to adenoid patients a characteristic look in the face. The lower jaw is dropped and the lips are kept constantly apart. In many cases the upper lip is short, showing some part of the upper teeth. The dropping of the jaw draws upon the soft parts and tends to obliterate the natural folds of the face about the nose, lips, and cheeks. The face has an elongated appearance and the expression is vacant, listless, or even stupid. The nose is narrow and pinched, from long continued inaction of the wings of the nose (alae nasi). The root of the nose may be flat and broad. When the disease sets in during early childhood, the palate may become high arched. If the disease continues beyond second teething, the arch of the palate becomes higher and the top of the arch more pointed. The upper jaw elongates and this often causes the front teeth to project far beyond the corresponding teeth in the lower jaw. The high arched palate is often observed to be associated with a deflected partition (septum) in the nose.
The speech is affected in a characteristic way; it acquires a dead character. There is inability to pronounce the nasal consonant sounds; m, n, and ng and the l, r, and th sounds are changed. Some backwardness in learning to articulate is often noticed.
Deafness is frequently present, varying in degree, transient and persistent. Attacks of earache are common and also running of the ears. The ear troubles often arise from the extension of catarrh from the nose-pharynx through the eustachian tubes to the middle ear. Sometimes the adenoids block the entrance to the tubes. The ventilation of the middle ear may be impeded. Dr. Ball, of London, England, says: "Ear troubles in children are undoubtedly, in the vast majority of cases, dependent upon the presence of adenoid vegetation" (growths).
Children with adenoids are very liable to colds in the head, which aggravate all the symptoms, and in the slighter forms of the disease the symptoms may hardly be noticeable, except when the child is suffering from a cold.
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Chronic catarrh is often caused by adenoids. A chronic pus discharge often develops, especially in children. There is often a half-pus discharge trickling over the posterior wall of the pharynx from the nose-pharynx. And yet some children with adenoids never have any discharge from the nose. There may be more or less dribbling of saliva from the mouth, especially in young children, and this is usually worse during sleep. Headache is not uncommon when these growths persist into adult life: they continue to give rise to most of the symptoms just described, although these symptoms may be less marked because of the relatively larger size of the nose-pharynx. The older patients seek relief, usually, from nasal catarrh symptoms. They complain of a dry throat on waking and they hawk and cough, In order to clear the sticky secretion from the throat. The adenoids have often undergone a considerable amount of shrinking, but they frequently give rise to a troublesome inflammation of the nose and pharynx. Rounded or irregular red elevations will often be seen on the posterior wall of the pharynx, outgrowths of adenoid tissue in this region. Similar elevations are sometimes seen on the posterior pillars of the fauces. The tonsils are often enlarged. A good deal of thick discharge will sometimes be seen in the posterior wall of the pharynx proceeding from the nose-pharynx.
Although adenoids, like the normal tonsil, usually tend to diminish and disappear with the approach of youth, they constitute during childhood a constant source of danger and trouble and not infrequently inflict permanent mischief. Also children afflicted with adenoids are less able to cope with diphtheria, scarlet fever, measles, whooping-cough, etc.
Deafness, mouth-breathing habit, and imperfect resonance of the voice, as well as the characteristic expression of the face, will often remain as permanent effects of the impairment of function due to these growths in childhood, even though they have more or less completely disappeared. The collapsed state of the wings of the nose, and wasted condition of their muscles, resulting from long disease, often contributes to the perpetuation of the mouth-breathing habit. On the other hand the rapid improvement, after a timely removal of the growths, is usually very striking.
Treatment.—The only thing to do is to remove them soon, no matter how young the patient may be. An anaesthetic is usually given to children. The operation does not take long and the patient soon recovers from its effects. The result of an operation, especially in young children, is usually very satisfactory. Breathing through the nose is re-established, the face expression is changed for the better. The symptoms as before described disappear to a great extent.
COLDS. (Coryza. Acute Nasal Catarrh. Acute Rhinitis).—This is an inflammation of the mucous membrane lining the nose.