Karpova E P, Kharina D V
Russian Medical Academy of Post-Graduate Education, Moscow, Russia, 123242.
Vestn Otorinolaringol. 2016;81(5):73-76. doi: 10.17116/otorino201681573-76.
The available literature data give evidence that viral infection is the main cause underlying the development of inflammatory nasopharyngeal pathology in the children. According to ICD-10, nether acute nor chronic adenoiditis should be considered as a self-consistent nosological entity. Acute adenoiditis is usually regarded as a form of acute nasopharyngitis (J02) or acute respiratory viral infection (J06.9) whereas chronic adenoiditis is commonly referred to as representing other chronic diseases of the tonsils and adenoids (J 35.8). The reactive changes in the nasopharyngeal tonsils begin to be manifested on days 3-5 after the onset of acute respiratory viral infection; thereafter, they persist and gradually disappear within the next 2-3 weeks. In the majority of the cases, acute adenoiditis is actually a physiological reaction of the nasopharyngeal tonsils as the organs of regional mucosal immunity to antigenic stimulation. There is no universally accepted opinion as regards the duration of the inflammatory process which would allow these pathological changes to be considered as turned into chronic ones. This condition is actually not a serious pathology provided it is not associated with the concomitant complications and produces no clinically significant effect on the child's quality of life. Under practical conditions, such children are most frequently treated with the use of irrigation therapy. Taking into account that otorhinolaryngologists all over the world do not consider chronic adenoiditis as an independent nosological entity but distinguish only hypertrophy of adenoid vegetations or chronic rhinosinusitis (in the presence of inflammatory changes in the nasopharynx), it appears correct to speak about chronic adenoiditis provided the clinical manifestations of the disease persist for more than 12 weeks. Based on the predominant etiological component, the viral, bacterial, and allergic forms of nasopharyngeal adenoiditis can be distinguished even though it is rather difficult to actually determine which etiological factor prevails in each concrete case. The aforedescribed situation poses a large number of questions pertaining to the choice of either systemic or topical antibacterial therapy.
现有文献资料表明，病毒感染是儿童炎性鼻咽部病变发生发展的主要原因。根据国际疾病分类第十版（ICD - 10），急性或慢性腺样体炎都不应被视为一个独立的疾病分类实体。急性腺样体炎通常被视为急性鼻咽炎（J02）或急性呼吸道病毒感染（J06.9）的一种形式，而慢性腺样体炎通常被认为是扁桃体和腺样体的其他慢性疾病（J35.8）。鼻咽扁桃体的反应性变化在急性呼吸道病毒感染发病后3 - 5天开始显现；此后，这些变化持续存在，并在接下来的2 - 3周内逐渐消失。在大多数情况下，急性腺样体炎实际上是鼻咽扁桃体作为局部黏膜免疫器官对抗抗原刺激的一种生理反应。对于炎症过程的持续时间，目前尚无普遍接受的观点，即何种时长可将这些病理变化视为转变为慢性病变。只要不伴有并发症且对儿童生活质量无临床显著影响，这种情况实际上并非严重的病理状况。在实际临床中，这类儿童最常采用冲洗疗法进行治疗。考虑到世界各地的耳鼻喉科医生并不将慢性腺样体炎视为一个独立的疾病分类实体，而是仅区分腺样体肥大或慢性鼻窦炎（存在鼻咽部炎症改变时），所以当疾病临床表现持续超过12周时，才可以说是慢性腺样体炎。基于主要的病因成分，尽管在每个具体病例中很难实际确定哪种病因因素占主导，但可区分出鼻咽腺样体炎的病毒型、细菌型和过敏型。上述情况引发了大量关于全身或局部抗菌治疗选择的问题。
