What are adenoids? Why are they needed? Why do they enlarge?

Adenoids are part of the lymphadenoid pharyngeal ring system, also known as Pirogov Waldeyer's ring. This system includes not only the nasopharyngeal tonsils, commonly referred to as 'adenoids,' but also the paired tubal tonsils (located near the openings of the auditory tubes), palatine tonsils (found in the oropharynx), and the lingual tonsil (situated at the base of the tongue). All these structures within the lymphadenoid ring are collections of lymphoid tissue and serve as peripheral components of the immune system.

Tonsils typically refer to the palatine tonsils, located in the oropharynx. Adenoids specifically refer to the nasopharyngeal tonsils, situated in the nasopharynx.

The main task of the adenoids is to process antigenic information coming through the upper respiratory tract (i.e., with inhaled air). That is, adenoids recognize pathogenic microorganisms (viruses, bacteria, fungi), neutralize them, and signal the immune system to respond to this foreign invasion (participating in the systemic immune response). This is why nasopharyngeal tonsils are called the first line of defense of the immune system.

Attention: All normally developing children have adenoids! That is, the presence of adenoids in the nasopharynx is not a diagnosis, it is not a 'formation,' and therefore should not cause concern in parents. Normally, by the age of 12-18, the adenoids completely disappear on their own. The problem is that parents usually bring children to an ENT doctor when they already exhibit signs of hypertrophy, which is the pathological growth of adenoid tissue.

Adenoids grow when the immune system in the nasopharynx is exposed to immune stimuli, such as infectious or allergic agents. Very often, the 'culprits' behind the hypertrophy of the nasopharyngeal tonsil include herpes viruses, respiratory pathogens, and bacteria, such as streptococci, staphylococci, and pneumococci. A mixed infectious-allergic load on the immune system is also possible.

Gastroesophageal or laryngopharyngeal reflux may also contribute to the growth of adenoids. Regular reflux of acidic contents into the pharynx and nasopharynx disrupts local immune mechanisms, creating favourable conditions for the colonization and growth of pathogenic bacterial microflora. Pathological reflux can be suspected during endoscopic examination of the nasopharynx and laryngopharynx. This procedure is typically carried out without the use of vasopressors and anaesthetics, taking from a few seconds to several minutes, and is well tolerated, even by infants. But we'll delve into this topic further later.

In addition to local antigen presentation, the immune system can also be triggered by a systemic mucosal epithelial or membrane inflammatory response. This refers to a state in which mucous membranes are irritated, and their immune system is stressed over a large area. What are we talking about? Of course, the intestines or the gut! It may seem as though the intestines and the nasopharynx are far apart, but the connection is direct!

If even a slight inflammatory process occurs over a large surface area of mucous membranes, such as the intestines (it's believed that if you were to expand all the folds of the intestinal mucosa, it would be equivalent to the area of a tennis court), the immune system of all mucous membranes, including those in the nasal cavity and nasopharynx, will respond.

With intestinal permeability syndrome (leaky gut syndrome), toxins and breakdown products of gluten, lectins, casein, and other proteins can enter the bloodstream, leading to an inflammatory response. Simultaneously, the lymphatic system is under enormous stress, and the adenoids serve as a lymphoid organ!

It is important not to take 'leaky gut' literally. There is no such concept in medicine. We are referring to a violation of the integrity of the intestinal barrier, which means that gaps between intestinal cells in the walls become larger than usual, allowing incompletely split molecules, such as proteins and toxins, to enter the bloodstream. In response, the immune system produces inflammatory compounds.

What Causes Leaky Gut Syndrome?

Leaky gut syndrome can be attributed to several factors, including:

Acute and/or chronic stress: Both acute and chronic stressors can contribute to the development of leaky gut syndrome.

Unhealthy diet: Consuming an unhealthy diet, often rich in processed foods and lacking essential nutrients, can be a significant factor in the onset of leaky gut syndrome.

Lack of healthy foods in the diet: Insufficient intake of nutritious foods, such as fruits, vegetables, and whole grains, can exacerbate the condition.

Food sensitivity or allergies: Individuals with food sensitivities or allergies may be more prone to developing leaky gut syndrome.

Non-steroidal anti-inflammatory drugs (e.g., Ibuprofen): The use of non-steroidal anti-inflammatory drugs like Ibuprofen can contribute to the weakening of the gut lining.

Parasitic infections: Infections caused by parasites can damage the intestinal barrier, potentially leading to leaky gut syndrome.

Antibiotics: The use of antibiotics can disrupt the balance of gut bacteria, potentially increasing the risk of developing leaky gut syndrome.

Imbalance of intestinal flora: An imbalance in the composition of the gut microbiota can play a role in the development of leaky gut syndrome.