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The diagnosis and the recommended clinical trials
I. Diagnosis of an adenoid disease during remission is based on collecting the anamnesis and results of a faringoskopiya. Treat local signs of an adenoid disease:
• hyperemia and thickening of edges of palatal handles;
• caseous and purulent exudate in lacunas of almonds;
• cicatricial commissures between handles and palatine tonsils;
• cicatricial changes of palatine tonsils;
• increase in regional lymph nodes.
• in the general blood test hypochromia anemia, a neutrophylic leukocytosis, a monocytopenia, a leukopenia, increase in SOE can be defined. However more often the adenoid disease is not followed by changes in peripheral blood;
• bacteriological research of smears from a surface of palatine tonsils;
• cytomorphological research separated lacunas.
• methods of specific diagnosis of the infection caused by S. pyogenes of group A;
• immunoserological tests (definition of credits of antistreptolysin, Anti-Dnkaza In, anti-Streptokinasas.
At development of general infectious and allergic diseases additional examination at the cardiologist or the rheumatologist is conducted.
II. Due to not specificity of clinical manifestations diagnosis of a chronic adenoiditis generally is based on data of a lobby and back rinoskopiya and endoscopic research of a nasopharynx. Survey of a nasal cavity and a nasopharynx at small children usually represents big difficulties because of their uneasy behavior. In most cases nevertheless it is possible to examine a nasopharynx if to use thin (diameter of 2,7 mm or 1,9 mm) the endoscope with a visual angle 00 or 300. This research is carried out after an anemization and anesthesia of a mucous membrane of a nose, carrying out at the same time the endoscope only on the general nasal course between a partition and the lower nasal sink. On the informational content endoscopic research much more exceeds data which give a front and back rinoskopiya, and allows to refuse almost completely a nasopharynx X-ray analysis in a lateral projection which is connected with unnecessary beam loading.
Cultural research of smears has limited value in connection with high risk of impurity of traveling microflora.
I. It is necessary to carry out differential diagnosis between an adenoid disease and a noninflammatory hypertrophy of palatine tonsils. The size of palatine tonsils never testifies in favor of an adenoid disease. At children existence of the increased palatine tonsils demonstrates only violently proceeding processes of forming of natural immunity. At children and palatine tonsils and hypermarket have the big sizes; with age they are exposed to involution process.
The nonspecific adenoid disease in rare instances demands differential diagnosis with specific processes (tuberculosis, syphilis, etc.).
At the expressed (especially unilateral) hypertrophy of palatine tonsils it is impossible to forget about probability of oncological and limfoproliferativny diseases (cancer, a lymphosarcoma).
II. The chronic adenoiditis should be differentiated with an acute and chronic rinosinusit and allergic rhinitis. The X-ray analysis or a computer tomography of okolonosovy bosoms and endoscopic research of a nasopharynx which allows to distinguish a true hypertrophy of hypermarket from its increase caused by inflammatory or allergic hypostasis is necessary. In the latter case the surface of hypermarket happens friable, the mucous membrane has pale gray color.
Carrying out the correct differential diagnosis between a hypertrophy of hypermarket and a chronic adenoiditis requires repeated endoscopic research after a course of the antiinflammatory and desensibilizing therapy (for example, local glucocorticoid drugs).