咽頭所見より見た学童集団の長期観察成績について

抄録

Two of the most common disorders of the throat encountered in grade school children are adenoids and tonsillitis, and their incidence in relation to chronic sinusitis has been widely investigated but basic knowledge of these conditions is still incomplete. As a means of elucida-ting some aspects of this problem, we have conducted periodic examinations in selected groups of urban and rural children, consisting of all age groups from childhood to puberty, for many years. This long-range study has provided us with information regarding the actual state and prevalence of these disorders, the changes associated with the growth of the individual which had not been observed in previous studies limited to a single period, and some differences due to environmental influence which were revealed by comparison of the findings in the urban and rural groups. The results of this long-range study with respect to the findings in the throat and of the adenoids and our observations concerning the influence of chronic sinusitis are presented.
Physiologic hypertrophy and hyperplasia of the adenoid, tissue, faucial tonsils, lateral pharyngeal bands and lymph follicles on the posterior pharyngel wall were found to differ in degree with the ages of the children. The greatest degree of adenoid hypertrophy was seen at the ages of 6 and 7 years, with subsequent atrophy which progressed rapidly after the age of 11 or 12. By observing the changes in single individuals over the years, we found that atrophy of the adenoid tissue took various forms which were divided into 6 types. It was also revealed that this stage differed between urban and rural chidren.
The faucial tonsils showed maximum enlargement at the ages of 6 and 7 years with gradual reduction in size thereafter, but physiologic hypertrophy was still present up to the age of 10 or 11, after which atrophy rapidly occurred. Atrophy of the faucial tonsils tended to occur more slowly in rural children. The lateral pharyngeal bands and lymphoid nodules on the posterior pharyngeal wall showed marked enlargement after the age of 12, possibly, it is thought, to compensate for atrophy of the adenoid and tonsils which normally occurs during this period.
There is as yet no established theory based on pathological and physiological grounds regarding the functions of the various groups of lymphoid tissue in the pharnx, and the reason for their changes with growth cannot be definitely explained. It is obvious though that their presence is not entirely meaningless during physical growth and that they possess certain signicant functions. The observations made in this study produced no evidence contradicting fi the view that ring of lymphoid tissue in the pharynx serves as a barrier against bacterial invasions into the body and that they aid in acquisition of immunity to such infections.
The closest correlation between the various groups of lymphoid tissue was shown by the adenoid and faucial tonsils, which proved to be statistically significant. The other groups of lymphoid tissue were also found to be related in varying degrees and moreover showed effects due to age.
Fairly close correlation between the adenoid and sinusitis was observed, particularly in elementary school children in the lower grades. Observations in individual children revealed that the degree of adenoid hypertrophy was considerably influenced by aggravation, improvement or alleviation of the inflammatory disorder of the sinuses. Although the influence of the adenoid on the paranasal sinuses is still controversial, in view of the strong effects demonstrated in this survery, the indication for adenoidectomy at a suitable time could be considered in the treator prevention of sinusitis.