Definition of pathological adenoid hypertrophy in children: Pathological adenoid hypertrophy is the state when pathological hyperplasia of the adenoids occurs and reaches ≥0.7 adenoids/nasopharyngeal cavity, resulting in corresponding clinical symptoms. Diagnosis of pathological adenoid hypertrophy in children Nasopharyngoscopy: Franco et al. recorded the extent of adenoidal obstruction of the posterior nostril with a fiberoptic nasopharyngoscope, with blockage ≤ 25% being degree 1, 26% to 50% being degree 2, 51% to 75% being degree 3, and 76% to 100% being degree 4. degree 4 is considered pathological adenoid hypertrophy. 1, not combined with chronic sinusitis: microscopically, the mucosa of the middle and lower turbinates is normal or mildly congested and swollen; the middle and lower nasal passages are clear, no mucopurulent secretions are retained; the lymphatic tissue from the top of the nasopharynx is visible at the upper edge of the posterior nostril; the lymphatic tissue in the nasopharynx is obviously hyperplastic and hypertrophic, the air passages of the posterior nostril are occupied by more than 3/4, and the air passages of the nasopharynx are obviously narrowed. 2. Combined with chronic sinusitis: microscopically, the mucosa of middle and lower turbinates is congested and swollen; a large amount of mucopurulent secretion is retained in the middle and lower nasal passages; lymphatic tissues protruding from the roof of the nasopharynx can be seen at the upper edge of the posterior nostril; lymphatic tissues in the nasopharynx are obviously hyperplastic and thickened, and mucopurulent secretions are attached to the surface, the air passages of the posterior nostril are occupied by more than 3/4, and the air passages of the nasopharynx are obviously narrow. Lateral nasopharyngeal radiographs showed that the adenoids were located at the base of the pterygoid saddle and outside the cranial aspect of the occipital slope, and were striped soft tissue with a smooth surface. In order to estimate the thickness of the adenoids more accurately, a simple method of measurement was used, which is more common among domestic and international researchers. A /N ratio (i.e., the ratio of adenoid thickness to nasopharyngeal airway width) was obtained by measuring the A – B distance (A value) and A – C distance (N value) at one time, and the ratio of A /N (i.e., the ratio of adenoid thickness to nasopharyngeal airway width) was found. A /N >0. 70 was considered pathological adenoid hypertrophy and was an indication for surgical treatment. In children with pathological adenoid hypertrophy, chronic rhinosinusitis: When pathological adenoid hypertrophy obstructs the normal flow of mucus blankets in the nasal cavity and sinuses, rhinosinusitis is not easily cured or recurrent. In chronic rhinosinusitis, the backflow of secretions full of inflammatory cells and factors stimulates further hyperplasia of adenoid lymphoid tissue. The two are mutually causal, vicious circle. Symptoms of chronic rhinosinusitis in children are: persistent purulent rhinorrhea; chronic nasal obstruction; posterior nostril leakage; cough; foul-smelling breath; headache, etc. The study showed that the mucus blanket transport time in normal children’s nasal cavity was 8.55 ± 2.11 minutes, while in children with adenoid hypertrophy it was 16.97 ± 3.1 minutes and 8.7 ± 2.14 minutes after adenoidectomy, indicating that adenoid hypertrophy affects the normal flow of mucus blanket and thus the drainage of the nasal cavity and sinuses. The preoperative neutrophil count in the nasal mucosa of children with adenoid hypertrophy increased and returned to normal 1 month after adenoidectomy. Chronic rhinosinusitis due to pathological adenoid hypertrophy is the basis for other risks, so I believe that it should be ranked first. UACS is a syndrome with cough as the main symptom caused by nasal and sinus pathology and is the most common cause of chronic cough. The mucosa of the nose and sinuses has an inflammatory response similar to that of the lower respiratory tract, and their sensory nerve endings contain neuropeptides and neurotransmitters that stimulate the sensory nerves of the airway, increase the sensitivity of the cough reflex, and produce cough; nasal and sinus secretions flow backward into the pharynx or respiratory tract, stimulating the cough receptors there and producing impulses that sensitize the cough reflex through neural reflexes. Because of its insidious onset, upper respiratory tract cough syndrome is easily misdiagnosed and mistreated, causing great emotional stress to the child and his parents. Recall that the first complaint of children diagnosed with pathological adenoid hypertrophy in our hospital is chronic cough with sputum. However, until now, upper respiratory cough syndrome in children has not been widely appreciated by pediatricians and otolaryngologists, and it is usually misdiagnosed as a lower respiratory tract infection and treated with prolonged antibiotics. Obstructive sleep apnea hypoventilation syndrome in children: Common symptoms of obstructive sleep apnea hypoventilation syndrome in children include snoring at night, open-mouth breathing, recurrent apnea and frequent awakenings, often with nightmares, excessive sweating, panic and urine loss. During the day, the symptoms are morning headache, drowsiness, irritability, irritability, inattention, and even abnormal personality and behavior. The growth and development of the affected children lag behind their peers to varying degrees. Severe hypoxemia and hypercapnia can also cause cardiovascular complications and endanger the life of the child. Studies have shown that about 57% of children with OSAHS first develop obstruction in the adenohypophysis plane at the same airway pressure, and the remaining 43% first develop at the level of the soft palate and below, indicating that adenoid hyperplasia is the most common cause of OSAHS in children. The efficiency of adenoidotonsillectomy for OSAHS in children was 90%. Children with OSAHS show significant improvement in clinical symptoms after surgery, and normal growth and behavior can be restored. OSAHS in children with pathologic adenoid hypertrophy has a serious impact on the sleep structure of children, which in turn affects their physical and mental health. Adenoidectomy can significantly improve OSAHS symptoms in children. Exudative otitis media: Hypertrophied adenoids tend to block the pharyngeal opening of the eustachian tube, resulting in impaired drainage of the eustachian tube, middle ear cavity, and middle ear gas exchange. The partial pressure of oxygen in the middle ear cavity decreases, the partial pressure of carbon dioxide increases, the pH value decreases, and the secretion of mucus glands increases, causing negative pressure in the tympanic cavity, resulting in mucosal exudation in the tympanic cavity, while obstructing the drainage of the eustachian tube and tympanic cavity and increasing the negative pressure in the tympanic cavity. The vast majority of children who underwent adenoidectomy in the United States in 1994 were reported to have oozing otitis media. The study confirmed that the highest percentage of children with exudative otitis media was found in the adenoid hypertrophy group with an A/N ratio >0.70, and that the degree of adenoid hypertrophy was positively correlated with the incidence of exudative otitis media. Adenohypertrophy with exudative otitis media is an indication for adenoidectomy in children with adenoid hypertrophy. Psycho-psycho-cognitive impairment: The impact of adenoid hypertrophy on the mental status of children is gaining attention. Studies have shown that children with adenoid hypertrophy have significantly higher scores on the Self-Rating Scale for Depressive Disorders in Children (DSRSC) and the Screening Scale for Anxiety-Related Emotional Disorders in Children (SCARED) than the Chinese norm. The scores of each item normalized three months after surgery. The total crude scores of psychological behavior in children with adenoid hypertrophy were significantly higher than those in the control group. Boys showed mainly schizophrenia, dysphoria, compulsivity, hyperactivity, and discipline, while girls showed mainly body complaints, hyperactivity, and aggression. Three months after tonsillectomy and adenoidectomy, the second test was performed on the children, and the scores of schizotypy, depression, obsessive-compulsive, somatic complaints and total gross scores were significantly lower in boys than in the preoperative group. In girls, the scores of depression, obsessive-compulsive schizophrenia, discipline, aggression, cruelty, and total gross scores were significantly lower than the preoperative values. Adenomatous hypertrophy is an important factor in cognitive impairment in children, especially in cognitive speed and memory; 12 years of age is an important cut-off age; cognitive impairment is greater in males than in females at the same baseline. Early surgical treatment is recommended, with a relatively relaxed indication for males to minimize cognitive impairment. Abnormal maxillofacial bone development: In children with adenoid hypertrophy, long-term respiratory obstruction and open-mouth breathing, in order to improve breathing, the child develops physiological adaptation to muscle feedback, causing changes in head position, which in turn can cause passive stretching of cervicofacial soft tissues, long-term nasal obstruction causes changes in skeletal development, resulting in abnormal maxillofacial development, such as long maxilla, high arched hard palate, protruding upper incisors, resulting in poor occlusion, thick lips, upper lip The result is the so-called “adenoid face”. Surgical method: Removal of the adenoids with a nasal endoscope under general anesthesia and an electric cutting suction under direct nasal vision. This is the most common procedure used today. Its advantages are obvious. The visual field is clear, and the cutter has a suction function on it, so that the bleeding can be aspirated in time and the lymphatic tissue near the round pillow of the eustachian tube can be completely removed. The cutting speed is fast and the resection is complete.