In recent years, as people pay more attention to sleep disorders in children, the consultation rate of children with adenoid and tonsillar hypertrophy is gradually increasing. However, most of the children we see have been diagnosed with adenoid hypertrophy in the past, and most parents have been told that surgery is needed. If children with adenoid hypertrophy do not receive the right treatment in time, many sequelae may occur. Due to long-term airway obstruction and open-mouth breathing, children experience physiological adaptation to muscle feedback, causing changes in head position, which in turn causes passive deep spreading of cervical and facial soft tissues and changes in bone development, resulting in abnormal jaw and facial development and adenoid facial features. Due to airway obstruction resulting in alveolar hypoventilation and hypoxemia, the pulmonary arteries constrict and pulmonary artery pressure increases. Some scholars believe that there is a causal relationship with the susceptibility to hypertension when growing up in the future; hypertrophic adenoids block the pharyngeal orifice of the eustachian tube, leading to secretory otitis media. Due to the obstruction of the posterior nostril, nasal mucus does not flow easily afterwards, which can aggravate the sinusitis of the child and make it difficult to heal. More importantly, the long-term sleep hypoxia has adverse effects on the physical and intellectual development of the child. With the increasing research on adult obstructive sleep apnea syndrome, it has been found that children with adenoid hypertrophy have partial disuse of the nasal cavity due to open-mouth breathing, resulting in impaired nasal development and excessive nasal stenosis in adulthood. Abnormal jaw development ratio due to open mouth breathing is also one of the important causes of pharyngeal cavity narrowing in adults with obstructive sleep apnea syndrome. Repeated inflammation of the tonsils can also cause serious complications such as nephritis and nephropathy, heart valve disease, and rheumatism.
Amoros et al. reported that serum IgA and IgG concentrations decreased after adenoidectomy in children, but were not lower than the normal range of pediatric humoral immunity, and that some children began to recover their immunoglobulin levels 4 months after surgery. Bock concluded that, due to the compensatory effect of other peripheral immune organs, the immunoglobulin levels decreased after tonsillectomy, but were not lower than the normal range and recovered after a certain period of time. Therefore, although tonsillectomy can cause changes in some aspects of the humoral immune system, these changes are not clinically significant and do not cause immune disorders. Whether a child with adenoid hypertrophy should be treated surgically should be evaluated in a comprehensive manner, weighing the pros and cons of the child’s condition. Surgical removal of the adenoids should be considered when the harm caused by adenoid hypertrophy outweighs the benefit of its immune effects. Children with milder symptoms may be treated conservatively, such as lateral sleep, nasal steroids, and aggressive treatment of sinusitis. It is advisable to perform polysomnography to facilitate scientific and objective assessment of sleep conditions. In addition, we found in our clinical practice that due to the long-term transoral breathing of children with adenoid hypertrophy, the nasal cavity is mostly disused, mainly because most children with adenoid hypertrophy do not have large inferior turbinates, while children with inferior turbinate hypertrophy are not found to have very serious adenoid hypertrophy intraoperatively. Therefore, conservative treatment such as nasal steroids can be considered for children with combined inferior turbinate hypertrophy. Children with more severe sleep disorders should be actively treated surgically. Adenoidectomy is usually performed after the age of 3 to 4 years, but children with severe symptoms do not need to be restricted by age and should be treated surgically as early as possible.