With the increasing knowledge of disease prevention and treatment for parents of children, adenoid hypertrophy, which was previously unknown, has become a common pediatric visit to otolaryngology. While we may be familiar with tonsillitis, tonsillar hypertrophy and surgery, we have more concerns and questions about adenoids because they are located in the relatively hidden nasopharynx and usually cannot be seen directly. So, what are adenoids, what are their physiological functions, what symptoms can be caused by adenoid hypertrophy, what are the health risks, and what degree of adenoid hypertrophy requires surgery are probably the most important concerns of parents. First of all, adenoids and tonsils (palatine tonsils) is a component of the pharyngeal lymphatic ring, also known as pharyngeal tonsils or proliferators, in early childhood development, there are generally varying degrees of physiological hyperplasia, usually no significant impact on normal breathing and other physiological functions, adenoids have certain immune functions but tend to degenerate, generally in adolescence on the obvious atrophy, adult tends to disappear, so unless Therefore, adenoidectomy does not affect immune function unless the patient is suffering from an immunodeficiency disease. Acute inflammation of the adenoids, like the tonsils, can occur during acute upper respiratory tract infections, but can subside with treatment. If chronic inflammation develops from repeated acute upper respiratory tract inflammation, it can manifest as a series of symptoms associated with adenoid hypertrophy. Since the nasopharynx, where the adenoids are located, is a crossroads, linking the nasal and pharyngeal cavities up and down, and adjacent to the pharyngeal opening of the middle ear on the left and right, adenoid hypertrophy can affect the related organs up and down, and its main local manifestations are nasal symptoms such as obstruction of the respiratory tract, obstruction of nasal ventilation, open-mouth breathing, snoring, and runny nose after the complication of rhinosinusitis, or it can be accompanied by obstruction of the pharyngeal opening of the pharyngeal tube, which can lead to secretory otitis media. In addition, some children may have ear symptoms such as ear stuffiness and hearing loss due to otitis media. Of course, some children may also have systemic symptoms, mainly chronic toxicity, nutritional developmental disorders and reflex neurological symptoms. These symptoms include poor general development and nutrition, dreamy sleep, teeth grinding, slow reaction, inattention and irritability. Very few children have poor jaw and facial skeletal development due to long-term nasal ventilation and poor compensatory open-mouth breathing, manifesting as long maxilla, high palate, curved nasal septum, uneven teeth, prominent upper incisors, thick lips, and lack of expression, the so-called “adenoid face”. For the diagnosis of adenoid hypertrophy, it is very important for parents and guardians to provide an accurate medical history, and endoscopy or palpation of the nasopharynx is helpful but not easy for children to cooperate, so imaging is the most commonly used diagnostic aid. hypertrophy, i.e., significant obstruction of the nasopharyngeal cavity. In conclusion, if the child has clear symptoms of snoring and open-mouth breathing that persist for at least 1 month or recurrent otitis media, and if the imaging supports pathological adenoid hypertrophy, surgical treatment is necessary. In cases of intermittent similar symptoms, it is necessary to exclude the interference of colds, rhinosinusitis, allergic rhinitis, and allergic constitution, and the corresponding experimental drug treatment can be performed for screening (see my other related articles), and it is not advisable to make a hasty surgical decision. However, for cases with definite medical history, clear examination and diagnosis, and no obvious effect of experimental treatment, timely surgical treatment is still advocated, and it is not advisable to wait and see for a long time to avoid the formation of adverse effects on the ear, nose and face. After clinical observation, if the indications are chosen correctly and the anesthesia and surgeon’s skills are excellent, simple adenoids surgery can be performed regardless of age. For children with chronic tonsillitis and tonsillar hypertrophy, it is necessary to consider that the larger tonsils can also cause snoring and open-mouth breathing alone or in conjunction with adenoid hypertrophy, and often require separate or simultaneous surgical treatment. It is worth noting that rhinosinusitis in children does not require concurrent nasal or sinus surgical intervention except in selected cases because of its tendency to heal spontaneously or to subside with resolution of the adenoids. As for surgical methods, low-temperature plasma ablation or mechanical aspiration with the assistance of general anesthesia and endoscopy are currently the most commonly used methods, of which plasma ablation has minimal or no bleeding and a mild postoperative response, but requires high operator skill and is more costly. Mechanical aspiration is more popular to deal with the hyperplastic tissue protruding into the posterior nostril, but bleeding is slightly higher during the operation. Unlike tonsils, adenoids do not have a complete peritoneum, so theoretically complete excision is not easy to achieve and is not advocated to avoid complications caused by excessive trauma, even if individual lymphatic tissue development may have local lymphatic tissue re-growth after surgery, but the incidence is extremely low and re-operation is effective.