Symptoms and Diagnosis? A disorder that manifests itself as snoring, open-mouth breathing, and drooling during sleep, causing daytime sleepiness, hyperactivity, and slower development. In addition to understanding the child’s symptoms and performing a physical examination of the child, the doctor will also need to perform some necessary tests in conjunction with the child. The general routine tests include nasopharyngoscopy and sleep monitoring. What is a nasopharyngoscopy? The adenoids are located in the “back of the nose” and are not easy to see during a physical examination. Nasopharyngoscopy is a technique that involves inserting a long, thin lens (we usually choose one that is as soft as a piece of string so as not to injure children) into the nose to examine the structures inside the nose and nasopharynx. Nasopharyngoscopy allows the doctor to visualize the size of the adenoids, assess the extent to which they are obstructing the child’s airway, and determine if surgical removal is necessary. The advantages of nasopharyngoscopy are that the adenoids can be directly visualized, and if the child is cooperative, it is virtually non-invasive and non-radioactive. Enlarged adenoids blocking both posterior nostrils, leaving only a gap What if the child is afraid and does not cooperate with the nasolaryngoscopy? Head and neck X-rays and CT show enlarged adenoids What is a sleep study? Sleep monitoring is a test that monitors the number and duration of apneas and oxygen deprivation during sleep by attaching the necessary leads to the child’s body. It is a painless test, similar to an EKG, although more or fewer leads may be connected than in an EKG, depending on the number of items being monitored. A 10-20 lead sleep study is performed in the hospital with the child’s parents. On the night of the monitoring, the child is connected to the lead wires with the help of the doctor and then sleeps through the night in the hospital. OAI: Obstructive Apnea Index, refers to the average number of apneas per hour during a child’s sleep, which is an important indicator to judge the severity of pediatric snoring. Minimum oxygen saturation: Oxygen saturation is the amount of oxygen contained in the blood measured during a child’s sleep, and the minimum oxygen saturation is the lowest level of oxygen in the blood throughout the night, which is an important indicator of pediatric snoring. This case suggests that the child has sleep hypoxemia (moderate). AHI: Apnea Hypopnea Index, refers to the average number of apneas or insufficient ventilation per hour during a child’s sleep, and is an important indicator for assessing the severity of pediatric snoring. This case suggests that the child has obstructive sleep apnea hypopnea syndrome (mild). What are the dangers of snoring in children? Slow growth: Sleep snoring and breath holding cause direct damage to the body due to lack of oxygen at night; it affects the quality of sleep, reduces the release of growth hormone at night, and affects the development of children’s bones. Lagging intellectual development: lack of oxygen at night leads to insufficient oxygen supply to the brain, affecting children’s intellectual development; poor sleep quality leads to hyperactivity or drowsiness during the day, poor concentration and poor academic performance. Poor development of face: children with adenoid hypertrophy breathe with their mouths open for a long time, which affects the development of face, and leads to the adenoid face with short, thick, and upturned upper lip, nostrils facing the sky, misaligned teeth, and dull expression. Otitis media, sinusitis: adenoid hypertrophy forward blocking the back of the nostrils, long-term easy to lead to poor sinus drainage, sinusitis; hypertrophy of the adenoids may also press both sides of the Eustachian tube pharyngeal orifice, resulting in poor drainage in the middle ear, causing otitis media. Frequently inflamed tonsils may also involve the surrounding tissues, otitis media, sinusitis, bronchitis and so on. Nephritis, arthritis, rheumatic heart disease: some children’s tonsils are often inflamed, inducing some special immune mechanisms, leading to nephritis, arthritis, rheumatic heart disease and other diseases. Surgical Treatment of Pediatric Snoring After a series of checkups, the cause of the disease can usually be determined as enlarged tonsils, enlarged adenoids or both. Accordingly, the surgeon will selectively perform simple tonsillectomy, simple adenoidectomy or tonsil and adenoidectomy for the child. Currently, our specialty uses the leading low-temperature plasma surgical system for tonsil and adenoid removal. Tonsil and adenoidectomy procedure General anesthesia is administered before the surgery to ensure that the child is asleep and pain is eliminated. The child’s mouth is held open with a special mouthpiece and a long, thin lens is inserted into the mouth. The tonsils and adenoids to be removed are then clearly magnified by the lens on a display screen, which helps the surgeon to see the boundaries of the surgical resection, the location of the hemostasis, and so on, more clearly. The surgeon then uses a low-temperature plasma tip to precisely remove both tonsils and/or adenoids, and then stops the bleeding thoroughly. Finally, the instruments are removed and the surgery is complete. Post-operative Recovery After the surgery is completed, the child will slowly wake up from the anesthesia, and once fully awake, the doctor will take the child out of the operating room. Since the anesthesia and surgery are just over and the child is not yet fully stabilized, the child will need to be taken to the recovery room for further observation, where the anesthesiologist will monitor the child and provide a full range of resuscitation equipment to ensure that he or she is safe during this period of time. At this time, most children will cry due to postoperative pain, uneasiness in an unfamiliar environment, etc. At this time, the anesthesiologist will allow parents to accompany the child to the room at his/her discretion. When the anesthesiologist assesses that the child is stable, he or she will notify the ward doctor to escort the child back to the ward. After surgery, children often have sore throat or discomfort, but generally within the child’s tolerance, if the pain level is intolerable, the doctor will give mild painkillers at the discretion of the doctor. Parents often observe increased snoring during sleep due to postoperative wound edema, but this will improve as the wound swells. Postoperative fever is a common complication after most surgeries. It is usually non-infectious, and most of them will not exceed 38℃ and will not last for a long time, and will get better as the child recovers from the surgery, so parents do not need to worry about it. If the fever is too high, persistent or recurring, a post-surgical infection may occur and the surgeon will intensify the anti-infection treatment. Another common complication after surgery is bleeding, which is usually seen in children as bleeding from the mouth and nose, or as frequent gagging if the blood is swallowed directly. Bleeding often occurs within 24 hours after surgery, or on the 5th or 6th day after surgery, when the white membrane on the surface of the surgical wound falls off, causing bleeding. Generally, parents do not need to be alarmed when the bleeding is small, and can apply ice packs on both sides of the child’s neck or allow the child to eat ice cream or drink ice water. In rare cases where bleeding is heavy and persistent, the surgeon may choose to stop the bleeding, including hemostasis surgery, depending on the circumstances of the case. Other common postoperative discomforts may include nausea, bad breath, and loss of appetite. Generally, children can eat 6 hours after surgery and return to normal in 1 week, but it may take up to 1 month for children to fully recover as the white membrane of the wound is shed. It is recommended to eat cold liquid during this period, avoid eating too hot or too hard food, so as not to cause postoperative bleeding; avoid strenuous exercise, pay attention to rest, prevent cold and flu. Low Temperature Plasma Surgical System There are many different ways to perform tonsil and adenoid removal surgery, but most of them are using the leading low temperature plasma surgical system at home and abroad. The basic principle of the system is that it generates a certain temperature when it is used to cut tissues. Advantages of low temperature plasma surgery system: short operation time, less bleeding, safe, no radiation, less pain after operation, early eating time Will my child have poor resistance after tonsil and adenoid removal? There are a large number of lymphoid tissues in the human pharynx other than tonsils and adenoids that play an immunoprotective role, so the possibility that the immune function will decrease and the child will have frequent colds and coughs after removal of tonsils and adenoids that people worry about is very rare. In addition, the immune process of chronically or repeatedly inflamed tonsils will be affected so that they cannot produce effective antibodies to protect the body. What’s more, it can induce diseases such as nephritis, arthritis and rheumatic heart disease. Enlarged adenoids and tonsils lead to sleep hypoxia, affecting children’s growth and development, and if the disadvantages outweigh the benefits compared to the immunoprotective role they play, surgical removal should be considered for treatment.