I. Definition of pathological adenoid hypertrophy in children Pathological adenoid hypertrophy refers to the state when pathological hyperplasia of adenoids occurs and reaches ≥0.7 adenoids/nasopharyngeal cavity, which leads to corresponding clinical symptoms. The diagnosis of pathological adenoid hypertrophy in children 1, nasopharyngoscopy with fiberoptic nasopharyngoscopy to record the extent of adenoidal obstruction of the posterior nostril, blockage ≤ 25% is 1 degree, 26% – 50% is 2 degrees, 51% – 75% is 3 degrees, 76% – 100% is 4 degrees. 4 degrees is pathological adenoid hypertrophy. (1) without combined chronic sinusitis: the mucosa of the middle and lower turbinates is normal or mildly congested and swollen; the middle and lower nasal passages are clear, without mucopurulent secretion retention; lymphatic tissue from the nasopharyngeal apex 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 in the nasopharynx are obviously narrowed. (2) Combined with chronic sinusitis: microscopically, the mucosa of the middle and lower turbinates was congested and swollen; a large amount of mucopurulent secretions were retained in the middle and lower nasal passages; lymphatic tissue protruding from the roof of the nasopharynx was visible at the upper edge of the posterior nostril; the lymphatic tissue in the nasopharynx was obviously hyperplastic and thickened, and mucopurulent secretions were attached to the surface; the air passages of the posterior nostril were occupied by more than 3/4, and the air passages of the nasopharynx were obviously narrowed. 2. Lateral radiograph of the nasopharynx Lateral radiograph of the nasopharynx The adenoids are located at the base of the pterygoid saddle and outside the skull of the occipital slope, in the form of strips of soft tissue with a smooth surface. In order to make a more accurate estimation of the adenoids thickness measurement, a simple measurement method, which is more common among domestic and foreign researchers, was used. A /N ratio (i.e., the ratio of adenoid thickness to the width of the nasopharyngeal airway) is 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 the width of the nasopharyngeal airway) is found. A /N > 0.70 is considered pathological adenoid hypertrophy, which is an indication for surgical treatment. The pathological adenoid hypertrophy in children is harmful to 1. chronic rhinosinusitis: when the pathological adenoid hypertrophy prevents the normal flow of mucus blanket in the nasal cavity and sinuses, resulting in rhinosinusitis is not easily cured or recurrent. When chronic rhinosinusitis is full of inflammatory cells and factors of secretions after the flow of stimulation, so that the adenoids lymphatic tissue further hypertrophy. The two are mutually causal and vicious cycle. Symptoms of chronic rhinosinusitis in children: persistent purulent rhinorrhea; chronic nasal obstruction; posterior nostril leakage; cough; foul-smelling breath; headache, etc. Studies have shown that the mucus blanket transport time in the nasal cavity of normal children is 8.55 ± 2.11 minutes, in children with adenoid hypertrophy it is 16.97 ± 3.1 minutes, and after adenoidectomy it is 8.7 ± 2.14 minutes, indicating that adenoid hypertrophy affects the normal flow of the mucus blanket and thus the drainage of the nasal cavity and sinuses. The increased number of neutrophils in the nasal mucosa of children with adenoid hypertrophy before surgery returned to normal 1 month after adenoidectomy. Chronic rhinosinusitis caused by pathological adenoid hypertrophy is the basis for other hazards, so I think it should be ranked first. 2. Upper respiratory cough syndrome (UACS) in children: UACS is a syndrome caused by nasal and sinus lesions with cough as the main symptom, and is the most common disease causing chronic cough. pathogenesis of UACS: when inflammatory diseases exist in the nasal cavity and sinuses, the nasal and sinus mucosa has an inflammatory response similar to that of the lower respiratory tract, and its sensory nerve endings contain stimulated airway The sensory nerve endings contain neuropeptides and neurotransmitters that stimulate the sensory nerves, 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 neuroreflexes. Since the onset of upper respiratory cough syndrome is insidious, it is easily misdiagnosed and mistreated, causing great emotional stress to the child and his parents. The first complaint of a child with pathological adenoid hypertrophy is a chronic cough with sputum. However, until now, upper respiratory cough syndrome in children has not received much attention from pediatricians and otorhinolaryngologists, and is often misdiagnosed as a lower respiratory tract infection and treated with prolonged antibiotics. 3. 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. 4. Exudative otitis media: The enlarged adenoids easily block the pharyngeal orifice of the eustachian tube, resulting in impaired drainage of the eustachian tube and middle ear cavity, and impaired gas exchange in the middle ear. 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 chamber and causing mucosal exudation in the tympanic chamber, which also hinders the drainage of the eustachian tube and tympanic chamber and aggravates the negative pressure in the tympanic chamber, resulting in middle ear exudate and exudative otitis media. The proportion of children with exudative otitis media was highest in the adenoid hypertrophy group with an A/N ratio >0.70. The degree of adenoid hypertrophy was positively correlated with the incidence of exudative otitis media. The degree of adenoidal hypertrophy and the incidence of exudative otitis media should be the indications for adenoidectomy in children with adenoidal hypertrophy and exudative otitis media. 5. Psycho-psycho-cognitive impairment: The impact of adenoid hypertrophy on the mental status of children is gradually being emphasized. 12 years of age is an important cut-off age, and cognitive impairment is greater in males than in females under the same baseline conditions. Early surgical treatment is recommended, with relatively relaxed surgical indications for males to reduce the impairment of cognitive function in patients. 7, abnormal maxillofacial bone development: children with adenoid hypertrophy due to long-term respiratory obstruction and open-mouth breathing, in order to improve breathing, the child appears to physiologically adapt to muscle feedback, causing changes in head position, which in turn can cause passive stretching of cervicofacial soft tissues, long-term nasal obstruction to bone development changes, resulting in abnormal maxillofacial development, such as the maxilla becomes longer, hard palate high arch, upper incisors protrude, resulting in poor occlusion, thick lips, The upper lip is thick and upturned, etc.-that is, the so-called “adenoid face”. Surgical methods: 1, general anesthesia nasal endoscopy under direct nasal vision electric cutting suction to remove adenoids. This is currently the most common application. Its advantages are obvious. The visual field is clear, and the cutter is equipped with suction function, which can aspirate the bleeding in time and completely remove the lymphatic tissue near the round pillow of the eustachian tube. The cutting speed is fast and the resection is complete. However, the disadvantage is that there is a lot of bleeding and it is difficult to stop the bleeding. Many times, it only takes 10 minutes to completely remove the adenoids, but it takes several times longer to stop the bleeding by electrocoagulation; secondly, the postoperative pain is heavy, which is mainly caused by the hyperthermic cauterization of electrocoagulation. 2, nasal endoscopy under general anesthesia under direct nasal vision low temperature plasma removal of adenoids. The advantages of low-temperature plasma are very obvious. It is non-bleeding when removing adenoids tissue. This is very, very critical in children with limited blood volume. Children have a blood volume of only 80 ml/kg and a 20 kg weight child has a blood volume of 1600 ml. Blood loss of more than 100 ml is considered mild and vital signs may fluctuate. The blood loss during the whole process of low temperature plasma adenoidectomy can be controlled to less than 5ml, which is only equivalent to the amount of blood needed for a single blood draw for physical examination. Secondly, the working temperature of low-temperature plasma is 40-70 degrees, and with room temperature saline continuously flushing, the tissue temperature is only about 40 degrees, so there is almost no painful reaction after surgery.