In daily life, there are many children snoring (commonly known as snoring), some parents think it is because the baby sleeps well, so they do not care; with the popularization of our medical science knowledge, most parents realize that the baby may be sick. Snoring is caused by the sound of pharyngeal tissue vibration due to partial blockage of the upper airway, which can lead to apnea and hypoventilation, and is medically known as obstructive sleep apnea hypoventilation syndrome (OSAHS) in children, with an onset age of 2 to 7 years. Short-term manifestations are: ① snoring, open-mouth breathing, mouth and nose spraying, breath-holding and even waking up during sleep; ② repeated sinusitis, postnasal drip (coughing and throat clearing), otitis media and other diseases. Long-term manifestations are: ① “adenoid face”: thick lips, uneven teeth, and even facial development deformities; ② lack of oxygen to the brain during sleep, memory loss, and affect intellectual development. ③Low growth and development, irritable or hyperactive personality. OSAHS is caused by upper airway blockage, including nasal disease, adenoid hypertrophy, tonsil hypertrophy, and also associated with obesity and small jaw (i.e., short chin). The most commonly used test is the electronic rhinolaryngoscope, which can directly determine the presence of adenoids, inflammation and masses in the nasal cavity. In addition, sleep apnea monitoring tests can further confirm the diagnosis of OSAHS and determine its severity. What is the treatment for OSAHS in children? For snoring or open-mouth breathing for a short period of time, conservative treatment can be given for 1 to 3 months, and if there is no improvement, surgery can be considered. Since adenoid tonsillar hypertrophy is the main cause of OSAHS in children, adenoid tonsillectomy is the main treatment and the most common operation in the ENT department of children’s hospitals. If a child snores in combination with severe obesity or a small jaw, the surgical result will be affected, and the risk and difficulty of the surgery will be correspondingly increased. The following are some of the doubts of parents and my personal experience in the diagnosis and treatment of this disease: 1.Is there any other examination method instead of the electronic nasopharyngoscopy for fear that the child will suffer or not cooperate? Electronic rhinolaryngoscopy is the best way to diagnose adenoid hypertrophy. The mirror of our department is the thinnest in the world, the head end is rounded, and it is not easy to damage the mucous membrane of the nasal cavity during the examination, so newborns can pass through the nasal cavity smoothly. So parents do not need to worry, by the way, the examination requires a 3-hour fasting before the examination. Sleep apnea monitoring test, as a golden indicator for diagnosing OSAHS, is not yet a complete substitute for electronic rhinolaryngoscopy. The child needs to sleep in the ward for one night, try to sleep less during the day, drink less water for a few hours before the test, and avoid strenuous exercise to facilitate sleep at night. If you have a cold or sinusitis, you will need to reschedule. Ten years ago our department, including now there are still many hospitals to do nasopharyngeal lateral film or CT examination, according to my observation, compared with electronic nasopharyngoscopy, the error rate of the above examination is larger. 2.Can conservative treatment cure adenoid tonsillar hypertrophy? Adenoid tonsil surgery is an elective surgery, children who are not particularly serious can be treated conservatively first, and the effect is still good for children with mild disease, but we should pay attention to avoid colds as much as possible, otherwise it is easy to repeat. 3. Why do you snore when you sleep on your back, but sleep on your side or on your stomach? Because when sleeping on the back, the tonsils will aggravate the blockage of the airway in the oropharynx due to the effect of gravity, while when sleeping on the side or stomach, the tonsils will favor the side to reduce the blockage of the airway there. 4.Does the removal of adenoid tonsils affect the immune function of children? The immune function of adenoids is minimal and can be disregarded. The tonsils have some immune function. Antibodies related to cellular and humoral immunity are reported to decrease after tonsillectomy, but they are still within the normal range and usually recover after six months. As the first barrier of the oropharynx against the invasion of germs, when the tonsils are removed, the lymphatic tissue in the back wall of the pharynx acts as a second barrier and takes on more responsibility when the germs come, leading to more pronounced symptoms of pharyngitis in a few children, such as sore throat, dry throat, and throat clearing. Of course, we have not found any cases where the removal of tonsils alone has led to systemic symptoms such as immune disorders. 5. Children are still young and are afraid of not being able to tolerate surgery and anesthesia. As long as surgery is necessary, there is no need to consider the child’s age. The youngest child who has undergone adenoid surgery in our department is less than 1 year old. The majority of children can tolerate surgery and the incidence of anesthesia accidents is very low. For children with severe OSAHS, it can be said that it is better to do it early and eat and sleep well afterwards, huh? 6.Do I need surgery if my child snores only when he has a cold and a runny nose but not normally? It is because when you have a cold or rhinitis and sinusitis, the upper airway will also be blocked, causing snoring. Normally, if the child can sleep with his mouth closed and breathe smoothly without snoring, even if the adenoids and tonsils are enlarged to a certain degree, he can be temporarily observed without surgery. 7.Does my child need surgery if he or she does not snore but only breathes with his or her mouth open? Since the mouth is open when sleeping, the airflow of breathing basically goes in and out through the mouth and does not need to go through the nasal cavity, so no snoring can be produced. If the adenoids and tonsils are found to be enlarged after examination and no improvement after 1 to 3 months of conservative treatment, surgery is recommended. 8.Can a child who does not snore but has repeated sinusitis or otitis media attacks have surgery? There are some children who do not snore or breathe openly but have recurrent sinusitis or otitis media and are not easily cured by conservative treatment, so if the adenoids are enlarged, adenoidectomy is recommended. The reason is that adenoid hypertrophy will obstruct the drainage of the nasal cavity, resulting in sinusitis that is not easily cured, and in turn, the repeated stimulation of the adenoids by inflammation will make the adenoids even more hypertrophic and a vicious cycle will occur. We all have an eustachian tube that connects the middle ear to the nasopharynx, and when the adenoids are enlarged, they can affect the opening of the eustachian tube next to it, resulting in otitis media not easily healed. 9. What are the methods of adenoid tonsil surgery? What are the best methods? The surgery is performed using general anesthesia with tracheal intubation. Currently, our department uses low-temperature plasma ablation to remove the adenoids, which has the advantage of little or no intraoperative bleeding, significantly reduced chance of postoperative bleeding, and significantly shorter intraoperative time compared to previous adenoide aspiration, with the disadvantage of high cost and some odor after surgery. Both methods have about the same chance of recurrence for adenoids after surgery. The brief surgical procedure is: a very fine diameter nasal endoscope is used to enter through the nasal cavity, which allows good exposure of the adenoids on the monitor, and a plasma knife is used to enter through the mouth to remove the adenoids. For the tonsils, our department has been using the electric knife to remove them since 8 years ago, which requires certain operating skills and significantly shortens the surgical time compared to the previous traditional stripping. 10.What are the results after surgery? What is the percentage of recurrence? The results after OSAHS surgery are generally good, and the chance of recurrence is relatively low. In our work, we often encounter parents who are hesitant to remove the tonsils. For some tonsils that are not particularly large, they are afraid that the immune function will be affected if they are cut, or the effect will be affected if they are not cut. My opinion is that if parents do not consider the cost and time of hospitalization, it is advisable not to cut them for the time being, and if the result is not good later, then hospitalize them for removal.