The pharyngeal tonsils, also known as adenoids, normally develop to their maximum at the age of 6 to 7 years, but begin to shrink after the age of 10. Due to the repeated stimulation of inflammation in the nasopharynx, pathological hyperplasia of the pharyngeal tonsils occurs and causes the corresponding symptoms, called pharyngeal tonsillar hypertrophy. This disease is most often seen in children, and may be triggered by inflammatory stimulation of neighboring organs, repeated upper respiratory infections, and poor living conditions, allergic reactions, nutritional and endocrine factors, and often exists in combination with chronic tonsillitis. Etiology】 Repeated stimulation of the nasopharynx and adjacent areas or the adenoids themselves by inflammation causes pathological hyperplasia of the adenoids. Clinical manifestations] The main symptom of adenoid hypertrophy is nasal congestion. Due to the blockage of the posterior nostril by the hypertrophic pharyngeal tonsils, the patient breathes with the mouth open for a long time, resulting in impaired facial bone development, elongated maxilla, high arched palate, uneven teeth, protruding upper incisors, poor bite, thick upper lip, curved, atrophied nasal wings, narrow nostrils, spreading nasolabial folds, mental depression, dull facial appearance, slow reaction, the so-called “adenoid face “The face is dull and unresponsive. Adenoids are often complicated by rhinitis and sinusitis, with symptoms of nasal congestion and runny nose. When speaking with an occlusive nasal sound, and when sleeping, it can make snoring sound. Because the secretions flow downward and irritate the respiratory mucosa, they often cause inflammation of the pharynx, larynx and lower respiratory tract mucosa and complicate tracheitis. The enlarged pharyngeal tonsils can block the pharyngeal orifice of the eustachian tube, or repeatedly inflame and complicate secretory otitis media, leading to hearing loss and tinnitus, which is one of the main causes of secretory otitis media in children. Adenoids have adverse effects on children’s development, mainly manifested by poor general development and nutrition, and symptoms such as lack of sleep, snoring, night terrors, teeth grinding, enuresis, emaciation, low fever, anemia, irritable temperament, memory loss, and poor concentration. In addition, long-term airway obstruction and insufficient pulmonary ventilation will cause pulmonary hypertension and pulmonary heart disease in children, which may lead to right heart failure in severe cases. In addition to poor mental development, it can also lead to low self-esteem and withdrawal, and a stubborn and strange personality. The child with the above mentioned “adenoid facies” should be considered for this disease. The child breathes with an open mouth, and oropharyngeal examination reveals a high and narrow hard palate, often accompanied by enlarged palatine tonsils. The child has symptoms of nasal obstruction, and anterior rhinoscopy reveals mucous or mucopurulent secretions in the nasal cavity. For those with large turbinates that are not easily examined, the nasal mucosa can be fully constricted and then examined, and a red nasopharyngeal bulge can be seen through the anterior nostril. Fiberoptic nasopharyngoscopy and nasal endoscopy can also be used (Figure 22-1). In children, a soft mass-like growth can be palpated at the top of the nasopharynx by finger palpation. Lateral nasopharyngeal radiographs and CT can assist in the diagnosis. Treatment】 Prevent colds and treat inflammation of adjacent organs. If the symptoms are heavy and affect breathing, accompanied by rhinitis, sinusitis, pharyngitis, tonsillitis, tracheitis, bronchitis, or secretory otitis media for a long time, as well as “adenoid face” or affect the development of children, surgery should be performed to remove. The surgery is usually performed together with the removal of the enlarged palatine tonsils. However, if the tonsils are not obviously enlarged and there is no clear indication for surgery, the pharyngeal tonsils can be removed alone. Early surgical removal of adenoid hypertrophy is recommended for those who have severe symptoms and are over 4 years of age.