Adenoid hypertrophy in children is more common in clinical practice and has attracted more and more attention from parents and doctors. Generally speaking, adenoids are largest at the age of 6 or 7, and gradually degenerate and shrink at the age of 10 or so. The adenoids are often enlarged and enlarged by repeated colds, and then they do not shrink when the cold gets better. Because of the location of the adenoids, their enlargement can cause a series of nasal, pharyngeal and ear symptoms. Adenoid hypertrophy or concurrent tonsillar hypertrophy in children can cause obstructive sleep apnea hypoventilation syndrome. The symptoms of this disorder are sleep snoring with breath-holding (i.e., apnea) and open-mouth breathing. The incidence of obstructive sleep apnea syndrome in children is about 0.7%-3% average 2%, mainly occurs in 2-6 years old, apnea, hypoxia will affect the growth and development of children to varying degrees, such as causing abnormalities in respiration, development, neurocognition, etc., and even cause sudden death in children in serious cases. Long-term breathing through the mouth, under the impact of airflow, the hard palate is high arched, which will make the facial development deformed, appearing short and thick upper lip cocking, lower jaw sagging, nasolabial groove disappeared, upper incisors protruding, poor bite, etc.. Due to the restricted movement of facial muscles, the child’s face lacks expression, which is called “adenoid face” in medical science. The enlarged adenoids and tonsils can obstruct upper airway breathing, making children prone to recurrent upper respiratory tract infections, rhinitis and sinusitis, resulting in further enlargement of the tonsils and adenoids, forming a vicious circle that is not easily relieved. Adenoid hypertrophy in children also causes inflammation of the nasal cavity and sinuses that cannot be easily drained, compression or obstruction of the eustachian tube (the passage between the middle ear cavity and the nasal cavity) inflammation of the adenoids themselves, and poor elasticity of the eustachian tube cartilage in children, all of which can cause exudative otitis media. According to clinical statistics, the incidence of exudative otitis media among children hospitalized with obstructive sleep apnea hypoventilation syndrome is 74.3%. Therefore, children with obstructive sleep apnea hypoventilation syndrome should be more alert to oozing otitis media. Indications for adenoids surgery 1. frequent snoring, breath-holding in sleep, poor breathing; 2. frequent colds with rhinitis and sinusitis that do not easily heal; 3. with secretory otitis media, adenoids compressing the eustachian tube, or inflammation of the adenoids themselves and otitis media that do not easily heal. What are the ways of that surgery? Because it is a surgery for younger children, general anesthesia is necessary. The traditional surgery is mainly adenoids scraping. The picture shows an adenoids scraping spoon. Nowadays, nasal endoscopic adenoidectomy or radiofrequency ablation is mostly used, which has the advantages of less trauma, less bleeding and faster recovery. Well, finally, a word about whether removal of adenoids can affect immunity in children. There is sufficient evidence that immunoglobulin levels in children are not significantly altered after adenoidectomy, that immune function is not affected, and that there is no increased risk of infection in children. In conclusion, children with confirmed severe snoring with adenoid hypertrophy should be operated early, with 4-10 years being the best age for surgery, and those with combined moderate to severe enlargement of the tonsils should be removed together with the tonsils. Conservative treatment should control nasopharyngeal infection and inflammation in a timely and effective manner, improve nasal ventilation, and use glucocorticoids if necessary. In view of the gradual atrophy of the adenoids with age and the possibility of spontaneous remission of symptoms, surgical treatment should still be carefully chosen for younger children.