Parents often ask if our child has adenoid hypertrophy, should it be removed surgically? Will it affect my child’s growth and development? As an immune organ, will the surgery damage the child’s immune function? Also, surgical bleeding and anesthesia accidents are a concern for many clinicians and parents. Adenotonsillectomy is the most common pediatric surgery and is mostly used to treat sleep breathing disorders caused by severe adenoid hypertrophy, recurrent tonsillar infections, and tonsillitis and tonsillar hypertrophy that have failed to respond to drug therapy. Since adenoid hypertrophy is often combined with tonsillitis or tonsillar hypertrophy, the tonsils are often removed together, so it is called adenotonsillectomy. The traditional surgery is mainly adenoids scraping, and nowadays, general anesthesia endoscopic adenoidectomy or radiofrequency ablation is the main procedure, which has the advantages of less trauma, less bleeding and faster recovery. Tonsil surgery can be traced back to the ancient Roman period, when inflamed tonsils were allegedly removed directly with the fingers. The adenoids, also called pharyngeal tonsils, are located at the top of the nasopharynx and the back wall of the pharynx and are lymphatic tissue. The adenoids, like the tonsils, grow with age after birth, proliferating most vigorously between the ages of 2 and 7, and gradually shrinking after the age of 10. The adenoids often undergo pathological hyperplasia due to repeated inflammatory stimulation, which causes symptoms of nasal congestion and open-mouth breathing, especially at night, and in severe cases, sleep disordered breathing, which is one of the most common causes of obstructive sleep apnea (OSA). The disease is commonly seen in children and is often combined with tonsillitis and tonsillar hypertrophy. Adenoid hypertrophy in children can block the nasopharynx, causing otitis media and nasopharyngitis; due to long-term open mouth breathing, resulting in abnormal facial bone development, long jaws, high arched palate, uneven teeth, and dull expression, which is called “adenoid face”. Poor nighttime breathing can lead to long-term oxygen deprivation and hormonal imbalance, resulting in impaired growth and development. In addition, the child may suffer from systemic symptoms such as anorexia and malnutrition. As children grow older, the adenoids will gradually shrink and the condition may resolve or disappear completely. Some children often have nasopharyngitis, and reasonable antibiotic treatment can improve nasopharyngeal ventilation and reduce clinical symptoms. If conservative treatment is ineffective, the adenoids should be surgically removed as soon as possible. Recurrent throat infections and sleep disordered breathing are the most common indications for adenotonsillectomy. Other indications include dysphagia or voice changes due to enlarged tonsils, peritonsillar abscesses, chronic tonsillitis where antibiotic therapy has failed, tumors or tonsillar hemorrhage, autoimmune disease due to recurrent streptococcal infections, and chronic group A streptococcal carriers. The most common cause of OSA in children is adenoid tonsillar hypertrophy, especially in children whose tonsils are in the growth phase. Untreated OSA in children can affect learning, growth and development, and cardiovascular health. Adenotonsillectomy is also the most common treatment for OSA in children, and a meta-analysis showed that the remission rate of OSA after surgery was about 58%. For mild to moderate pharyngeal infections, symptomatic and reasonable antibiotic management is usually all that is needed, and surgical treatment is not recommended; for severe and recurrent pharyngeal infections, surgical excision can significantly benefit the child. Contraindications to surgery include hematologic disorders, active infections, and uncontrolled systemic diseases, with consideration of eustachian tube insufficiency. Postoperative infections often cause bleeding, halitosis, fever, pain, and slow healing of the incision; therefore, routine preoperative antibiotics are recommended to prevent infection. Weight gain has been reported in children after adenotonsillectomy. In children with inherent developmental delays, weight gain is beneficial, while in children who are already overweight or obese, weight gain may increase the risk of obesity. This may be caused by increased energy intake, decreased consumption, relief of hypoxemia, and increased secretion of growth hormone. Whether removal of the tonsils and adenoids, which are lymphoid tissues, will affect the immunity of children is also a concern for many parents. There is sufficient evidence that immunoglobulin levels in children are not significantly altered after adenoid tonsillectomy, that immune function is not affected, and that there is no increased risk of infection in children. In conclusion, children with recurrent adenoid tonsil infections and the presence of OSA should be operated on 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 along with the tonsils. Conservative treatment should be timely and effective in controlling nasopharyngeal infections and inflammation, improving nasal ventilation, and using glucocorticoids for 3-5 days if necessary. Given that the adenoids can gradually shrink with age and the possibility of spontaneous remission of symptoms, surgical treatment should still be carefully chosen for younger children.