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06 February 2025, Volume 40 Issue 2 Previous Issue   

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Expert consensus on clinical diagnosis and treatment management of adenoid hypertrophy in children Children's Otolaryngology Committee of the Pediatric Branch of the Chinese Medical Doctor Association, Pediatric Allergic Committee of Chinese Maternal and Child Health Association, Otolaryngology-Head and Neck Surgery Branch of Asia-Pacific Association of Medicine and Bio-Immunology 2025, 40(2): 89-95.  DOI: 10.19538/j.ek2025020601 Abstract ( )   Adenoids hypertrophy is a common disease in children and is the most common cause of upper airway obstruction in children and adolescents. Due to the special anatomical position of the adenoids，adenoids hypertrophy often leads to several complications such as chronic rhinosinusitis，secretory otitis media，obstructive sleep apnea，etc.，which cause many symptoms and affect children's growth and maxillofacial development. Adenoids hypertrophy has received widespread attention from otolaryngologists and parents，but there is still a lack of expert consensus on the standardized diagnosis and treatment of adenoids hypertrophy in children in China. Therefore，the Children's Otolaryngology Committee of the Pediatric Branch of the Chinese Medical Doctor Association organized relevant experts to compile this consensus based on the literatures at home and abroad as well as clinical expert experience，in order to guide the standardized diagnosis and treatment of adenoids hypertrophy in children.

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Attention to standardized diagnosis and treatment of pediatric upper airway inflammatory diseases XU Zheng-min 2025, 40(2): 96-99.  DOI: 10.19538/j.ek2025020602 Abstract ( )   This paper mainly discusses how to pay attention to the standardized diagnosis and treatment of pediatric upper airway inflammatory diseases. It emphasizes the unique characteristics of these diseases in children，highlighting that the upper airway has distinctive anatomical structure with physiologicaland pathological continuity and consistency. These diseases often display individual characteristics while being closely interconnected，which are referred to as comorbid diseases. Examples include the coexistence of allergic rhinitis with chronic rhinosinusitis，and the concurrent presence of allergic rhinitis，chronic rhinosinusitis，and adenoid hypertrophy. This paper introduces the clinical diagnosis of these comorbidities，including symptom-based diagnosis，laboratory diagnosis，and endoscopic and imaging diagnosis. Furthermore，it summarizes the treatment options for these comorbidities，including standardized pharmacological conservative therapy and minimally invasive surgical treatment.

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Diagnosis and treatment and management of allergic rhinitis in children ZHANG Jian-ji, WEI Ping, KOU Wei, et al 2025, 40(2): 100-105.  DOI: 10.19538/j.ek2025020603 Abstract ( )   Allergic rhinitis（AR） is one of the most common chronic inflammatory diseases in children. In clinical practice, the issues related to its diagnosis and treatment frequently arise in children，often leading to misdiagnosis or missed diagnosis. Due to the lack of standardized management and health education，the children and their parents often have insufficient understanding of the nature of AR and are not clear about the appropriate process of medication and immunotherapy. This lack of understanding contributes to many problems，such as withdrawal of medication earlier，decongestant abuse，blind medication，glucocorticoid phobia，immunotherapy fear or lack of confidence in immunotherapy，refusing treatment if the disease cannot be cured，etc., which result in poorly controlled AR symptoms, and negatively impact the children’s quality of life，learning and sleep and their growth and development，and may even lead to psychological and behavioral issues in children. These issues can be harmful to the physical and mental health of the children and impose a disease burden on families and society. Targeting the common problems in clinical diagnosis, treatment and management, this article summarizes the diagnosis，treatment and management regimens of AR in children，aiming to provide reference for otolaryngologists and primary pediatricians in the standardized diagnosis and treatment of AR in children.

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New advances in allergen-specific immunotherapy YAO Hong-bing 2025, 40(2): 105-111.  DOI: 10.19538/j.ek2025020604 Abstract ( )   Allergen-specificimmunotherapy（AIT） is the only treatment that can alter the course of allergic rhinitis，preventing the progression of rhinitis to asthma and reducing the need for medication. It is the only therapy that can induce long-term tolerance to allergens，but its traditional protocols are time-consuming and may be associated with adverse reactions. Over the past decade，many new types of AIT have been developed，focusing on optimizing allergen identification，structural modifications that preserve B or T cell epitopes，post-translational changes through chemical modifications，and the addition of adjuvants. These modified allergens can increase tolerance to other related allergens with fewer side effects. This article reviews the development of AIT，its mechanism of action，the modification of allergens，the application of adjuvants，the use of peptides and recombinant proteins，molecular engineering，bioinformatics and computer-aided design，the application of artificial intelligence and machine learning in the treatment of allergic diseases，as well as the importance of precision and individualized medical treatment. It discusses the strategies to enhance the immunogenicity of allergens through chemical modifications，to strengthen the immune response using different adjuvants，and to develop low molecular weight allergens. It emphasizes the importance of integrating research with clinical practice to advance the treatment for allergic diseases. The review also covers the progress of research on the potential of various new types of AIT to improve the treatment for allergic diseases.

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Adenoid hypertrophy and allergic rhinitis in children LU Ying-xia, GU Qing-long 2025, 40(2): 111-113.  DOI: 10.19538/j.ek2025020605 Abstract ( )   Adenoid hypertrophy and allergic rhinitis are common chronic inflammatory diseases of upper airway in children. In recent years，a number of studies have shown that there is a high co-morbidity rate between the two diseases and there may be a close relationship between them in terms of allergens，pathological changes and pathogenesis. In the process of clinical diagnosis and treatment，otolaryngologists need to deeply understand the internal relationship between adenoid hypertrophy and allergic rhinitis，in order to achieve long-term control of symptoms and get a better prognosis.

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Prevention and early treatment of adenoidal hypertrophy in children SHEN Ling, LIN Zong-tong, LIU Ping-fan, et al 2025, 40(2): 114-117.  DOI: 10.19538/j.ek2025020606 Abstract ( )   Adenoid hypertrophy is one of the most common diseases in childhood.If adenoid hypertrophy is not treated in time，it can cause many symptoms and complications，which seriously affect the quality of life of children.Based on clinical practice and research progress at home and abroad，this paper discusses the etiology，prevention and treatment of adenoid hypertrophy in order to provide reference for the prevention and early treatment of adenoid hypertrophy in children.

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New technology for treating sinusitis in children LIU Jia, FU Yong 2025, 40(2): 117-121.  DOI: 10.19538/j.ek2025020607 Abstract ( )   Sinusitis in children is a common disease in the department of otolaryngology，head and neck surgery. Repeated sinusitis increases the treatment difficulty of lower airway inflammation，such as pneumonia and asthma，which becomes a difficult problem in pediatric otolaryngology department. The clinical characteristics and outcomes of sinusitis in children are significantly different from those in adults. Most evidence-based treatments for sinusitis in adults have no evidence of treatment for sinusitis in children. Due to the lack of sufficient attention，there are still some problems in the current treatment of sinusitis in children. In recent years，scholars have been studying better treatment methods，for example, seeking better local administration of antibiotics and glucocorticoids so as to improve the insufficient local drug concentration in the nasal cavity and sinuses and reduce the side effects of systemic medication；the prediction and evaluation of the effect of sinus surgery in children，and the choice of surgical method and timing and staged surgical treatment; the emerging application of TCM treatment and immunomodulators. Based on the summary of the latest research literature at home and abroad and through the combination with the clinical experience of the department，this paper summarizes the new treatment technology for sinusitis in children. The aim is to improve the clinical treatment effect on sinusitis in children，improve the clinical efficacy and satisfaction，save clinical expenditure, and reduce the occurrence of adverse reactions.

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Diagnostic strategies for obstructive sleep apnea in children ZHANG Yun-fei, XU Zheng-min 2025, 40(2): 121-125.  DOI: 10.19538/j.ek2025020608 Abstract ( )   With the growing awareness of the detrimental impacts of sleep-disordered breathing，particularly obstructive sleep apnea（OSA），on neurocognitive and behavioral developmentof children，the demand for diagnosing sleep-disordered breathing and identifying the obstructive sites is constantly increasing. Standard polysomnography（PSG）remains the gold standard for diagnosing obstructive sleep apnea in children；however，it cannot be widely implemented among children.Drug-induced sleep endoscopy（DISE）and cine magnetic resonance imaging（Cine-MRI）are the most commonly used tools for upper airway evaluation，yet each has its own pros and cons in clinical applications. Hence，for many years，discussions have been ongoing to propose strategies to optimize polysomnography in children and assess the sleep breathing status of the upper airway.

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Clinical value of urinary NAG and serum Cys-C in early renal damage of simple obesity in children WANG Xiao-yan, HUA Min, WANG Feng-yun, et al 2025, 40(2): 126-135.  DOI: 10.19538/j.ek2025020609 Abstract ( )   Objective    To investigate the clinical value of urine N-acetyl-β-D-glucosaminidase（uNAG）and serum cystatin-C（Cys-C）in the assessment of early renal damage in children with simple obesity . Methods    A total of 302 children with simple obesity were selected，who were diagnosed in the Department of Endocrinology，Genetics and Metabolism of Children's Hospital of Soochow University from October 2021 to January 2024，and 53 children of similar age in the same period were selected as the normal control group. The clinical data of the two groups were collected，including basic data，blood and urine test results，compare the differences in clinical data of different stages of obesity and normal control group. Analyze the correlation between serum Cys-C，urine NAG，and kidney function. Compare simple obesity group based on their urnie albumin creatine raio （UACR），dividing them into an albuminuria group and a normal albuminuria group. Examine the differences in general clinical data and laboratory parameters between these two subgroups. Multivariate Logistic regression analysis was used to identify the predictors of renal damage . Results    There were statistically significant differences in total cholesterol（TC），triglyceride（TG）and triglyceride-glucose index（TyG）between the obese albuminuria group and the obese no-albuminuria group（P<0.05），and there were significant differences in β2-microglobulin（mALB），uNAG and UACR（P<0.05）. In the obese albuminuria group，uNAG was moderately positively correlated with mALB and UACR，and moderately negatively correlated with β2M . uNAG was an independent influencing factor for early renal damage in children with simple obesity . The area under the ROC curve was the largest in the combined detection of uNAG and serum Cys-C，and the specificity and sensitivity were relatively high. Conclusion    The children with simple obesity may have early kidney damage . uNAG is an independent influencing factor for early renal damage in children with simple obesity . The combination of uNAG，uNAG and serum Cys-C has certain value in the evaluation of early renal damage in children with simple obesity .

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Analysis of differences in fractional exhaled nitric oxide levels among children with different allergic types of asthma ZHU Si-yu, ZHAO Ran, LI Fei-die, et al 2025, 40(2): 136-142.  DOI: 10.19538/j.ek2025020610 Abstract ( )   Objective    To explore the clinical value of fractional exhaled nitric oxide in monitoring airway inflammation in children with different allergic types of asthma. Methods    This was a retrospective study. The clinical data ofasthma children aged from 6 to 18 years were collected，who visited Shanghai Children’s Hospital，School of Medicine，Shanghai Jiao Tong University from March 2020 to March 2023. The patients were divided into different groups according to allergen results：inhalant allergy group （inhalation group），food allergy group （food group），mixed allergy group （mixed group），and allergen-negative group （control group）. The differences in fractional expiratory nitric oxide levels among the groups were compared，and stratification analysis was made concerning asthma control，recent infection and history of rhinitis. Results    The study included 487 children with asthma with allergen information，328 boys and 159 girls，including 455 allergen-positive children，among whom 238 children were in inhalationgroup，36 children in food group，181 in mixed group and 32 children in control group. FeNO50 and FeNO200 in inhalation group and mixed group were significantly higher than those in food group and control group（P<0.001）. CaNO was not different among the groups（P> 0.05）. Under the conditions such as good control of asthma，no infection，and combination with rhinitis，FeNO50 and FeNO200 were significantly higher in the inhalation group and the mixed group than in the food group and the control group（P<0.05）. CaNO was higher in the inhalation group and the mixed group than in the food group among the children with good asthma control and combination with rhinitis（P< 0.05）. Conclusion    FeNO50 and FeNO200 are significantly higher in the inhalation group and the mixed group than in the food group and the control group. CaNO is not different among the groups. FeNO50，FeNO200 and CaNO are significantly increased in children with inhalant and mixed allergic asthma who are well-controlled and with a history of rhinitis，and the airway inflammatory response is more obvious. Fractional exhaled nitric oxide better reflects and monitors the severity of airway inflammation in children with inhalant allergy asthma and mixed allergy asthma，which can be a guide for adjusting diagnostic and therapeutic strategies.

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Clinical characteristics of children with myocardial injury caused by SARS-CoV-2 infection in Kunming YUAN Ting-yun, YANG Jian, XU Jian-hong, et al 2025, 40(2): 143-149.  DOI: 10.19538/j.ek2025020611 Abstract ( )   Objective    To investigate the clinical characteristics of children with myocardial injury caused by SARS-CoV-2 infection in Kunming after the optimization of prevention and control measures for novel coronavirus（SARS-CoV-2） pandemic. Methods This was a retrospective study. The children with myocardial injury caused by SARS-CoV-2 infection hospitalized in 6 tertiary grade A hospitals from December 10，2022 to March 31，2023in Kunming were recruited as myocardial injury group. They were subdivided into myocarditis group and non-myocarditis group according to whether the myocardial injury was caused by myocarditis. A total of 82 general-type hospitalized children with SARS-CoV-2 infection at the same period were selected as control group. The clinical and laboratory data were compared among the groups. The t-test，Mann-Whitney U test and X2 test were employed to make comparison between each two groups. Multivariate regression was used to analyze the risk factors for myocardial injury,and ROC curve was used to evaluate the diagnostic value of related indexes in myocarditis. Results    During the study period，1640 children infected with SARS-CoV-2 were hospitalized in 6 hospitals. Among them，82 had myocardial injury，including 17 cases of myocarditis. The incidence of myocardial injury and myocarditis was 5%（82/1640） and 1%（17/1640），respectively. Among the 82 patients with myocardial injury，56 were male and 26 were female，and the median age was 3months.Compared with the control group，the hospital stay in the myocardial injury group was longer（χ2=-3.779，P<0.001），and the number of severe cases was higher（χ2=22.778，P<0.001）. In addition，leukocytes，neutrophils，C-reactive protein（CRP），serum ferritin（SF），interleukin-6（IL-6），lactate dehydrogenase（LDH），D-dimer，aspertate aminotransferase，creatine kinase-MB（CK-MB），and brain natriuretic peptide（BNP） were markedly increased, while the lymphocyte count，CD4+ and CD8+T lymphocyte proportion were significantly decreased in myocardial injury group compared with control group（all P<0.05）. The myocardial injury group was subdivided into myocarditis group（17 cases） and non-myocarditis group（65 cases）. The neutrophils account，levels of SF，IL-6，LDH，D-dimer，CK-MB and BNP，and cardiactroponin（cTn） grades were higher while the lymphocytes and the proportions of CD4+ and CD8+T lymphocytes were lower in myocarditis group than in non-myocarditis group（all P<0.05）. Multivariate Logistic regression analysis revealed that the increase in leukocytes account，IL-6，D-dimer，LDH and BNP levels and the decrease in CD4+T were the risk factors for myocardial injury caused by SARS-CoV-2 infection ［OR=1.892（95% CI 1.213-2.951）；1.024（95% CI 1.008-1.040）；0.287（95% CI 0.086-0.957）；1.009（95% CI 1.000-1.017）；1.022（95% CI 1.010-1.034）；0.900（95% CI 0.823-0.985），respectively，all P<0.05］. Meanwhile，increases in D-dimer，cTn grades and BNP were risk factors for myocarditis with a cutoff value of 1.73mg/L，3.5 and 273.5ng/L，respectively, calculated by Jorden index,，for prediction of myocarditis. Conclusion    The incidence of SARS-CoV-2-induced myocardial injury and myocarditis in children is 5% and 1%, respectively. The patients with myocardial injury，especially with myocarditis, have more severe inflammatory response，cellular immune suppression and coagulation disorder. The increase in leukocyte，IL-6，D-dimer，LDH and BNP，and the decrease in CD4+ T are risk factors for myocardial injury caused by SARS-CoV-2 infection. Meanwhile, the degree of increased D-dimer，cTn grade and BNP has a good diagnostic value in predicting myocarditis.

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Analysis of clinical characteristics and different detection methods in asthmatic children with persistent small airway airflow limitation WANG Xia, GONG Cai-hui, LIN Ying, et al 2025, 40(2): 150-154.  DOI: 10.19538/j.ek2025020612 Abstract ( )   Objective    To explore the clinical characteristics of children with persistent small airway airflow limitation and the sensitivity of different small airway assessment methods. Methods    Asthmatic children aged 9 to 18 years who were in clinical remission with small airway airflow limitation suggested by routine pulmonary function tests for more than 2 times in the past year，who visited the outpatient clinic of our hospital from February 2023 to April 2024，were enrolled to summarize the clinical characteristics. Chest high-resolution CT （HRCT） was used to compare the ratio of small airway wall area and thickness. Meanwhile，routine pulmonary function tests，pulse oscillation （IOS），plethysmography and exhaled nitric oxide （FeNO） were perfected，and the examination results and their correlation were analyzed. Results    A total of 53 children were included，including 30 males and 23 females，aged 10 （10，11） years. 8 patients （15. 09%） had a family history of asthma，and 27 patients （50. 94%） had a clear history of allergy. 51 cases （96. 23%） were treated according to the doctor's advice，and 6 cases （11. 32%） had definite acute attack of asthma in the past 1 year. In the past year，asthma control drug were reducted in 18 cases （33. 96%），including 3 cases of recurrent symptoms （16. 67%），cough and wheezing occurred in 4 from 9 cases who underwent drug withdrawal （44. 44%）. Pulmonary function，FeNO and HRCT were also tested in 36 children. The FEF75 and MMEF values of 36（100%） children were lower than the lower limit of normal value，and the HRCT results showed that the ratio of airway wall area （WA%） and thickness ratio （T/D） were significantly increased in this group. The results of plethysmography showed that only 2 cases had RV and RV/TLC Z-scores greater than 1. 64. The IOS results showed only 1 case indicated peripheral airway obstruction. FeNO detection showed only 4 cases with elevated FeNO200 and CaNO. Conclusion    Asthmatic children with standard treatment and clinical remission but with persistent small airway airflow limitation may have developed small airway remodeling and have a higher rate of recurrent symptoms after drug withdrawal. The sensitivity of small airway dysfunction indicated by routine ventilation was superior to IOS，plethysmography and FeNO.

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Research progress in eating disorders in children with autism spectrum disorder LIANG Yan, HE Yu-ying, CHEN Yan-ni 2025, 40(2): 155-160.  DOI: 10.19538/j.ek2025020613 Abstract ( )   Children with autism spectrum disorder （ASD） are often complicated with eating disorders，including abnormal eating behavior and other gastrointestinal symptoms. The etiology involves neurobiological，psychosociological and other aspects. Identifying the influencing factors and accurately evaluating them are the basis for intervention，and the current evaluation system needs to be further improved. The intervention of ASD combined with eating disorders is family-centered，supported by behavioral and dietary interventions，and multidisciplinary professional guidance is neededin all aspects and through the whole process of intervention.

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Observational learning and its research progress in children with cognitive disorders LIU Yan-nan, FU Jie, ZHANG Gen-fu, et al 2025, 40(2): 161-164.  DOI: 10.19538/j.ek2025020614 Abstract ( )   Observational learning （OL） is a key learning ability and a widespread learning method. Learning subjects can acquire new skills through the "Stimulus-Response-Outcome （S-R-O）" association without relying on direct reinforcement or direct behavioral response， and reflect them in their actions，speech，and perceptions，which is beneficial to risk avoidance and cost reduction. Observational learning is closely related to cognitive function. Autism Spectrum Disorder （ASD） and epilepsy are two diseases with high prevalence and comorbid cognitive impairment in childhood. The importance and effectiveness of observational learning have been confirmed in studies of children with ASD. However，there are few studies on observational learning in children with epilepsy，and only a few animal experiments have reported a significant reduction in observational learning ability in rats modeled for epilepsy，suggesting that observational learning may be a potential application as an evaluative tool and training method for the diagnosis and intervention of cognitive co-morbidities.

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Research progress in executive function ofpreschool children ZHANG Jian-zhao, YANG Jian 2025, 40(2): 165-170.  DOI: 10.19538/j.ek2025020615 Abstract ( )   Executive function is a higher-level cognitive process that is crucial for children's learning and social behavior. However，there have been few studies on executive function of preschool children，and there is a lack of corresponding assessment tools. This review will discuss the research on executive function of children with neurodevelopmental disorders，focusing on attention deficit hyperactivity disorder （ADHD），autism spectrum disorder （ASD），and tic disorder. It will also discuss the current assessment tools for children's executive function.

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Report on three cases of STING-associated vasculopathy with onset in infancy CHEN Ling, WANG Ke, LIANG Yan, et al 2025, 40(2): 171-176.  DOI: 10.19538/j.ek2025020616 Abstract ( )   Clinical data of three cases of STING-associated vasculopathy with onset in infancy（SAVI）were collected，diagnosed and treated at Shandong Provincial Hospital Affiliated to Shandong First Medical University between Jan. 2020 and Dec. 2023. A review of the relevant literature was then conducted in order to analyze the clinical features，genetic characteristics and therapeutic approaches. The results demonstrated that all three cases had their onsets in infancy and exhibited a dry cough and shortness of breath; two cases presented with rash，one case displayed recurrent fever，and one case exhibited a pestle-and-mortar finger. All cases demonstrated interstitial pneumonitis on chest CT；all cases exhibited de novo mutations in the TMEM173 gene by genetic testing. Case 1 was treated with glucocorticoids，case 2 with tofacitinib，and case 3 with a combination of the two. The rashes and shortness of breath were relieved in the tofacitinib-treated cases （cases 2 and 3），but the interstitial lung disease did not improve significantly. Ultimately，case 1 died of respiratory failure. A summary of the literature reports shows that the onset of SAVI is mostly in infancy，and the early symptoms are insidious, with skin rash，interstitial lung disease，recurrent fever，shortness of breath and growth restriction being the main clinical features. Genetic testing is the gold standard for diagnosis. JAK inhibitors are partially effective in the treatment of SAVI.