The tonsils, which include the palatine tonsils and the pharyngeal tonsils (adenoids), are the largest lymphoid tissues in the human body and serve as important immune organs. During childhood, when humoral immunity is not yet fully developed, the body primarily relies on these organs’ immunity to fend off external pathogens. Tonsils typically begin to develop by the end of the first year of life and reach their peak growth between the ages of 4 and 10. At this stage, children may experience physiological tonsillar hypertrophy. As they age, the tonsils gradually regress and start to decompose around puberty (ages 14 - 15). Enlarged tonsils can lead to various clinical manifestations, including difficulty swallowing, unclear speech, obstructed breathing, snoring during sleep, frequent awakenings, poor nighttime sleep quality, daytime fatigue, lack of focus, and hyperactivity or irritability. These symptoms are often accompanied by adenoid hypertrophy, which severely impacts children’s physical and mental health as well as their growth and development [1]. Before the age of 12, children’s oral structures develop rapidly, stabilizing around the ages of 15 - 16 or 17 - 18. If adenoid hypertrophy persists, it may lead to breathing difficulties, and the lack of airflow stimulation can negatively affect the normal development of the nasal cavity. Additionally, chronic mouth breathing may impact the soft palate, causing palatal elevation and incomplete lip closure, resulting in adenoid facies. According to surveys, the prevalence of this condition among preschool children is 4.17%, with the highest incidence in the 3-year and 6-year age groups; for school-aged children, the prevalence is 4.29%, with the highest incidence in the 7-year age group. Therefore, implementing effective treatment measures is particularly important [2]. To explore the efficacy of a combined treatment of traditional Chinese medicine (TCM) internal medicine and external therapy for pediatric tonsillar hypertrophy, our hospital selected 120 outpatient cases of tonsillar hypertrophy for this study, as detailed in the text below.

The overall clinical efficacy in the observation group was significantly higher than that in the control group, with a statistically significant difference (P < 0.05). Specific data can be found in Table 1. In the observation group, there were 34 cases with significant effect, 25 cases with effective effect, and 1 case with ineffective effect, resulting in an overall clinical efficacy rate of 98.33%. In contrast, the control group had 22 cases with significant effects, 22 cases with effective effects, and 16 cases with ineffective effects, resulting in an overall clinical efficacy rate of 73.33%. The Chi-square value for comparing the overall clinical efficacy between the observation and control groups was 15.42, with a P-value of 0.01, indicating that the observation group had a significantly better treatment effect than the control group. The detailed results are shown in Table 1.

Table 1. Comparison of clinical efficacy between two groups.

The tonsils are an important lymphoid tissue in children’s bodies, playing a crucial role in immune function. Particularly during early childhood, as their humoral immune system is not yet fully developed, the tonsils are vital in resisting external pathogens. However, tonsil hypertrophy can lead to a series of health issues, including difficulties in swallowing, unclear speech, obstructed breathing, and sleep disorders (such as snoring and frequent awakenings). These problems not only affect a child’s daily life and learning attention but can also lead to behavioral issues such as hyperactivity and irritability. Moreover, prolonged mouth breathing may result in palatal elevation, affecting lip closure and presenting features of adenoid facies [7]-[11]. Therefore, there is an urgent need to find effective treatment options.

According to Traditional Chinese Medicine (TCM) theory, tonsil hypertrophy can be attributed to “phlegm turbidity.” The primary cause is the deficiency of the spleen leading to phlegm production; prolonged retention of phlegm dampness can obstruct the meridians, often accompanied by blood stasis, resulting in a pathological state of phlegm and blood stasis intermingling [12]-[14]. Consequently, our hospital recommends a treatment strategy that combines TCM internal medicine with external therapies to achieve a “syndrome and root treatment” effect.

In the selection of herbal medicines, we recommend a modified Baohuan Decoction. This formula emphasizes the use of hawthorn and malt, effectively dissipating food stagnation caused by dietary indiscretion, particularly from meat and fatty foods. Hawthorn serves as the chief herb, playing a crucial role in digestive functions; Shencu aids in strengthening the spleen and improving digestion, particularly suitable for cases of indigestion; while radish seeds assist in relieving qi and aiding digestion, especially effective in eliminating grain stagnation. These three herbs work synergistically to address dietary stagnation. Additionally, to counteract the impact of food obstruction on qi dynamics, we include Pinellia and dried tangerine peel to promote qi circulation and eliminate stagnation; Poria is used to drain dampness, strengthen the spleen, and harmonize the stomach, preventing the generation of damp-heat; and Forsythia serves as an adjunct to clear heat and dissipate nodules. The combination of these herbs effectively promotes digestion, regulates qi, clears heat, and eliminates dampness, facilitating the digestion of food accumulation, restoring normal gastric qi flow, and removing damp-heat. Furthermore, loofah fiber and curcuma are included to invigorate blood circulation, eliminate stasis, and open meridians, further promoting the reduction of swelling and dispersing lumps.

In terms of external treatments, we employ cauterization therapy. The tonsils, as immune organs, contain rich germinal centers and lymphocytes at different functional stages. Under antigenic stimulation, the tonsils can produce plasma cells (including T cells and B cells), antibodies (immunoglobulin Ig), and memory cells, thereby exerting local and systemic immune effects. By cauterizing the tonsils, partial resection and destruction of their tissues can promote the generation of immune antigens; additionally, repeated stimulation of the tonsillar germinal centers can help stimulate the body’s immune function, enhancing resistance to diseases.

The combination of TCM internal and external treatments for pediatric tonsil hypertrophy not only effectively preserves the physiological functions of the tonsils, maintaining the child’s immune barrier against pathogen invasion, but also achieves the treatment goal of addressing both symptoms and root causes. The results of this study indicate that this method is safe and effective, with good clinical promotion value. We look forward to further research and practice to verify its long-term efficacy and provide more solid evidence for the treatment of pediatric tonsil hypertrophy.

Although this study demonstrates significant clinical effects of the combined TCM internal and external treatments for pediatric tonsil hypertrophy, there are still some limitations. Firstly, the sample size is relatively small, consisting of only 120 cases, which may affect the generalizability of the results and the statistical power. Secondly, this study is a single-center clinical trial, lacking multi-center data support, which may introduce bias in the results. Furthermore, the follow-up period of this study is relatively short, failing to adequately assess the long-term effects of the treatment and potential recurrence. Lastly, individual differences among patients (such as age, sex, underlying diseases, etc.) may impact the efficacy, but subgroup analyses were not performed sufficiently. Therefore, larger-scale, multi-center randomized controlled trials are needed in the future to further validate the conclusions of this study.

This research received the support and assistance of all medical staff at our institution. We would like to express our special thanks to the children and their families who participated in this study for their cooperation and trust. We also appreciate the guidance and suggestions from experts in traditional Chinese medicine research, which provided valuable insights for the design and implementation of this study.

*First author.

^#Corresponding author.