Local Microenvironment in Adenoid Hypertrophy and Its Clinical Relevance

Adenoid hypertrophy (AH) is among the most common otolaryngologic disorders in childhood, and its development cannot be adequately explained by a single inflammatory process. Increasing evidence suggests that the adenoid functions not only as an important component of upper airway mucosal immunity but also as a critical site for persistent microbial colonization and local immune remodeling. This review examines AH from structural, immunologic, and microecological perspectives, offering an integrated analytical framework to better understand coordinated imbalance within the adenoidal microenvironment. Furthermore, we investigate the relationships between distinct microenvironmental patterns and clinical phenotypes and discuss both current therapeutic strategies and emerging precision intervention approaches. Collectively, existing evidence indicates that AH is a multifaceted disorder closely associated with microenvironmental reprogramming, and its clinical heterogeneity appears to be attributed to diverse underlying biological processes.