<prompt> A children presents with recurrent upper respiratory tract infection with mouth breathing and impairment of hearing. Treatment isTonsillectomyGrommet insertionAdenoidectomy Grommet insertionTympanoplasty  <response>: Adenoidectomy Grommet insertion 228- Dhingra 4th Recurrent URTI mouth breathing and impairment of hearing reflects - diagnosis is ADENOIDSClinical featuresAetiology - Physiological enlargement Recurrent attack of rhinitis, sinusitis or chronic tonsillitis URTI Nasal symptoms Aural Symptoms General Symptoms Nasal obstruction is the commonest symptoms. This leads to mouth breathing Nasal discharge Sinusitis - chronic maxillary sinusitis Epistaxis Voice change - tonelessi Tubal obstruction 1t conductive hearing lossii Recurrent attacks of Acute otitis mediaiii CSOMiv Serous otitis media1 Adenoid facies2 Pulmonary hypertension and cor pulmonale Adenoidectomy Grommet insertion is treatment of choice 