<prompt> A child presenting with recurrent respiratory tract infections, mouth breathing and decreased hearing. Treatment of choice isTonsillectomyAdenoidectomyGromet insertionMyringotomy  <response>: Adenoidectomy 228-385- Dhingra 4th, 367- Logan Turner 10th Recurrent RTI, mouth breathing and decreased hearing suggest that child is suffering from adenoids, Treatment of choice for adenoids is - AdenoidectomyADENOIDS Adenoids or nasopharyngeal tonsil is situated at junction of the roof and posterior wall of the nasopharynx Adenoids are present at birth, shows physiological enlargement upto the age of 6 years and then tends to atrophy at puberty and almost completely disappears by age of 20 years Nasal obstruction is the commonest symptoms. This leads to mouth breathing . It also interferes with feeding or sucking. As respiration and feeding can not take place simultaneously such a child fails to thrive Nasal symptoms - Nasal obstruction, Nasal discharge, chronic sinusitis, Epistaxis, voice change Aural symptoms - Tubal obstruction, Recurrent attack of acute DM, CSOM, Serous ottitis mediaChronic nasal obstruction and mouth breathing leads to characteristic facial appearance called Adenoid facies the child has an elongatedface with dull expression, open mouth, prominent and crowded upper teeth and hitched up upper lip Hard palate is highly arched as moulding action of the tongue or palate is loss Diagnosis by examination of post nasal space is possible in some children. Soft tissue lateral radiograph will reveal size of adenoids as also the extent to which nasopharyngeal air space which has been compromised.CT scan has no role in diagnosisIndications of Adenoidectomy Adenoid hypertrophy causing snoring, mouth breathing, sleep apnoea syndrome or speech abnormalities i.e. rhinolalia Recurrent rhinosinusitis Chronic secretory otitis media aw adenoid hyperplasia Recurrent ear discharge in benign CSOM aw adenoitis adenoid hyperplasia Dental malocclusion Adenoidectomy doest correct dental abnormalities but will prevent its recurrence after orthodontic treatment 