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132                  THE PHARYNX AND NASOPHARYNX

necessary. The differential diagnosis may be made by lateral radiography of
the nasopharynx (Fig, 51), which will demonstrate a normal nasal airway in
the resting phase, and by the cold spatula test. This consists in holding a cold
metal spatula against the upper lip below the nose and estimating the nasal
airway during normal respiration by the amount of steaming produced on the

The other symptom arising from adenoid hypertrophy is deafness due to the
adenoid mass obstructing the openings of the auditory tubes. This diminishes
air entry to the middle ears.

Symptoms due to infection are also referred to the nose and middle ears.
Infection of the adenoids will cause an infection of the mucous membrane of
the nose, and vice versa. This, in turn, may lead to an obstruction to the
drainage of secretion from the paranasal sinuses and thus to infection of the
sinuses. Removal of adenoids is usually sufficient to clear up most cases of
sinus involvement in children. More serious is the effect of spread of infection

Fig. 52. Adenoids as seen by posterior

from the adenoids along the auditory tubes to give recurring attacks of acute
otitis media, or to perpetuate a chronic otitis media. Enlarged infected
adenoids are also a contributory factor in secretory otitis media.

CLINICAL FEATURES. On posterior rhinoscopy a lobulated mass of the same
colour as the mucous membrane is seen in the nasopharynx (Fig. 52). It may
be so slight as to form only a moderate projection which does not encroach on
the posterior nares, or it may hang down and obscure either part or the whole
of the septum and choanae. The growths occasionally extend laterally to lie in
close relation to the openings of the auditory tubes (the tubal tonsils). In rare
instances the adenoids extend into the pharynx and project below the soft
palate. Examination with a postnasal mirror can sometimes be carried out in
young children. If not, it is never necessary to palpate the nasopharynx
unless under general anaesthesia. Lateral radiographs of the nasopharynx will
demonstrate the presence and size of adenoids (Fig. 53).

DIAGNOSIS. The diagnosis is usually easy, but in the case of young infants it
may not be possible to come to a definite conclusion prior to operation. In
such cases it is wiser to give an anaesthetic and to palpate the postnasal
space, and if adenoids are present they may then be removed. In all cases
anterior rhinoscopy should be carried out to eliminate any other cause of nasal
obstruction, The possibility of a coexistent infection of the paranasal sinuses
must not be forgotten.