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DISEASES OF THE NASOPHARYNX                    133

TREATMENT. If adenoid hypertrophy is not well marked and the symptoms
are slight, surgical treatment should not be advised. Simple breathing exercises
may suffice in such cases. The patient should be reassessed after an interval of
a few months. When, however, one or more of the cardinal symptoms are
present no time should be lost in removing the adenoids. It is not a sufficient
contra-indication to operation that the adenoids tend to atrophy at puberty.

Fig. S3. Lateral radiograph showing a large mass of adenoids.

COMPLICATIONS OF ADENOiDECTOMY. Among these incomplete removal must
be mentioned. This occurs in part because the removal of adenoids is a blind
operation. The adenoids may be partly, detached and hang down below the
soft palate as a tag. This can usually be removed later, although removal of
adenoid remnants at a later date is made more difficult by fibrous scarring.
Adenoid remnants produce symptoms by virtue of the sepsis they may
contain, and persisting deafness or middle ear infection may be experienced.

Hypernasality may occur after removal of adenoids from children whose
soft palate is insufficient to close the nasopharynx during speech. Their speech
is often affected, even before operation, and surgery may have been sought
because of this. The inadequate palate may depend upon a large pad of
adenoids for any contact during phonation. If this large adenoid mass is
completely removed to relieve aural or nasal symptoms the insufficient palate
may then be unable to close off the nasopharynx. Nasal escape occurs and
hyporhinophonia has been converted into the more serious hyperrhinophonia.
This may be sufficiently severe to require correction by pharyngoplasty, or
more simply it may be helped by the injection of Teflon paste into the
posterior aspect of the soft palate. If the condition is diagnosed preoperatively,