Ans. b. Adenoidectomy with grommet insertion (Ref: Dhingra 5/e p73, 258)History of recurrent upper respiratory tract infections, month breathing, and nasal-obstruction, hearing impairment, with high arched palate are suggestive of adenoid hypertrophy. The management would be adenoidectomy with grommet insertion.Adenoid HypertrophyCommon in preschool children of 3-6 vis.Common with URTI'sAdenoidal facies* Pinched up noseQ* Upper lip protrusionQ* Crowding of upper incisorsQ* High arched palateQ* Otitis media with effusionQ (serous or secretory otitis media or glue ear causing conductive hearing loss).Etiology:Rhinitis, sinusitis, allergy and tonsillitisQAdenoid Hypertrophy: Clinical FeaturesNasal SymptomsAural Symptoms* Bilateral nasal obstruction (MC symptom)Q* Wet bubbly noseQ* SinusitisQ* EpistaxisQ* Voice change* Voice is toneless, loses nasal quality (Rhinolalia clausa)* Conductive hearing loss due to tubal obstruction* Recurrent attacks of acute otitis media* CSOM* Serous otitis mediaDiagnosis:Soft tissue lateral radiograph reveals size of adenoidQCT has no role in diagnosisTreatment:To remove the cause that is adenoidectomy, appropriately called adenoidal resection because it has no capsule as seen in Tonsil (Tonsillectomy)Grommets are also called 'ventilation tubes' as they help in maintaining middle ear air pressure equal to that of nasopharyngeal pressure and hence equal to atmospheric pressure.