Pharyngeal Tonsil Enlargement (Adenoid Hyperplasia): Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore:
    • Inspection (viewing) of the oral cavity.
      • Skin and mucous membranes
    • Examination of the nasopharynx (nasopharynx) by rhinoscopy.
      • Anterior rhinoscopy: reflection of the palate area.
      • Posterior rhinoscopy: reflection of the pharyngeal tonsil (tonsilla pharyngea). This is located on the roof of the nasopharynx, in the area behind the nose.

      [Pharyngeal tonsil hyperplasia: enlarged and reddish, lobulated, longitudinally furrowed organ; obscured posterior opening to the nasopharynx (choane)]Note: Choane (internal nasal opening): paired opening of the nasal cavity (cavum nasi) into the oral or pharyngeal cavity.

    • Examination of the ears by otoscope (otoscopy) due topossible secondary diseases: Seromukotympanon (tympanic effusion) due torecurrent (recurrent) otitis media (otitis media) [Seromukotympanon: possibly yellowish shimmering eardrum, which is dull and thickened with increased vascular markings; decreased transparency of the eardrum].
    • Palpation (palpation) of the cervical and nuchal (“belonging to the neck and neck”) lymph nodes [marked lymph node enlargement of the cervical lymph nodes]
  • ENT medical examination, if necessary:
    • Rhinoscopy (see above).
    • Otoscopy (see above)
    • If necessary, transnasal endoscopy (reflection by means of a rigid or flexible optics through the nose) – delimitation of a rhinosinusitis (simultaneous inflammation of the nasal mucosa (“rhinitis”) and the mucosa of the paranasal sinuses (“sinusitis“)) or adenoiditis.
    • Testing procedures in adults or older children:
      • Toynbee’s test (patency test of the auditory tube/ear trumpet): the patient is asked to swallow with the nose held shut. This leads to a change in pressure in the middle ear and at the same time to a movement of the eardrum, which is visible by otoscopy (ear examination).
      • Valsalva trial: forced expiration (breathing out) against the closed mouth and nasal opening. This causes air to be forced through the tube into the middle ear. Auscultatory (“by listening”) a cracking sound is audible and otoscopic shows a protrusion of the tympanic membrane.