Transnasal fiberendoscopy of the nasopharinx is the easiest and most effective way to assess
adenoidal hypertrophy in children. On this basis, the Authors proposed a 4-stage
classification to guide the case management: the first two stages are characterized by moderate
or discrete adenoidal hypertrophy, and adenoidectomy is not necessary; in 4th stage
obstruction adenoidectomy is mandatory. The most important therapeutic problems are
present in 3rd grade obstruction, characterized by hypertrophic adenoids taking up about
3/4 of the rhinopharynx. In this group, which includes the largest number of hypertrophic
adenoids, the therapeutic strategy must take into account the existance of obstructed
breathing and of frequent complications such as recurrent otites, sinusites, sleep apnea etc.
The Authors conclude that when transnasal fiberendoscopy shows important though incomplete
obstruction, the decision about treatment must be based on complementary investigations
to assess the presence and severity of complications.