FIBERSCOPY IN PEDIATRIC NASOPHARYNX 157 nontypable Haemophilus influenzae (NTHI) has become the predominant cause of both acute suppurative otitis media and chronic otitis media with effusion (5-7). As shown in some of our cases, an antiinfectious treatment should be planned first rather than initially attempting surgery. In summary, the authors conclude that fiberscopy is the only examination that allows direct visualization of the nasal cavity and nasopharynx and that it is especially useful for the visualization of the local condition of the nasopharynx. It is the only examination that allows differentiation of adenoid hypertrophy, infection, and scar formation. When the pres- ence of adenoid hypertrophy resulting in nasal obstruction, snoring, and/or otitis media is confirrned, adenoidectomy proves to be highly efficacious in relieving these symptoms. ACKNOWLEDGEMENTS The authors thank Peter Lottefier for his contribution to this article. REFERENCES 1. Wang D, Clement P, Kaufman L, et al. Fiberoptic examination of the nasal cavity and nasopharynx in children. Int J Pediatr Otolaryngol, 1992;24:35-44 2. Wang D, Clement P, Kaufman L, et al. Chronic nasal obstruction in children. A fiberscopic study. Rhinology, 1994 (in press) 3. Wang D, Clement P, Kaufman L, et al. Fiberoptic evaluation of the nasal and nasopharyngeal anatomy in children with snoring. J Otolaryngol, 1994;23:57-60 4. Selkin SG. Flexible fiberoptics and pediatric otolaryngology: a simple technique for examination and photodocumentation. Int J Pediatr Otolaryngol, 1983;5:325-333 5. Murphy TF, Bernstein JM, Dryja DM, et al. Outer membrane pro- tein and lipooligosaccharide analysis ofpaired nasopharyngeal and middle ear isolates in otitis media due to nontypable Haemophilus influenzae: pathogenetic and epidemiological observation. J Infect Dis, 1987;156:723-731 6. Bernstein IM, Dryja DM, Loos BG, et al. Restriction fragment mapping of nontypable Haemophilus influenzae: a new tool to study this middle ear pathogen. Otolaryngol Head Neck Surg, 1989; 100:200-206 7. Faden H, Bernstein J, Brodsky L, et al. Otitis media in children, I: The systemic response to nontypable Haemophilus influenzae. J Infect Dis, 1989; 160:999-1004