FIBERSCOPY IN PEDIATRIC NASOPHARYNX 155 fiberscopy of the nasal cavity and nasopharynx was, there- fore, required. A 4-year-old girl had complaints of hear- ing difficulty and a history of continuous mouth breathing and snoring (Fig. 2A). Tympanometry showed a flat curve without minimal impedance (type B) on both sides. Fiberscopic examination performed under local anesthe- sia with premedication showed enlarged adenoid tissue that completely blocked the choana and the nasopharyn- geal orifices of the eustachian tube. Within 1 week after adenoidectomy, snoring had disappeared and normal nose breathing was observed. Medical advice was sought for a 1-year-old boy because of bilateral otitis media with effusion (Fig. 2B). There was a history of periodic mouth breathing and snoring. The tym- panogram showed a fiat curve forboth ears. Underlocal anes- thesia with premedication, fiberscopy showed a small adenoid tissue. A pus stream from the nasal cavity passed over the patent eustachian tubal orifice. Further examination was recommended to confirm the existence of sinusitis. A 6-year-old girl presented with continuous mouth breathing, snoring, and heating loss, although adenoidec- tomy had been performed 2 1/2 years before (Fig. 2C). An adenoidectomy again was advised by the general physician. Tympanometry suggested the existence of oti- tis media with effusion in both ears. Fiberscopic exami- nation of the nasal cavity and nasopharynx was performed under local anesthesia only. Minimal adenoid tissue was encountered; however, endoscopy did reveal a swollen Figure 2B With a small adenoid tissue, the eustachian tubal orifice is anatomically open. There are some purulent secretions passing over the tubal orifice. torus tubarius that nearly blocked the eustachian tubal ori- rice and partially blocked the choana. A 4-year-old boy was referred with continuous mouth breathing, snoring, and hearing loss (Fig. 2D and E). The patient had undergone adenoidectomy on two previous oc- casions, as well as tonsillectomy and multiple myringo- tomies with tympanostomy tube insertions (three times) Figure 2 Different conditions of the nasopharynx (+: adenoid; 1": nasopharyngeal orifice of the eustachian tube, -: torus tubarius). A, large adenoid tissue that has completely blocked the choana as well as the nasopharyngeal orifice of the eustachian tube. Figure 2C Small adenoid tissue but very swollen torus tuba.flus that blocked the eustachian tubal orifice almost completely as well as partially blocked the choana.