History of rhinorrhea, epistaxis and allergy should be noted. A complete examination of the head and neck is performed. Resting mouth position is noted. This is nonspecific for chronic nasal obstruction and adenoid enlargement may be only one of the causes. Other craniofacial anomalies may be associated with these symptoms including cleft palate, Down syndrome, etc.
Dental malocclusion supports the diagnosis of long standing significant nasal obstruction.
Consultation with the pedodontist or orthodontist may be necessary. Tonsillar hypertrophy, macroglossia and oropharyngeal masses should be evaluated. Evaluation of the voice quality includes as assessment of nasality and clarity. Having the child to speak words that enhance nasality such as lemon, milkman, Mickey Mouse, ninety nine, bananas are normally nasal transmitted words and words such as baseball and Jack are normally non-nasal transmitted words. The ears should be evaluated as otitis media certainly is associated with nasal obstruction problems.