. A practical treatise on medical diagnosis for students and physicians . be found onthe pillow in the morning. The hearing is frequently may be simply dulness of hearing,or it may amount to marked deafness,either because of pressure of the adenoidvegetations or extension of secondary in-flammation to the Eustachian tubes. Thesenses of taste and smell are often much im-paired. There is increase in the secretionof pharyngeal mucus, which in older per-sons causes difficult expectoration. Rhinoscopic Examination. The roofof the pharynx is covered with rounded orvillous projections,
. A practical treatise on medical diagnosis for students and physicians . be found onthe pillow in the morning. The hearing is frequently may be simply dulness of hearing,or it may amount to marked deafness,either because of pressure of the adenoidvegetations or extension of secondary in-flammation to the Eustachian tubes. Thesenses of taste and smell are often much im-paired. There is increase in the secretionof pharyngeal mucus, which in older per-sons causes difficult expectoration. Rhinoscopic Examination. The roofof the pharynx is covered with rounded orvillous projections, often concealing theposterior nares. Rarely the villi may beseen projecting below the soft palate. Inchildren the examination is difficult, andhence digital exploration must be usedunder an anaesthetic. The finger readilyI detects the masses, which sometimes aresoft, at other times tough and of fibrous or; cartilaginous consistency. The Appearance. The expression of the face is characteristic. It is1 dull and stupid, and may be drawn. (Figs. 357, 358, 359.) The mouth. Appearance in adenoid disease.(Dawson-Williams.) 988 DISEASES OF THE MOUTH, FAUCES, PHARYNX, ETC. is kept open in breathing. The lips are thickened, dry, and may becracked. The palatal arch is high and narrowed. The nostrils are flattened laterally. Rarely they may be one instance, which the writer saw with Harrison Allen, the ex-terior of the nose suggested inherited syphilis, especially because of ourknowledge of the possible presence of the disease. There were no otherevidences of hereditary syphilis in the child or in any member of thefamily. The voice is thick and muffled, becoming indistinct upon the occur-rence of slight cold. The Chest. While there is a general lack of physical development,the appearance of the chest is most striking; the cases have been fre- Fig. 358. Fig. 359.
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