NASOPHARYNGEAL TONSIL, ENLARGEMENT OF.—The geal tonsil is called also the pharyngeal or third tonsil. When it is enlarged one speaks of proliferations in the nasopharyngeal space. This tonsil cannot be seen when the mouth is open, and it should not be founded with the palatal tonsils situated to the right and left of the uvula. Enlargement of the geal tonsil results in loud snoring with the mouth open, snuffling speech, temporary difficulties of hearing, and stitches in the ears. Small children often stop abruptly when drinking ; older ones eat insufficiently and slowly, and snort when chewing or drinking. At night they sleep with their mouths open, restlessly tossing from side to side ; sometimes they breathe superficially, at other times they sigh deeply, and they are apt to scream aloud during their dreams. Even older children often void their urine in bed when asleep. School-children often complain of headache and fatigue. Their vivacity, attention, and comprehension, as well as their memory, may become impaired ; and their gaiety and fondness of bodily exercise diminish. Even without preceding or inflammation, hearing may become impaired to such an extent that the teacher's lectures can he only imperfectly understood. The
of these symptoms in a child should cause the parents to have it examined by a physician. Physicians who regularly attend to a school will readily single out children thus afflicted. A hereditary predisposition to the affection is often present.
Proliferation of the pharyngeal tonsil has still more remote consequences, which are of importance to parents and teachers. The features become changed ; the nose becomes too small ; the hard palate assumes an abnor mally high curvature resembling a pointed arch, so that the front teeth of the upper jaw are advanced in front of the lower ones, as is the case in rodents. Many teeth may turn so that their side-edges point forward ; others may be completely crowded out of the row, owing to lack of space. Also the shape of the thorax may change, its lower portion becoming depressed. A person suffering from enlargement of the nasopharyngeal tonsil usually has a typical facial ex pression, as shown in Figs. 292 and 293. These iliastrations also show the inferior development of the chest due to the respiratory difficulties.