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The adenoid, or nasopharyngeal tonsil, is similar in all respects to the two tonsils visible within the throat, but is situated behind the nose. In childhood, it enlarges and reaches its maximum size at around seven years of age. It may cause obstruction to the back of the nose and may also contribute to the development of secretory otitis media (Chapter 14). In cases where the adenoid is large at an unusually early age, there may be interference with breathing at night (see the section in this chapter on obstruction of the airway by enlarged tonsils and adenoids). Generally speaking, the adenoid comes to clinical attention either because of the occurrence of secretory otitis media, or because of troublesome nasal obstruction with infected nasal discharge.