الفهرس 
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Abstract
Adenoid hypertrophy is a common childhood disorder. It plays a significant role in the pathogenesis of intra tympanic pressure variations. which is the commonest cause of hearing impairment in children. Thus, it predisposes to delayed speech, poor academic and language development. Also ,An untreated adenoid hypertrophy may lead to obstructive sleep apnea, ear problems, failure to thrive, pulmonary hypertension, and craniofacial anomalies.
Adenoid hypertrophy may obstructing the Eustachian tube orifice resulting in middle ear pressure level changes leading to pathological changes in the middle ear .so ,this may affect the ventilation system of the middle ear cleft which affect the mastoid air cell pneumatization.
So, In our study, we planned to explain if there is relation between adenoid hypertrophy and change in the middle ear pressure level and any effect on mastoid air cells pneumatization.
This study included 40 child at preschool age patients collected from outpatient clinic of ENT department. Children had a different a degree of adenoid hypertrophy and different intra tympanic pressure, Every patient undergoes investigation include plain x-ray nasopharynx (lateral view), tympnometry, CT mastoid bone and measuring the adenoid tissue volume after adenoidectomy in addition to complete routine investigation.
In our current results we found that adenoid hypertrophy increase negative middle ear pressure level and there is significant correlation between adenoid volume and middle ear pressure changes level, we have total 80 ears, we had 24 ears type A curve tympanogram with median adenoid volume 4.90 4 ears type As with median adenoid volume 5, 42 type B with median adenoid volume 5.7 and 10 type C with median adenoid volume 6.20(p.value= <0.001).
Also ,in our result, we found that no significant relation between adenoid volume and mastoid air pneumatization as According to adenoid volume 5.48±0.94 well mastoid air cell pneumatization 35 cases (70ears) and adenoid volume 5.40±1.19 poorly mastoid air cell pneumatization 5 cases (10ears) (p.value= 0.864)
Adenoid tissue volume has a significant effect on intratympanic pressure level, as increasing in adenoid volume tissue change intra tympanic pressure level as otitis media with effusion which may effect on mastoid air pneumatization, but there is no significant direct relation between adenoid tissue volume and mastoid air cells pneumatization.