Hello, I am Dr. Atul Kumar Nimawat, MS (ENT). As you mentioned, your son has been diagnosed with Grade 4 adenoid hypertrophy, which is causing mouth breathing due to significant nasal obstruction. In such advanced cases, medical management is usually not effective. The recommended treatment is surgical removal of the adenoids (adenoidectomy). If not treated in a timely manner, chronic mouth breathing can lead to a condition known as adenoid facies, which is a set of characteristic facial changes seen in children with long-standing adenoid hypertrophy. Features of Adenoid Facies: 1. Persistent mouth breathing 2. Open mouth posture at rest 3. Long and narrow facial structure 4. High-arched palate 5. Dental malocclusion, such as overbite or crowded teeth 6. Prominent upper front teeth 7. Dull or flattened facial expression 8. Narrowed nostrils (pinched nasal alae) 9. Underdeveloped upper jaw (maxilla), giving the appearance of a receding chin.

If adenoid r not decreased by medication than their is need of surgery otherwise it hamper day to day activities of ur child and problem in hearing

Better to get it done Other wise there will be visible complications like adenoid facies later

If it's grade 4 then better to remove by surgery.