A child presents with recurrent respiratory tract infection, mouth breathing and decreased hearing. Treatment is:

Child is presenting with mouth breathing. Palate is high arched.There is nasal obstruction and recurrent respiratory tract infections along with hearing impairment. All these features are suggestive of adenoid hyperplasia. In case of adenoid hyperplasia, impairment of hearing is due to secretory otitis. Thus the logical step in the management would be myringotomy with grommet inseion (to treat SOM) and adenoidectomy or tonsilectomy (to remove the causative factor).