Adenoidal hypertrophy is probably the most frequent pathology in the pediatric population. This disorder manifests with several symptoms such as bilateral nasal obstruction, rhinorrhea, cough, snoring, hyponasal speech, hypopnea, and sleep apnea. When tonsillar hypertrophy is also present, obstructive sleep apnea syndrome can manifest. To date, nasal endoscopic examination is the standard technique to diagnose and estimate adenoid mass. Adenotomy is considered the surgical treatment of choice to resolve nasopharyngeal obstruction due to adenoidal hypertrophy. At present, several pitfalls of adenotomy (i.e., alteration of the immunological system, postoperative bleeding, and recurrence of adenoids) are object of criticism. For this reason, some researchers have tested the efficacy of topical nasal steroids in decreasing the severity of nasal symptoms and adenoidal mass. Herein, we review the literature on conservative treatments including also our personal experience.