Objective: To investigate the appropriate drug therapy based on a novel classification system for adenoids based on their appearance. Methods: We used fiberoptic nasal endoscopy to determine the degree and appearance of adenoid hypertrophy (AH). The adenoids were divided into three types: edematous type, common type, and fibrous type. In adenoid tissues, the eosinophils were counted. Immunohistochemistry and western blot were done to determine the expression of CysLTR1, CysLTR2, CGR-α, and CGR-β in different types of adenoids. Results: 70.67% (106/150) AH patients with AR, and of them 68% (72/106) of adenoids were the edematous type. The expression of CGR-α and CGR-β and eosinophil count were higher in the edematous type but not in common and fibrous types. The expression of the leukotriene receptor was stable in all types. There was a positive correlation between eosinophil count in the blood and in the adenoid tissue. Conclusion: AR was the risk factor for the development of AH. Leukotriene receptor antagonist was an important drug for the treatment of AH. The glucocorticoid was only useful in the edematous type. Therefore, for AH patients with AR, patients with edematous type adenoids and/or patients with increased eosinophils in blood routine choose nasal glucocorticoid combined with leukotriene receptor antagonist is appropriate. On the contrary, leukotriene receptor antagonists alone can be selected to treat AH.