Abstract
IntroductionImaging studies have hystorically been used to support the clinical otorhinolaryngological evaluation of the upper respiratory tract for the diagnosis of obstructive causes of oral breathing. ObjectiveThe objective of this study was to compare 3D volumetric measurements of nasal cavity, nasopharynx and oropharynx of obstructed mouth-breathing children with measurements of non-obstructed mouth-breathing children. MethodsThis retrospective study included 25 mouth-breathing children aged 5–9 years evaluated by otorhinolaryngological clinical examination, flexible nasoendoscopy and full-head multi-slice computed tomography. Tomographic volumetric measurements and dichotomic otorhinolaryngological diagnosis (obstructed vs. non-obstructed) in three anatomical regions (the nasal cavity, nasopharynx and oropharynx) were compared and correlated. An independent sample t-test was used to assess the association between the 3D measurements of the upper airways and the otorhinolaryngological diagnosis of obstruction in the three anatomical regions. Inter- and intra-observer intraclass correlation coefficients were used to evaluate the reliability of the 3D measurements. ResultsThe intra-class correlation coefficients ranged from 0.97 to 0.99. An association was found between turbinate hypertrophy and nasal cavity volume reduction (p<0.05) and between adenoid hyperplasia and nasopharynx volume reduction (p<0.001). No association was found between palatine tonsil hyperplasia and oropharynx volume reduction. Conclusions(1) The nasal cavity volume was reduced when hypertrophic turbinates were diagnosed; (2) the nasopharynx was reduced when adenoid hyperplasia was diagnosed; and (3) the oropharynx volume of mouth-breathing children with tonsil hyperplasia was similar to that of non-obstructed mouth-breathing children. The adoption of the actual anatomy of the various compartments of the upper airway is an improvement to the evaluation method.
Highlights
Imaging studies have hystorically been used to support the clinical otorhinolaryngological evaluation of the upper respiratory tract for the diagnosis of obstructive causes of oral breathing
All these children were diagnosed as obstructive sleep apnea (OSA) patients by polissonography and referred to a multi-slice computed tomography (MSCT) study to better clarify the levels of the upper airway obstruction
The MSCT-3D nasal cavity measurements showed a 30% volume reduction (p < 0.05) in the mouth breathing (MB) children with obstructive turbinates, in comparison with the MB children whose turbinates were considered within normal limits (10,564 vs. 15,073 mm3)
Summary
Imaging studies have hystorically been used to support the clinical otorhinolaryngological evaluation of the upper respiratory tract for the diagnosis of obstructive causes of oral breathing. An ENT clinical examination of the upper airway has been historically performed with the aid of radiographic images to diagnose obstructive causes of mouth breathing (MB).[1] In recent decades, flexible nasoendoscopy has become a diagnostic tool.[2] A clinical examination combined with flexible nasoendoscopy (FN) is the gold standard for the diagnosis of upper airway obstruction.[3,4] With the increasing use of computed tomography (CT) in several health science fields and the development of commercial software, new perspectives have occurred. Validation of using 3D reconstructions for the diagnosis of obstructive tissues has not been presented
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