Versatility and Benefits of 4.0mm Flexible Nasal Endoscopy in 118 Children up to 10 Years of Age.

Ved P Narang,Giovanni Sambiagio,Anna Loroch

doi:10.7759/cureus.22656

Abstract

PurposeThis retrospective study looked at the feasibility of using adult 4.0 mm flexible nasendoscopes (FNE) examination under local anesthetic (LA) in children three to 10 years old to diagnose adenoid hypertrophy (AH) and other conditions. We also looked for a correlation between the adenoid size on FNE and a) tonsil size, b) the typical symptoms of snoring, mouth breathing, impaired hearing, and apnoeic episodes c) the management options of otitis media with effusion (OME) and d) the adenoid size intraoperatively.MethodsA retrospective, observational study of 118 children in an NHS pediatric otolaryngology clinic led by a single consultant. One hundred ten consecutive patients with suspected AH were divided into two groups of three to five years and six to 10 years. We compared the acceptance rate to FNE in two subgroups (three to five years and six to 10 years old) and examined the correlation between various parameters as outlined above, using the Chi-square test. Eight children underwent FNE for other reasons of change of voice and epistaxis.ResultsFNE was successfully performed in 86% of the patients without restraint. Thirty-three percent of patients had non-obstructive adenoids (OA) and did not require surgical intervention. The intraoperative adenoid size, symptoms of snoring, mouth-breathing, and apnoeic episodes positively correlated with OA; however, no correlation was seen with the tonsil size (p=0.1143). All patients with OA and type B tympanogram needed adenoidectomy and grommet insertion (p=0.0119), and those with type C curves recovered with adenoidectomy alone.Conclusions4.0 mm adult scope helped reach a definitive diagnosis for AH in most children above three years of age, thus proving cost-effective. The symptoms of snoring, mouth-breathing, and apnoeic episodes had a positive correlation to the presence of OA; however, the tonsil size was seen to be independent of adenoid size.Primary surgical management can be considered the treatment of choice for all patients with OA and type B tympanogram without a trial of conservative therapy.

Highlights

Snoring, mouth breathing, and apnoeic episodes are a source of great distress and anxiety for many parents
The intraoperative adenoid size, symptoms of snoring, mouth-breathing, and apnoeic episodes positively correlated with obstructive adenoids (OA); no correlation was seen with the tonsil size (p=0.1143)
All patients with OA and type B tympanogram needed adenoidectomy and grommet insertion (p=0.0119), and those with type C curves recovered with adenoidectomy alone

Summary

Introduction

Mouth breathing, and apnoeic episodes are a source of great distress and anxiety for many parents. Parents often express grave concerns, record videos, and commonly feel the need to quiver their child to stimulate breathing when confronted with an apnoeic spell. There are many reasons for a young child to develop symptoms of snoring, mouth breathing, apnoeic episodes, and nasal discharge, enlarged adenoids by far remain the most common cause [1,2]. The diagnosis is often based on a parents' account of symptoms and clinical examination that does not involve assessing the post-nasal space. It has not been widespread practice across the UK to offer flexible nasendoscopy (FNE) for the pediatric population of patients. One of the reasons might be suspicion of noncooperation and poor tolerance of the procedure under local anesthesia in the outpatient setting [3]

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