Adenoid Hyperplasia Research Articles

Are computed tomography 3D measurements of the upper airways in mouth-breathing children in agreement with the ENT clinical diagnosis of obstruction?

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.

Nasal obstructive disorders induce medical treatment failure in paediatric persistent allergic rhinitis (The NODPAR Study).

Allergic rhinitis (AR) is the most common chronic disease among children. To characterize the disease, a modified classification of severity (m-ARIA) has recently been validated in AR children. When medical treatment fails, surgery for nasal obstructive disorders (NOD) may be a therapeutic option. Our objective was to assess the prevalence of NOD and their influence in medical treatment response among children with persistent AR (PER). In a prospective, real-life study, 130 paediatric PER patients (13.1±2.8years, females 31.5%, severe rhinitis 49%) referred from Allergy to ENT department were assessed for their response (R, responders; NR, non-responders) to medical treatment (intranasal steroids and antihistamines or antileukotrienes) by direct questioning and nasal symptom visual analogue scale, the presence of NOD (septal deformity, turbinate enlargement and adenoidal hyperplasia), comorbidities, nasal symptoms, rhinitis severity (modified ARIA criterion) and asthma control (International Consensus On Pediatric Asthma criterion). After 2months of treatment, the NR group presented a higher prevalence of obstructive septal deformity and severe inferior turbinate enlargement when compared with the R group. Higher septal deformity and turbinate enlargement scores were strongly associated with treatment refractoriness. The prevalence of severe PER was also higher for the NR group. Higher asthma control scores were associated with the probability of treatment-induced improvement. In paediatric PER patients, medical therapy refractoriness was associated with NOD, mainly septal deformity and turbinate enlargement. In those patients, ENT examination will facilitate an early NOD diagnosis in order to indicate potential corrective surgery.

Rebound adenoid hyperplasia after chemotherapy in pediatric patients with head and neck lymphoma: MR imaging findings.

To assess MR imaging findings of rebound adenoid hyperplasia after chemotherapy in pediatric patients with head and neck lymphoma. Eight pediatric patients with head and neck lymphoma treated with chemotherapy alone or concurrent chemoradiotherapy were included. All patients underwent pre-therapeutic assessment and post-therapeutic follow-up by MR imaging. The maximum thickness of the adenoid was assessed on transverse T2-weighted images. Rebound adenoid hyperplasia was defined as more than half of the pre-therapeutic thickness after severe atrophy. The pre-therapeutic maximum thickness of the adenoid ranged from 10 to 18mm (mean, 15mm). In all patients, the thickness of the adenoid dramatically decreased (mean 1mm) within 1year after the cessation of chemotherapy. On follow-up MR imaging, rebound adenoid hyperplasia was observed in five patients (63%). Re-atrophy following rebound adenoid hyperplasia was observed in two patients (25%), and no re-atrophy was observed in three patients (37%). Rebound adenoid hyperplasia was not observed in three patients (37%) who were in their late teens, and who had been treated with concurrent chemoradiotherapy. Rebound adenoid hyperplasia was often observed after chemotherapy in pediatric patients with lymphoma. MR imaging was useful for the assessment of rebound adenoid hyperplasia.

Histopathological results of nasopharyngeal masses of adult patients: a study from two centres in Port Harcourt, Nigeria

Background: Nasopharyngeal masses in adult patients in most cases are considered to be tumours unless proven otherwise. Aim: To determine the histopathological results of nasopharyngeal masses seen in adult patients in Port Harcourt Nigeria. It will also highlight the management outcomes of these patients. Methods: A prospective (January 2010 to December 2013) study of 45 patients with both clinical and radiological evidence of nasopharyngeal masses seen at the Ear Nose and Throat (ENT) surgery clinics of University of Port Harcourt Teaching Hospital (UPTH) and Kinx Medical Consultants clinic in Port Harcourt. All the patients had examination under anaesthesia (E/U/A) of the nose and nasopharynx and biopsy. The data collected were documented in a proforma designed for the study by the researchers. The data are bio-data, clinical features, investigations, histopathological findings, treatment, complications and management outcome. The data were entered into an SPSS version 14 computer soft ware and analyzed descriptively. Results: Forty five adult patients had E/U/A of the nose and nasopharynx and biopsy of nasopharyngeal masses. They all had history of chronic rhinorrhoea, snoring and nasal obstruction. Age range was 18-72 years. There were 20 males and 25 females with male to female ratio of 1:1.25. The commonest histopathological diagnosis was adenoidal hyperplasia (n=36, 80%) followed by non-Hodgkin lymphoma (n=5, 11.11%). Conclusion: Even though the predominant histopathological result of nasopharyngeal masses in adult patients we encountered was adenoidal hyperplasia, all tissues from the nasopharynx irrespective of their benign macroscopic appearances should be subjected to histopathological examination to avoid missing out more sinister diagnosis. Keywords: Examination under anaesthesia, Nasopharyngeal masses, Non-Hodgkin lymphoma, Adenoidal hyperplasia, Squamous cell carcinoma

Association of β-Lactam-Sensitive Haemophilus influenzae Type B with Adenoid Biofilm Formation in Patients with Adenoidectomy Surgery.

Chronic adenoid infection by β-lactam-resistant Haemophilus influenzae type b (Hib) and biofilm formation contribute to adenoid hyperplasia. Middle ear disease consequently remains a critical issue in the pediatric population. The aim of this study was to investigate the correlation of Hib biofilm formation with middle ear effusion with adenoid hyperplasia (MEE-AH) and with pediatric obstructive sleep apnea (OSA). A total of 384 patients with adenoidectomy from January 2008 to December 2012 were recruited in this investigation. Thirty-two patients (14 female and 18 male; age 4-13 years) who obtained routine adenoidectomy surgery had Hib-positive cultures were enrolled in a retrospective manner. By using polysomnography, 18 patients were diagnosed as having MEE-AH with chronic adenotonsillitis, and 14 patients were diagnosed as having pediatric OSA. The results of the Hib biofilm, antibiotic resistance profiles, and scanning electron microscopy observation, which correlated with the clinical diagnosis, were analyzed by the chi-square test and Fisher exact test. Biofilm formation by Hib was significantly present in the patients with MEE-AH rather than patients with OSA. β-lactam-sensitive Hib were resistant to augmentin because of the adenoid biofilm formation. However, this finding was uncommon in the pediatric OSA group. Properly treating β-lactam-sensitive Hib infection may be an important issue in reducing MEE-AH and adenoid vegetation in the pediatric population. Further research is warranted to elucidate the association of Hib-related biofilm formation with treatment failure and the need to consider earlier surgical intervention.

Pilot study: Association between Helicobacter pylori in adenoid hyperplasia and reflux episodes detected by multiple intraluminal impedance in children

ObjectivesThe aim of this pilot study was to investigate an association between laryngopharyngeal reflux detected by combined multiple intraluminal impedance and pH monitoring and Helicobacter pylori in adenoid hyperplasia detected with real time polymerase chain reaction (PCR). MethodsThe study group consisted of 30 children (median age 5.34 years) with extraesophageal symptoms of gastroesophageal reflux disease with adenoid hyperplasia. All children underwent adenoidectomy with subsequent PCR detection of H. pylori DNA in the tissue and multiple intraluminal impedance and pH monitoring. The most proximal impedance sensor was located 1cm caudal to the entrance of the oesophagus. ResultsWe found significant differences in the number of reflux episodes among patients with PCR positivity (median 35) and negativity (median 0) of H. pylori (p-value of Mann–Whitney U-test 0.0056). Patients with PCR positivity of H. pylori had significantly more reflux episodes reaching the upper oesophageal sphincter (p-value of Mann–Whitney U-test 0.023). The absence of reflux episode was the only independent factor for PCR negativity of H. pylori in the multiple logistic regression model. ConclusionsThese results support the hypothesis that reflux episodes reaching the upper oesophageal sphincter may play an important role in the transmission of H. pylori into lymphoid tissue of the nasopharynx and thus may contribute to adenoid hyperplasia in children.

Surgical Outcome in Paediatric Tympanoplasty: Our Experience

The aim of the Retrospective Study is to see the surgical outcome of Tympanoplasty in Paediatric age group in our Institute. The study includes a total of 50 children of age group 9 to 14 years, who underwent type I tympanoplasty in our Institute between January 2011 and December 2013. The children were divided in 2 groups, Group I of 20 cases ,which comprised of children less then 11 years and other as group II of 30 cases, which constituted children above 11 years. Patients who had adenoid hyperplasia, persistent U.R.T.I., those patients who had chronic squamosal disease of the same ear or who had any type of previous or concurrent ossicular chain reconstruction, were excluded from the study. In our study we have seen success rate i.e. graft uptake, was higher in Group II (90.3%) as compared to Group I(75%). and it was not found to be statistically significant (p> 0.05). Overall success was in 43 cases out of total of 50 cases ( 86%). Audiological improvement was seen in 40 (80%) cases. Conclusion:Tympanoplasty is the best known modality of treatment of central perforation in children . However, results are better in children who are greater then 11 years of age .

Adenoid hypertrophy existence in adulthood- a truth revealed

Background and aims: The adenoids (nasopharyngeal tonsils) are part of Waldeyer’s ring of lymphoid tissue. Endoscopic examination of the nasopharynx increasingly recognized that adenoidal tissue in adults is not an uncommon finding. The aims of this study were to determine prevalence of adult adenoid tissue and the possible reasons behind it. Methods: A retrospective study of 1,100 adult patients, who had routine nasal endoscopic examination for nasal obstruction and related pathologies, was undertaken. 84 cases with incidental hypertrophied adenoid were reviewed to determine the probable cause, presenting symptoms, clinical suspicion and final histological diagnosis. Results: The age of patients ranged from 18 years to 77 years. Median age was 32 years. 59 (70.24%) of adenoid hypertrophy patients were smokers and only 25 (29.76%) were nonsmokers suggesting strong association between smoking and adult adenoid hypertrophy with odds ratio=5.3251, %2value of 54.23 and an extremely significant p value. All the 84 cases were confirmed histopathologically as Reactive adenoid hyperplasia and no signs of malignancy in any of them. Conclusions: The true incidence of adenoidal hypertrophy in adults is unknown. Adenoidal tissue in adults, if present, must always be biopsied or removed irrespective of their macroscopic appearance. The result underlines the importance of considering adenoid hypertrophy as a cause or contributing factor in nasal obstruction and related pathologies in adults. It also supports the theory that it represents a long-standing inflammatory process rather than being a novel clinical entity.

Adenoid hypertrophy existence in adulthood- a truth revealed

Abstract Background and aims: The adenoids (nasopharyngeal tonsils) are part of Waldeyer’s ring of lymphoid tissue. Endoscopic examination of the nasopharynx increasingly recognized that adenoidal tissue in adults is not an uncommon finding. The aims of this study were to determine prevalence of adult adenoid tissue and the possible reasons behind it. Methods: A retrospective study of 1,100 adult patients, who had routine nasal endoscopic examination for nasal obstruction and related pathologies, was undertaken. 84 cases with incidental hypertrophied adenoid were reviewed to determine the probable cause, presenting symptoms, clinical suspicion and final histological diagnosis. Results: The age of patients ranged from 18 years to 77 years. Median age was 32 years. 59 (70.24%) of adenoid hypertrophy patients were smokers and only 25 (29.76%) were nonsmokers suggesting strong association between smoking and adult adenoid hypertrophy with odds ratio=5.3251, χ2value of 54.23 and an extremely significant p value. All the 84 cases were confirmed histopathologically as Reactive adenoid hyperplasia and no signs of malignancy in any of them. Conclusions: The true incidence of adenoidal hypertrophy in adults is unknown. Adenoidal tissue in adults, if present, must always be biopsied or removed irrespective of their macroscopic appearance. The result underlines the importance of considering adenoid hypertrophy as a cause or contributing factor in nasal obstruction and related pathologies in adults. It also supports the theory that it represents a long-standing inflammatory process rather than being a novel clinical entity.

Airway management in a patient with Morquio–Brailsford syndrome

Airway management in a patient with Morquio–Brailsford syndrome

Is There a Relationship Between Serum Levels of Vitamin A, Vitamin E, Copper and Zinc and Otitis Media with Effusion in Children?

The aim of this study is to determine whether the serum levels of vitamin A, vitamin E, copper and zinc have a role in the development of otitis media with effusion (OME) in childhood. This prospective study was conducted between February 2010 and February 2011 at a tertiary Otorhinolaryngoloy Clinic. There were 113 subjects and subdivided into three groups. Group 1 consisted of 44 patients who underwent adenoidectomy with ventilation tube placement due to OME. Group 2 consisted of 43 patients underwent adenoidectomy alone and group 3,called control group, included 26 healthy children. Serum values of vitamin A, vitamin E, copper and zinc were measured preoperatively. Comparison of the patient groups showed that group 1 patients had significantly lower serum zinc levels than group 2 patients (p=0.002), although differences between both patients groups and controls were not significant. We found that the differences among the three groups in terms of serum levels of vitamin A, vitamin E and copper were not statistically significant (p>0.05). The results of this study showed that serum levels of vitamin A, vitamin E and copper may not play a role on development of OME. We postulated that high serum zinc status may have the preventive effect in the predisposition to OME which may related to adenoid hyperplasia.

Adenoid basal hyperplasia of the uterine cervix: a lesion of reserve cell type, distinct from adenoid basal carcinoma

Adenoid basal hyperplasia is an underrecognized cervical lesion, resembling adenoid basal carcinoma, except the absence of deep invasion into the stroma. We report a series of 10 cases, all extending less than 1 mm from the basement membrane. Our results support the hypothesis that adenoid basal hyperplasia arises from reserve cells of the cervix. Lesions were found close to the squamocolumnar junction, in continuity with the nearby subcolumnar reserve cells. They shared the same morphology and immunoprofile using a panel of 4 antibodies (keratin 5/6, keratin 14, keratin 7 and p63) designed to differentiate reserve cells from mature squamous cells and endocervical columnar cells. We detected no human papillomavirus infection by in situ hybridization targeting high-risk human papillomavirus, which was concordant with the absence of immunohistochemical p16 expression. We demonstrated human papillomavirus infection in 4 (80%) of 5 adenoid basal carcinoma, which is in the same range as previous studies (88%). Thus, adenoid basal hyperplasia should be distinguished from adenoid basal carcinoma because they imply different risk of human papillomavirus infection and of subsequent association with high-grade invasive carcinoma. In our series, the most reliable morphological parameters to differentiate adenoid basal hyperplasia from adenoid basal carcinoma were the depth of the lesion and the size of the lesion nests. Furthermore, squamous differentiation was rare in adenoid basal hyperplasia and constant in adenoid basal carcinoma. Finally, any mitotic activity and/or an increase of Ki67 labeling index should raise the hypothesis of adenoid basal carcinoma.

The effect of adenotonsillectomy on serum insulin like growth factors and the adenoid/nasopharynx ratio in pediatric patients: A blind, prospective clinical study

Objectives Obstructive adenoid and tonsillar hyperplasia may present with retardation of growth. An adenoid–nasopharynx (A/N) ratio determined by means of lateral cephalometric radiographs has long been used as a diagnostic tool in the assessment of adenoid size. This study was designed to investigate the effect of adenotonsillectomy on insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) levels and correlation between A/N ratio and IGF-I and IGFBP-3 levels. Methods Patients ( n = 48) that had been operated on our clinic with a diagnosis of adenotonsillar hypertrophy between July 2009 and January 2010 were included in the study. The routine ear–nose and throat examination was done in all patients. Blood samples were taken, and lateral cephalometric radiographs were obtained preoperatively and repeated at 6–9 months (mean 7.2 ± 1.0 mo) following tonsillectomy and adenoidectomy. The chemiluminescent enzyme-linked immunosorbent method was used to IGF-I and IGFBP-3 levels. Each cephalometric radiograph was evaluated by a blinded radiologist. The A/N ratio was calculated using the Fujioka method. Results When the preoperative and postoperative results were compared, a statistically significant increase in serum IGF-I and IGFBP-3 and a decreased A/N ratio were found. However, although correlation between the Δ(preoperative − postoperative difference) IGFBP-3 and ΔA/N ratio was 40%, it was not statistically significant. Additionally, no statistically significant correlation between the ΔIGF-I and ΔA/N ratio was found. Conclusions The results of the present study indicate that adenotonsillectomy could result in the relief of nasopharyngeal obstruction and have a positive effect on growth in children by decreasing the A/N ratio and increasing IGF-I and IGFBP-3. There was no correlation between the ΔA/N ratio and ΔIGF-I and ΔIGFBP-3 levels.

Activity of soluble aminopeptidase A and dipeptidyl peptidase IV and membrane-bound aminopeptidase B and pyroglutamyl peptidase I in adenoid hyperplasia, tonsillar hyperplasia and chronic tonsillitis

Objective To analyze soluble and membrane-bound peptidase activities in the tonsils and adenoids removed from patients with adenoid hyperplasia, tonsillar hyperplasia and chronic tonsillitis. Methods A total of 48 tissue samples from patients undergoing adenoidectomy and tonsillectomy for adenoid hyperplasia, tonsillar hyperplasia or chronic tonsillitis were analyzed. The catalytic activity of a pool of peptidases in the soluble (dipeptidyl peptidase IV, aminopeptidase A, aminopeptidase N and cystinyl aminopeptidase) and membrane-bound (prolyl endopeptidase, aspartyl aminopeptidase, aminopeptidase B and pyroglutamyl peptidase I) fractions was measured fluorometrically. Results The activity of membrane-bound aminopeptidase B was higher in cases of chronic tonsillitis and adenoid hyperplasia than in tonsillar hyperplasia, p = 0.004. Soluble dipeptidyl peptidase IV and membrane-bound pyroglutamyl peptidase I were found to be more active in tissues from male chronic tonsillitis tissues, p < 0.05, while membrane-bound aminopeptidase B activity was higher in tissues of females with tonsillar hyperplasia, p < 0.001. In the case of chronic tonsillitis, soluble aminopeptidase A was found to have a higher level of activity in tissues from children than those from adults, p = 0.005. Conclusions Our results suggest a potential role of soluble aminopeptidase A, soluble dipeptidyl peptidase IV, membrane-bound aminopeptidase B and membrane-bound pyroglutamyl peptidase I in the pathobiology of adenoid hyperplasia, tonsillar hyperplasia and chronic tonsillitis that is differently regulated as a function of gender. These finfings may modify in the future the clinical approach to these diseases.

Association of adenoid hyperplasia and bacterial biofilm formation in children with adenoiditis in Taiwan

The adenoid is a bacterial reservoir that contributes to chronic otolaryngologic infections. Staphylococcus aureus (S. aureus) is a common pathogen in the adenoid. The increase of antibiotic resistance in S. aureus has become an important issue in public health. The aim of this study was to compare adenoid hyperplasia and biofilm formation in children with S. aureus adenoiditis in Taiwan. The patients were divided into methicillin-resistant and methicillin-sensitive S. aureus groups according to the S. aureus obtained from adenoid tissue after antibiotic susceptibility testing. Adenoid hyperplasia was assessed by lateral cephalometry, and the severity of sinusitis was evaluated by Water's view. Microbiological investigation of available S. aureus isolates was performed by in vivo morphological observation and an in vitro bacterial biofilm assay. Sixty isolates of S. aureus were identified in 283 children (21.2%) after adenoidectomy, of which 21 (35%) were methicillin-resistant S. aureus (MRSA). The severity of adenoid hyperplasia and extensive biofilm formation were more prominent in patients infected with methicillin-resistant S. aureus than in those infected with methicillin-sensitive S. aureus (MSSA). The primary outcome of this study was to provide evidence that S. aureus constituted a significant portion of the adenoidal pathogens. The secondary outcome of this study was that MRSA adenoiditis may be associated with adenoid hyperplasia and biofilm formation.

Excessive Reactive Lymphoid Hyperplasia in a Child With Persistent Obstructive Sleep Apnea Despite Previous Tonsillectomy and Adenoidectomy

Both lingual tonsil and adenoid are the lymphoid tissue members of Waldeyer ring. Enlargement of the lingual tonsil and adenoid occurs in children with persistent obstructive sleep apnea despite previous tonsillectomy and adenoidectomy relatively frequently.In this article, we present a case with upper airway obstruction and infection findings because of excessive lingual tonsil and adenoid tissue hyperplasia and, additionally, bilateral multiple cervical lymphadenopathies. The patient had had tonsillectomy and adenoidectomy 8 years ago. Etiopathogenetic mechanisms, clinical, radiologic, histopathologic aspects, and surgical therapeutic options for obstructive sleep apnea related to excessive reactive lymphoid hyperplasia in children are discussed reviewing the literature.

In reference to Proposed definitive grading system tool for the assessment of adenoid hyperplasia

In reference to <i>Proposed definitive grading system tool for the assessment of adenoid hyperplasia</i>

In response to Proposed definitive grading system tool for the assessment of adenoid hyperplasia

In response to Proposed definitive grading system tool for the assessment of adenoid hyperplasia

Altered dipeptidyl peptidase IV and prolyl endopeptidase activities in chronic tonsillitis, tonsillar hyperplasia and adenoid hyperplasia

Objective To analyse peptidase activities in the removed tonsils and adenoids from patients with chronic tonsillitis, tonsillar hyperplasia and adenoid hyperplasia. Methods We have analyzed 48 tissue samples from patients undergoing tonsillectomy and adenoidectomy for chronic tonsillitis, tonsillar hyperplasia or adenoid hyperplasia. Tonsillectomy and adenoidectomy samples were collected and frozen for later enzyme analysis. The catalytic activity of a pool of peptidases (dipeptidyl peptidase IV, prolyl endopeptidase, aminopeptidase A, aminopeptidase N, aspartyl aminopeptidase, aminopeptidase B, neutral endopeptidase, pyroglutamyl peptidase I, puromycin-sensitive aminopeptidase and cystinyl aminopeptidase) was measured fluorometrically. Results The activity of prolyl endopeptidase was higher in tonsillar hyperplasia and adenoid hyperplasia than in chronic tonsillitis. On the contrary, dipeptidyl peptidase IV activity was higher in chronic tonsillitis than in hypertrophic tissues. When data were stratified by age and gender, dipeptidyl peptidase IV was also found to be more active in adult and male chronic tonsillitis tissues. Inversely, dipeptidyl peptidase IV activity was higher in tissues of females with tonsillar hyperplasia. Conclusions These data indicate the involvement of dipeptidyl peptidase IV and prolyl endopeptidase in the mechanisms underlying chronic tonsillitis, tonsillar hyperplasia and adenoid hyperplasia.

Proposed definitive grading system tool for the assessment of adenoid hyperplasia

To propose a definitive standard grading scale in the assessment of adenoid tissue in relation to size, position, and proximity to surrounding anatomic structures. This will allow for better clinical communications among practitioners when treating this pathology, a better understanding of its relationship and how it effects neighboring structures (eustachian tube and choanae), and allow for a more precise description of this tissue for the purpose of research data collection and analysis. A prospective evaluation of adenoid tissue during adenoidectomy was obtained documenting its size and descriptive relationship to adjacent structures (eustachian tube and choanae). A convenience sample of 150 children undergoing adenoidectomy alone or concurrently with tonsillectomy and/or myringotomy and tubes were prospectively evaluated. Mirror nasopharyngeal exam was performed in all cases. Size of the adenoid, as well as its relationship to the choanae and eustachian tube were recorded. A descriptive grading system tool was created accounting for these relationships. Statistical analysis was performed to offer a preliminary validation of the tool. Adenoid grading scores were assigned to 150 pediatric patients, 74 males and 76 females, who underwent surgery for adenoidectomy with or without tonsillectomy and/or myringotomy and tube placement. Seven patients were found to have no adenoid tissue in the nasopharynx as they had previous adenoidectomy and received a grade of 0A-. The mean age was 5.71 years (range, 1-17 years). Of the 150 scores, 107 patients had an associated diagnosis of chronic hypertrophic adenoids and/or tonsils (CHAT) accounting for 71.3% of the sample. There was a significant increasing trend of CHAT with an increasing size and increasing blocking of the choanae. However, there is no relationship of this morbidity with blocking of the eustachian tube (ET). There is a strong inverse relationship between blocking of the choanae and chronic and recurrent adenotonsillitis. The percentage of patients with this morbidity significantly decreases with increasing blocking of the choanae. A total of nine patients with chronic sinusitis were found to have no relationship between size, blocking of the choanae, and abutting of the eustachian tube. Eustachian tube dysfunction (ETD) was significantly related to blocking of the eustachian tube (ET) in this study, as 54.3% experienced ETD in the presence of blocked ET compared to only 15% in the absence of a blocked ET. Among the components of the adenoid score, the diagnosis given preoperatively, and the surgical treatments performed, there were strong correlations found giving merit to the descriptive nature of this grading tool proposed. This grading system is simple, reliable, and easily used. It offers standardization for clinicians and researchers in facilitating communications, and allowing interpretation of adenoid tissue observed with its relationship to and effect on adjacent anatomic structures. This will allow more detailed information of findings during adenoid surgery to assist in future clinical research studies and outcomes analysis.