Adenoid-nasopharyngeal Ratio Research Articles

Risk Factors, Clinical Profile and Association of Clinical Grading With Radiological Grading of Adenoid Hypertrophy in Children

BACKGROUND: Adenoid hypertrophy producing obstructive airway symptoms is the most commonly encountered pediatric ENT problem. Clinical symptoms in combination with lateral nasopharyngeal x ray is a reliable technique for selection of children requiring surgical intervention. METHODOLOGY: The current cross sectional prospective study was conducted among 250 children aged 3-12 years with clinical symptoms and radiological evidence suggestive of enlarged adenoids, at Pediatric outpatient department of a tertiary care center, Dhaka, during 1-year period. RESULT: In our current study, majority children (74%) with adenoid hypertrophy were 3-6 years old followed by 26% between 7-12 years. 66% children were male and 34% were female with a male to female ratio of 1.9:1. 44% children were from lower class family and history of atopy was present among 54% children. Clinical grading of adenoid hypertrophy was done on the basis of presenting symptoms (mouth breathing, snoring, sleep disturbances and adenoid facies) and radiological grading was done from calculating adenoid nasopharyngeal ratio. Correlation between clinical scoring and radiological grading of adenoid hypertrophy among study population was observed. Clinical score of 0-4, 5-8, 9-12 and 13-16 was graded clinically into Grade I, II, III and IV respectively. Highly significant p value (.000) was observed in Grade II clinical and radiological grade of enlarged adenoid. The remaining clinical and radiological grade of enlarged adenoids showed significant p value .031, .024 and .019 among grade I, III and IV respectively. CONCLUSION: Though various diagnostic modalities for detection of degree of obstruction caused by enlarged adenoids are available, clinical scoring in combination with radiological grading can be effectively used to select patients requiring surgical intervention for pediatric adenoid hypertrophy. J Shaheed Suhrawardy Med Coll 2022; 14(2): 11-17

Any correlation between severity of symptoms and the adenoid nasopharyngeal ratio?

Objective: Adenoid Hypertrophy is a common childhood condition that presents with mouth breathing, nasal discharge, snoring and sleep apnea. Lateral Nasopharyngeal X-ray aids diagnosis and assessment of patency of the Nasopharyngeal air column through Adenoid Nasopharyngeal Ratio (ANR). This study aims to correlate ANR with symptoms and signs of Adenoid Hypertrophy. Material and Methods: A retrospective study conducted in the Ear, Nose and Throat/Head and Neck Surgery (ENT/HNS) Department of University of Abuja Teaching Hospital, Gwagwalada from January 2019 to December 2021. The case notes and Lateral Nasopharyngeal X-rays of 66 Children aged between 2months to 11 years, with suspected Adenoid Hypertrophy were retrieved and relevant retrieved data analyzed. Results: A total of 66 patients were enrolled into this study with 50 (75.76%) males and 16 (24.24%) females. The age range was between 2 months to 11 years, with a mean of 3.65±2.76 years. ANR ranged from 0.03 to 0.94 with mean 0.71±0.15. Out of the 66 participants, 30 (46.15%) had ANR of 0.7, while 35 (53.85%) had ANR of > 0.7. Linear regression analysis showed association between age and ANR (P < 0.05). Snoring was the most common symptom (92.42%), followed by Mouth breathing (89.39%) and Nasal Discharge (77.27%). Majority of patients (88.6%) had a Mild Symptom Score. There was no statistically significant relationship between any of the clinical features and ANR. Conclusion: There is no significant correlation between the clinical features and adenoid nasopharyngeal ratio.

Assessment Of Adenoid Nasopharyngeal Ratio In Children With Symptoms Suggestive Of Obstructive Adenoid Disease

Background: Adenoid hypertrophy (AH) is a common childhood illness that occurs due to obstruction of the nasopharynx by enlarged adenoids. Lateral nasopharyngeal X-ray is used for diagnosis and assessment of patency of the nasopharyngeal air column by assessing the Adenoid Nasopharyngeal Ratio (ANR). This study aims to assess the ANR of symptomatic patients with AH that presented to Ear, Nose and Throat/ Head and Neck Surgeon (ENT/HNS) Department of the University of Abuja Teaching Hospital (UATH).
 Methodology: This was a retrospective study conducted in the ENT/HNS Department of UATH, Gwagwalada from January 2019 to December 2021. The case notes and lateral nasopharyngeal xrays of 112 children aged between 3 months to 15 years, diagnosed with Adenoid Hypertrophy, were retrieved. Relevant information such as demographics, and Lateral Nasopharyngeal X-ray measurements were extracted.
 Results: A total number of 112 participants were enrolled into this study. Out of these, 77 (68.8%) were males and 35 (31.2%) were females. The mean age of participants was 3.86 0.27 years, and age range was 3 months to 15 years. Most participants were between 0 – 5 years. The mean ANR among participants was 0.69 0.02. The minimum ANR was 0.03, and the maximum ANR was 1.00 Majority of participants had ANR 0.69. None of the participants between 10 – 15 years had an ANR > 0.79. Regression analysis showed statistically significant correlation between ANR and Age (p = 0.05).
 Conclusion: We observed an Adenoidal Nasopharyngeal Ratio that was lower than the benchmark of ANR considered for AH, this may probably be due to our inability to control the timing for obtaining the radiographs from clinic visit and some may have commenced treatment

Predictive Value of Adenoid-Nasopharyngeal Ratio in the Diagnosis of Secretory Otitis Media.

To explore the associated factors of otitis media with effusion (OME) and analyze the diagnostic value of the adenoid-nasopharyngeal (A/N) ratio to OME. Patients with adenoid hypertrophy (AH) recently in 2years were collected, including sex, age, duration, with/without rhinosinusitis, and examination results, including Cone Beam Computerized Tomography (CBCT) sinus imaging, tympanometry, pure tone audiometry (PTA), blood test, and allergen detection. According to Liden/Jerger's classification, the patients were divided into two groups: Type B and type C, which were defined as the tympanometry abnormal group (TAG), and the rest were classified as the tympanometry normal group (TNG). A total of 316 children were included in this study. Age and duration were significantly younger and shorter in TAG (6.0(4.0-9.0) vs.5.0(4.0-7.0)); 12.0(4.0-24.0) vs.6.0(2.0-12.0)). Compared to TNG, the allergen test results of fx5 (protein, milk, cod, wheat, peanut, and soybean) in TAG were higher (0.09(0.04-0.25) vs.0.14(0.05-0.45)), but eosinophilia in blood was lower (count: 0.21(0.13-0.35) vs. 0.18(0.12-0.27); ratio: 3.10 (1.90-4.70) vs. 2.50 (1.65-3.80)). A/N ratio and Visual obstruction ratio had a statistical difference (Z = -3.770, P < .01) but the two ratios didn't have too much disparity (0.82(0.74-0.88) VS 0.80(0.75-0.80)), and they had a positive correlation (r = 0.345, P < .01). A/N ratio of TAG was higher than TNG (0.78(0.70-0.85) vs. 0.86(0.82-0.90)) and had a positive correlation with increasing negative middle ear pressure (r = -3.777, P < .01). A/N ratio was an associated factor of OME (OR:1355.611, P = .006), the cut-off value of A/N ratio was 0.815(sensitivity: 75.3%, specificity: 64.3%, area under the curve (AUC): 0.747). A/N ratio indirectly reflected the abnormality of tympanometry in this study. When A/N ratio reaches 0.815, patients are at a higher risk of having OME so it could be a predictor of OME in patients with adenoid hypertrophy.

Correlation between radiographic adenoidnasopharyngeal ratio and clinical symptoms of adenoid hypertrophy in a tertiary health institution in North West Nigeria

Background: Adenoid hypertrophy is the most common cause of nasopharyngeal airway obstruction in children. The radiographic evaluation of the adenoid hypertrophy using the adenoid-nasopharyngeal ratio is a simple, economical, and reliable method in determination of the position, size, and shape of the adenoids. Aims and Objectives: The study was conducted to determine the correlation between radiographic adenoid-nasopharyngeal ratio and clinical symptoms of adenoid hypertrophy. Materials and Methods: This crosssectional prospective study was carried out in the Department of Radiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, North West Nigeria. A total of 90 consecutive patients aged between 3 and 12 years with clinical symptoms of adenoid hypertrophy were included in the study. All the patients had plain radiography of the post-nasal space. The adenoid-nasopharyngeal ratio (ANR), which is the ratio of the adenoid thickness measured from the maximum convexity of the adenoid to the margin of the basiocciput and the nasopharyngeal depth measured from the posterior border of the hard palate to the anteroinferior aspect of the sphenobasioccipital synchondrosis (Fujioka method), was calculated and scores obtained for each patient were graded into mild (0.50–0.62), moderate (0.63–0.75), and severe (0.76–0.88). The clinical symptoms assessed included snoring, mouth breathing, sleep apnea, otitis media, and recurrent upper airway infections. Each symptom was scored on a 4-point scale and the sum of the scores was graded into mild (0–5), moderate (6–10), and severe (11–15). The data were collected using a structured questionnaire and analyzed using Statistical Package for the Social Sciences version 22. Results: A total of 90 patients were involved in the study, their age ranged between 3 and 12 years (mean=6.11±2.77); and male-tofemale ratio was 2:1.5. The mean ANR score was 0.71±0.11 and that of the clinical symptoms score was 8.67±3.23. ANR correlated significantly with the clinical symptoms scores (r=0.901; P&lt;0.0001). The association was significant at ANR grading for mild (χ2=20.91; P=0.003) and severe (χ2=11.39; P=0.022). Conclusion: This study shows that radiographic ANR can predict the degree of nasopharyngeal airway obstruction especially for mild and severe grading. A severe nasopharyngeal airway obstruction as determined by both ANR and symptom’s severity was observed in the 3–5 years age group.

Association between Adenoid-Nasopharyngeal Ratio and Tympanogram Width in Adenoid Hypertrophy Patients

IntroductionAdenoid hypertrophy is a change in adenoid size that can lead to obstruction the Eustachian tube and become a risk factor for otitis media effusion (OME) in children. Standard objective examination of adenoid hypertrophy uses adenoid-nasopharyngeal ratio (A-N ratio) based on correct lateral skull radiography. Adenoid hypertrophy is one of the factors causing OME in children. There is still much debate about the association between A-N ratio and tympanogram width (Tw). Determining the association of A-N ratio and Tw in adenoid hypertrophy patients.MethodsParticipants performed a true lateral radiographic examination using Fujioka method to determine A-N ratio, and Tw to determine middle-ear pressure. The distance between examination of A-N ratio and tympanogram examination was at maximum of ∼1 week. The association between A-N ratio and Tw in patients with adenoid hypertrophy used the Pearson correlation test. This research employed significance levelp&lt; 0.05.ResultsMost participants were aged between 6 and 10 years (38.10%), male patients (57.14%), and the symptom most participants complained of was snoring during sleep (38.10%). Most participants had A-N ratio of 0.53 to 0.70 (61.90%) with an average of 0.60 ± 0.05. The average value of Tw measurement was 102.83 ± 50.03 daPa (r= 0.605;p&lt; 0.001).ConclusionThere is a significant association between A-N ratio base on true lateral radiographic examination and Tw in adenoid hypertrophy patients.

Radiological and Audiological Assessment in Patients with Adenoid Hypertrophy Undergoing Adenoidectomy.

Enlarged adenoids in children can lead to obstruction of the ET, leading to negative intratympanic pressure and development of Otitis media effusion. Adenoid-nasopharyngeal ratio (ANR) on lateral radiograph of nasopharynx, is one of the most reliable and cost-effective ways of determining the size of adenoids with respect to the nasopharyngeal space. Patients who were clinically diagnosed with adenoid hypertrophy, above the age of 5years, undergoing adenoidectomy were included in the study. Lateral nasopharynx radiograph, Pure tone audiometry (PTA) and tympanometry were performed. The ANR calculated, graded, and compared with the PTA, tympanograms and size on endoscopic assessment. Taking 0.835 as cut-off value, significant correlation of ANR with PTA and impedance (p = 0.002) was found. 71% abnormal PTA and tympanogram was found with ANR > 0.835 whereas 30.8% with ANR < 0.835. ANR is a useful adjunct as a pre-operative tool for determining the need for adenoidectomy in paediatric patients who are not easily willing to undergo endoscopic evaluation. A major drawback is the lack of identification of lateral extent of adenoids.

Association between adenoid bacteriology and clinical characteristics of adenoid-related diseases in children.

Introduction:The aim of this research is to find the association between the pathogenic bacteria obtained from the adenoid culture and clinical characteristics of adenoid-related diseases in children.Methods:In this retrospective study, we reviewed the medical records of children who had adenoidectomy for adenoid-related diseases. Demographic data, diagnoses, indications for adenoidectomy and bacterial culture results were collected. The adenoid size was measured in the lateral skull X-ray as adenoid–nasopharyngeal ratio. Associations between the culture results and the demographic data, adenoid size, and the diagnoses were analyzed.Results:There were 407 children who had adenoidectomy for obstructive sleep-disordered breathing (75.2%), otitis media with effusion (19.2%), and chronic sinusitis (5.6%). Median age was 5.9 years. Common pathogenic bacteria in the adenoid were Haemophilus influenzae (26.2%), Staphylococcus aureus (23.5%), Streptococcus pneumoniae (18.2%), and Moraxella catarrhalis (12%). The patient’s age had significant association with the prevalence of pathogenic bacteria. S. pneumoniae was most prevalent in young children up to 7 years. S. aureus was more common in children over 7 years. H. influenzae had similar prevalence in all age groups. Size of the adenoid and type of adenoid-related diseases had no association with the outcome of bacterial culture.Conclusion:Age of the patients was the significant factor associated with the bacteriological findings of the adenoid while size and types of adenoid-related diseases were not associated with the outcome of bacterial culture.

Hypoxia induced factor-1α levels in patients undergoing adenoidectomy

Among the most common causes of nasal congestion in childhood is adenoid hypertrophy (AH) which leads to hypoxia. In this study, we studied plasma concentrations of hypoxia induced factor-1α (HIF-1α) in children undergoing adenoidectomy. The study included a total of 86 participants: 39 patients with AH and 47 healthy individuals. Serum HIF-1α levels (ng/mL) were measured by ELISA. HIF-1α concentrations were compared to the adenoid-nasopharyngeal ratio (ANR) of patients with AH, as recorded in the medical records. We found significantly higher concentrations of HIF-1α (0.30 ± 0.47 ng/mL) in patients with AH as compared to healthy controls (0.24 ± 0.07 ng/mL, p = .011). HIF-1α levels were not significantly different regarding gender between patients with AH (p = .77) and in the control group (p = .97). In patients with AH, there was a moderately significant positive correlation between HIF-1α levels and Hb (p = .000), (correlation coefficient r = 0.542). There was a positive correlation between HIF-1α and ANR in patients with AH (p = .005, r = 0.439). This study indicates that AH increases HIF-1α levels. We also observed a moderately significant positive correlation between HIF-1α and ANR in patients with AH. HIF-1α levels are a potential biomarker for hypoxia in patients with AH.

Asymptomatic Otitis Media With Effusion in Children With Adenoid Enlargement

ObjectivesTo estimate the burden, and clinical factors associated with development of Otitis media with effusion (OME) in children with enlarged adenoids. MethodsConsecutive eligible patients with adenoid (sometimes with tonsillar) enlargement managed operatively in a period of five years. Patients had no complaints suggestive of hearing impairment. Age, sex, clinical diagnosis, and weight of patients were recorded. Otoscopic, audiometric, and radiological examinations findings were recorded. Tympanometry patterns were classified according to Jerger's classification; type B and C tympanograms represented OME. Some patients had Pure Tone Audiometry (PTA). Plain nasopharyngeal X-ray assessed the adenoid: nasopharyngeal (AN) ratio with >0.5 regarded as obstructive adenoid. Results216 ears of 108 children were assessed. 49.1% of children were in age range 1-3 years, mean 3.6 ± 2.6 years. 62.0% were males, weight ranged from 7.8 to 31.0 kg, mean was 14.3 ± 5.2 kg. 63.9% had associated tonsillar enlargement. Mean AN ratio was 0.69 ± 0.07.Tympanometric findings showed prevalence of OME in all ears was 63/216 = 29.2%, consisting of 30.5% with unilateral (Right ear 19.4%, Left ear 11.1%), and 13.9% with bilateral OME. Acoustic reflexes were absent in both ears in 32 (29.6%) of the patients. There was normal hearing in 16/38 ears (42.1%), while others had different types of hearing loss. Two factors namely increased age and weight were significantly associated with OME in patients with Adenoid enlargement. Conclusions29.2% of children with adenoid enlargement had a co-morbidity of asymptomatic OME. The factors associated with OME were increased age and weight of the patients.

Correlative Multicentric Analysis of Dimensions of Nasopharynx and Adenoid Size, and its Burden in Otitis Media with Effusion: An Indian Scenario.

Diseases of adenoids are commonly observed in children. It indirectly leads to pathology in the middle ear cleft. It has been demonstrated both by radiological techniques and middle ear pressure studies that adenoids can and do obstruct the Eustachian Tube. The Adenoid-Nasopharyngeal Ratio (ANR), can offer a simple arithmetic measure of nasopharyngeal obstruction. Coupled with tympanometry, it also predicts the degree to which the middle ear is affected. Multicentric study done at two centres in India. 230 patients were studied. Children were in the age group of 5-14years. The nasopharyngeal and adenoid dimensions were measured separately using the Fujioka method. The adenoid-nasopharyngeal ratio was derived by the arithmetic method. All patients were also subjected to tympanometry. ANR decreased from 0.728 to 0.663 with an increase in age from 5 to 12years. ANR between 0.701-0.800 had maximum number of Type B (140) and Type C (71) Tympanogram whereas between 0.801 and 0.900, all Tympanogram were found to be of Type B or Type C with none belonging to Type A. Using ANR and Tympanometry, the effects of the adenoids on the middle ear can be quantified indirectly. Both these modalities are easily available, economical, safe and can be performed at the Out Patient Level. This aids in timely and appropriate management thus preventing discomforting symptoms caused by the adenoids locally and also the morbidity caused to the middle ear in the long term.

Development of the nasopharynx: A radiological study of children.

The relation between pharyngeal tonsil and the bony nasopharynx determines the nasopharyngeal airway patency. Despite its importance, an anatomical study utilizing advanced imaging has not been conducted. The aim of the study was to evaluate the pharyngeal tonsil and bony nasopharynx depth and their ratio (adenoid-nasopharyngeal ratio [ANR]) with relation to sex and age in the general pediatric population. After excluding reported history of adenoidectomy, acute upper airway illness, allergy, and poor quality, 200 randomly selected head computed tomographies (CTs) of children were evaluated. CTs were divided into five age groups (0-5, 5.1-8, 8.1-11, 11.1-14, and 14.1-17 years). For each CT scan, the pharyngeal tonsil, bony nasopharynx and ANR values were calculated. A significant difference was found in the bony nasopharynx and pharyngeal tonsil depth between the five age subgroups (P < 0.001). Both bony nasopharynx and pharyngeal tonsil depth significantly increased between the age groups of 0-5 years to 5.1-8 years (4.17 mm increase, P < 0.001 and 3.47 mm increase, P < 0.009, respectively). The pharyngeal tonsil depth gradually decreases following the age of 8 years. No difference was found between age groups beyond age of eight for both the pharyngeal tonsil tissue and the bony nasopharynx. The ANR has an upward trend in the age group of 5.1-8 years. No sexual predilection was found. The bony nasopharynx and the pharyngeal tonsil tissue both grow during childhood. Different growth rates result in the narrowest airway in the age group of 5.1-8 years (ANR peak). These growth curves should be taken under consideration when treating pediatric pharyngeal tonsil hypertrophy. Clin. Anat., 33:1019-1024, 2020. © 2019 Wiley Periodicals, Inc.

Associations among sleep symptoms, physical examination, and polysomnographic findings in children with obstructive sleep apnea.

The relationships among PSG findings, OSA symptoms, and tonsil and adenoid size are not clear. In this study, we aimed to investigate the associations between pediatric OSA and tonsil and adenoid size using subjective (OSA-18 questionnaire) and objective (PSG) measurements. 101 consecutive patients aged from 2 to 12years (mean age, 5.4 ± 2.2years; boys, 72.3%) diagnosed with OSA were enrolled in two age groups (2-6years group and 7-12years group) and underwent PSG and lateral cephalometric radiography. Tonsil size and the adenoid-nasopharyngeal (A/N) ratio were determined. Quality of life and sleep symptoms were measured using the Chinese version OSA-18 questionnaire. Demographic and clinical data were obtained. 75 and 26 patients were separately enrolled in 2-6years group and 7-12years group. In 2-6years group, the multiple linear regression revealed that tonsil size and A/N ratio were associated with log apnea-hypopnea index (AHI), and the Spearman's rank correlation reflected a positive correlation between log AHI and the OSA-18 sleep disturbance score (r = 0.362, P = 0.001). Log OSA-18 score was correlated with tonsil size (r = 0.349, P = 0.002) but not the A/N ratio in 2-6years group. Finally, no significant associations were observed between log OSA-18 scores and log AHI in all patients. As PSG stays the golden standard for diagnoses of pediatric OSA, physical examinations and quality-of-life assessments are needed to fully assess the impact of OSA on children.

Association of asymptomatic otitis media with effusion in patients with adenoid hypertrophy

ObjectiveClinical symptoms of otitis media with effusion are rarely brought forward to the guardians of young children who the disease is most prevalent in. This often leads to poor scholastic performances and difficult social interactions. The objective of this study was to identify asymptomatic cases of otitis media with effusion present in individuals with adenoid hypertrophy. Material and MethodsIn a cross sectional study advocated in Justice K.S.Hegde Hospital, Karnataka India we evaluated one hundred patients above the age of three from August 2016 to December 2017. Candidates who presented with an adenoid nasopharyngeal ratio of more than 0.5 were selected for the study. Individuals who complained of otological symptoms were not considered for the study. Patients cleared of other pathological otological conditions were underwent audiological evaluation with pure tone audiometry and tympanometry for evaluating the middle ear status and hearing loss. ResultsThe study showed a total of 36% of patients evaluated presented with asymptomatic otitis media with effusion. In candidates who presented with a bilateral B tympanogram, 40% had significant conductive hearing loss of more than 25dB. ConclusionAn objective test such as impedance audiometry in all patients with adenoid hypertrophy would aid in the diagnosis of fluid in the middle ear, so that timely intervention can be done and possible complications be averted.

Adenoid nasopharyngeal ratio in children suffering from otitis media with effusion

Adenoid nasopharyngeal ratio in children suffering from otitis media with effusion

Comparison of adenoid size in lateral radiographic, pathologic, and endoscopic measurements.

BackgroundOtitis media (OM) is a major health problem that usually results from adenoid hypertrophy. Diagnosis is based on symptoms like mouth breathing and imaging studies like lateral neck radiography (LNR). Adenoid-nasopharyngeal ratio (A/N ratio) is one of the most important and most widely used criteria in LNR study that could estimate the real size of adenoid gland measurements. However, there are huge controversies regarding LNR rules in the management of patients with OM.ObjectiveThis study aimed to determine Adenoid Nasopharyngeal Ratio (A/N ratio) in children with otitis media with effusion (OME) and its relation with different factors.MethodsThis was a cross-sectional study on OME suspected children who needed adenoidectomy. The study was conducted from the fall to winter of 2016 on patients referred to ENT clinics of Mashhad University of Medical Sciences. Before surgery, all children underwent standard LNRs and indirect laryngoscopy to assess adenoidal size, and nasopharyngeal length, and A/N ratio. After adenoidectomy, pathologic analysis was performed for assessment of pathologic size. SPSS 21 was used for data analyzing using Pearson’s correlation, independent t test and Mann-Whitney U test (p<0.05 was considered significant).ResultsA total of 27 children were enrolled. Most of the patients were male (70.4%, mean age=7.81±2.52 year). All patients in the study were symptomatic and the most frequent symptom was mouth breathing (100%). The mean A/N ratio, pathologic adenoid size, and laryngoscopic adenoid size were 0.825±0.099, 18.22±5.97, and 5.33±19.15 mm. There was a significant correlation between the A/N ratio laryngoscopic adenoid size (r=+0.46, p=0.01) and pathologic adenoid size (r=+0.44, p=0.02).ConclusionsThe results of this study showed that A/N ratio can be used to estimate the actual size of the adenoid gland and the necessity of adenoidectomy. Considering the reasonable costs and availability of this diagnostic method, researchers recommend using this procedure in assessment of patients with OME.

The prevalence and impact of otitis media with effusion in children admitted for adeno-tonsillectomy at Dr George Mukhari Academic Hospital, Pretoria, South Africa

IntroductionOtitis media with effusion (OME) is a leading cause of acquired hearing loss in children worldwide. However, previous South African studies have consistently reported the local paediatric OME prevalence to be lower than typically published in international literature. Furthermore, no South African studies have investigated OME in children with adenotonsillar hypertrophy. The objective of this study was to determine the prevalence of OME in children admitted for adeno-tonsillectomy at our institution in Pretoria, South Africa. In addition, the study sought to gauge the impact of OME on quality of life using a validated questionnaire (OM-6). MethodsA cross-sectional, observational study was conducted between July 2015 and May 2016 at the Otorhinolaryngology outpatient department at DGMAH. he study included 109 consecutively sampled children, aged 2–12 years (mean 6.1; 49.7% female). Pneumatic otoscopy and tympanometry were performed on all participants. Adenoid hypertrophy was quantified using he adenoid-nasopharyngeal ratio (ANR) on a lateral post-nasal space radiograph (Fujioka's method). The OM-6 questionnaire was completed for each participant. Pure tone audiometry was performed for participants diagnosed with OME. ResultsThe prevalence of bilateral OME was 11.9%. For unilateral OME, the prevalence was 22.9% and 16.5%, for the left and right ears, respectively (p > 0.05). The mean hearing loss (SD) was 19.8 dB (9.4). Clinically significant adenoid hypertrophy (ANR ≥ 0.71) was present in 43% of participants. There was no statistically significant (p > 0.05) correlation between the presence OME and adenoid hypertrophy. The mean total OM-6 survey score was 1.67 (SD ± 0.59) in children with OME, and 1.31 (SD ± 0.45) without OME, showing no statistically significant difference (p > 0.05). There was a significant (P < 0.05) correlation between OME and the presence of atopy. ConclusionAdeno-tonsillar pathology may play an aetio-pathological role in the development of OME. However, this may be due to the presence of biofilms rather than obstructive adenoid hypertrophy, given the lack of a significant (p > 0.05) correlation between adenoid hypertrophy and OME. Whilst OME was not found to impair quality of life in this population group, the validity of the OM-6 in the South African paediatric population requires further investigation.

The impact of adenotonsillectomy on pulmonary arterial pressure in West African children with adenotonsillar hypertrophy

ObjectivesTo assess the improvement or otherwise, in the mean pulmonary arterial pressure (mPAP) among children with adenotonsillar hypertrophy (ATH) after adenotonsillectomy (AT), and to examine the impact of timing of surgery as well as the patients' characteristics on the mPAP changes. MethodsWe included 39 children with ATH in this study. The adenoidal enlargement was evaluated radiologically with adenoid nasopharyngeal ratio (ANR) parameter from lateral neck radiograph, whereas the clinical assessment of adeno-tonsillar obstruction was conducted with the ‘symptom score’. Pulmonary arterial pressure (PAP) measurement was performed noninvasively by Doppler echocardiography. All patients underwent adenotonsillectomy (AT). After 6 weeks, they were subjected again to clinical and echocardiographic assessments, and the mean pulmonary arterial pressures (mPAP) were then compared. The mPAP changes after AT were further related to the grades of ANR, symptom scores, tonsillar size, and timing of AT. ResultsThe preoperative mPAP was 23.46 mmHg and was 18.98 mmHg post-operatively (P = 0.003). Seventeen of subjects (43.6%) had pulmonary hypertension (PH) (mPAP ≥ 25 mmHg) preoperatively, out of which 14 (82%) decreased to normal range 6 weeks after AT. Non-reversal of pulmonary hypertension was associated with ANR > 0.75 (P = 0.043), but was not related to the timing of surgery, tonsillar size, and symptom score. Significant reduction in mPAP was more likely with ANR ≤ 0.75 and pre-operative mPAP ≥ 25 mmHg. All the symptoms also improved significantly after AT. ConclusionElevated PAP due to ATH in children was mostly reversible by AT irrespective of the timing of surgery, symptom severity, and tonsillar size, but gross enlargement of adenoids seem to be associated with non-reversal of PH.

Are three-dimensional airway evaluations obtained through computed and cone-beam computed tomography scans predictable from lateral cephalograms? A systematic review of evidence.

To systematically review the literature correlating upper airway parameters between lateral cephalograms (LC) and cone-beam computed tomography (CBCT) or computed tomography (CT) scans to determine the utility of using LC to predict three-dimensional airway parameters. Both electronic and manual searches of the included studies were performed by two reviewers, and the quality of the studies that met selection criteria were assessed. A total of 11 studies from the literature met the selection criteria. Assessed outcome variables showed correlation r < .7 between the LC and CT scans. The correlation between the LC and CBCT ranged from weak to strong with -.78 ≤ r and r ≤ .93 reported in the nasopharyngeal segment. In the oropharyngeal segment, a weak to strong correlation was reported with a range of -37 ≤ r and r ≤ .83 between the CBCT and LC. All associations in the hypopharyngeal segment showed a weak correlation. Four of studies were of weak quality, five were of moderate quality, and two were rated to be of strong quality. No strong correlations were reported between the LC and CT scans. However, the LC-derived adenoid-nasopharyngeal ratio and the linear measurement (posterior nasal spine, PNS, to posterior pharyngeal wall) had a strong correlation with upright nasopharyngeal area and volume in the CBCTs. The area measurement in conventional LC can be also used as an initial screening tool to predict the upright three-dimensional oropharyngeal volumetric data. The variability of the hypopharyngeal segment cannot be predicted by LCs. However, more well-designed studies are needed to determine the clinical utility of using LC to predict airway size.

Prevalence and associated factors of pulmonary hypertension in Kenyan children with adenoid or adenotonsillar hypertrophy

ObjectivesAdenotonsillar hypertrophy is a common condition in childhood, whose serious complications of pulmonary hypertension and cor pulmonale are devastating but local prevalence is unknown. This study determined the prevalence and associated factors of pulmonary hypertension in children with adenoid or adenotonsillar hypertrophy at Kenyatta National Hospital, Kenya. MethodsThis was a cross sectional hospital based survey conducted among children below 12 years of age with clinical and radiological adenoid hypertrophy attending the ear, nose and throat (ENT) outpatient clinic and general pediatric wards. Doppler echocardiography was used to determine pulmonary hypertension defined as a mean pulmonary arterial pressure (mPAP) of ≥25mm Hg using the Chemla equation. Children with mPAP of ≥25mm Hg were compared to those with lower pressures and clinical and radiological factors associated with pulmonary hypertension determined using multivariate logistic regression analysis. ResultsOf the 123 eligible children in the study, 27 had pulmonary hypertension giving a prevalence of 21.9% (95% CI 14.64%–29.27%). Independent factors associated with pulmonary hypertension included nasal obstruction (OR=3.0 [95% CI 1.08–8.44] p=0.035) and hyperactivity on history (OR=0.2 [95% CI 0.07–0.59] p=0.003) and adenoid-nasopharyngeal ratio (ANR) >0.825 on lateral neck radiography (OR=5.0 [95% CI 1.01–24.37] p=0.048). ConclusionOne in five children with adenoid or adenotonsillar hypertrophy had pulmonary hypertension with a 3-fold and 5-fold increased odds in those with nasal obstruction on history and ANR >0.825 on lateral neck radiography respectively and an 80% reduced odds in reportedly hyperactive children.