Adenoidal-nasopharyngeal Ratio Research Articles

Adenoidal nasopharyngeal ratio and its correlation with skeletal class II malocclusion in children: A cross-sectional study

Introduction: The relationship between skeletal class II malocclusion and airway has gained significant interest in the field of orthodontics and is crucial for accurate diagnosis and treatment planning. Various etiologies contribute to airway obstruction, which may disrupt the breathing pattern and swallowing functions, affecting the development of the craniofacial complex and consequently resulting in the development of skeletal Class II malocclusion. Adenoid hypertrophy (AH) has been linked to cardiopulmonary complications, craniofacial growth disturbances and obstructive sleep apnea. Patients with AH often exhibit a characteristic adenoid face and mouth breathing pattern with a narrow constricted maxillary arch and retrognathic mandible. Adenoidal- nasopharyngeal ratio is a simple linear measurement obtained from lateral cephalograms that can reliably express adenoidal size and patency of the nasopharyngeal airway and give further insight into the etiology of development of class II malocclusion and correlation with the same. Materials and methods: Sample of 40 individuals between 10-16 years of age was divided into two groups of 20 each based on their ANB angle, Group A comprised of individuals showing skeletal class I and group B showing skeletal class II malocclusion respectively. Lateral cephalograms were taken and AN ratio was assessed using the Fujioka et al method for both groups. AN ratios were correlated with skeletal class of malocclusion and values of both groups were compared.

Correlation between Adenoidal–nasopharyngeal Ratio and Otitis Media with Effusion: A Cross-sectional Study

Correlation between Adenoidal–nasopharyngeal Ratio and Otitis Media with Effusion: A Cross-sectional Study

Effect of different degrees of adenoid hypertrophy on pediatric upper airway aerodynamics: a computational fluid dynamics study.

To improve the diagnostic accuracy of adenoid hypertrophy (AH) in children and prevent further complications in time, it is important to study and quantify the effects of different degrees of AH on pediatric upper airway (UA) aerodynamics. In this study, based on computed tomography (CT) scans of a child with AH, UA models with different degrees of obstruction (adenoidal-nasopharyngeal (AN) ratio of 0.9, 0.8, 0.7, and 0.6) and no obstruction (AN ratio of 0.5) were constructed through virtual surgery to quantitatively analyze the aerodynamic characteristics of UA with different degrees of obstruction in terms of the peak velocity, pressure drop (△P), and maximum wall shear stress (WSS). We found that two obvious whirlpools are formed in the anterior upper part of the pediatric nasal cavity and in the oropharynx, which is caused by the sudden increase in the nasal cross-section area, resulting in local flow separation and counterflow. In addition, when the AN ratio was ≥ 0.7, the airflow velocity peaked at the protruding area in the nasopharynx, with an increase 1.1-2.7 times greater than that in the nasal valve area; the △P in the nasopharynx was significantly increased, with an increase 1.1-6.8 times greater than that in the nasal cavity; and the maximum WSS of the posterior wall of the nasopharynx was 1.1-4.4 times larger than that of the nasal cavity. The results showed that the size of the adenoid plays an important role in the patency of the pediatric UA.

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

Using sleep heart rate variability to investigate the sleep quality in children with obstructive sleep apnea.

Obstructive sleep apnea (OSA) is associated with impaired sleep quality and autonomic dysfunction. Adenotonsillectomy significantly improves subjective and objective sleep quality in children with OSA. However, the postoperative changes in heart rate variability (HRV) indices (indicators of cardiac autonomic function) and their importance remain inconclusive in childhood OSA. This retrospective case series aimed to investigate the association of sleep HRV indices, total OSA-18 questionnaire score (a subjective indicator of sleep quality) and polysomnographic parameters (objective indicators of sleep quality), and effects of adenotonsillectomy on HRV indices, total OSA-18 questionnaire score and polysomnographic parameters in children with OSA. Seventy-six children with OSA were included in baseline analysis, of whom 64 (84%) completed at least 3 months follow-up examinations after adenotonsillectomy and were included in outcome analysis. Associations between baseline variables, and relationships with treatment-related changes were examined. Multivariable linear regression models in the baseline analysis revealed independent relationships between tonsil size and obstructive apnea-hypopnea index (OAHI), adenoidal-nasopharyngeal ratio and very low frequency (VLF) power of HRV (an indicator of sympathetic activity), and normalized low frequency power (an indicator of sympathetic activity) and OAHI. The outcome analysis showed that adenotonsillectomy significantly improved standard deviation of all normal-to-normal intervals, and high frequency power, QoL (in terms of reduced total OSA-18 questionnaire score), OAHI and hypoxemia. Using a conceptual serial multiple mediation model, % change in OSA-18 questionnaire score and % change in VLF power serially mediated the relationships between change in tonsil size and % change in OAHI. The improvement in OAHI after adenotonsillectomy was serially mediated by reductions in total OSA-18 questionnaire score and VLF power. These preliminary findings are novel and provide a direction for future research to investigate the effects of VLF power-guided interventions on childhood OSA.

Voice characteristics in patients with nasal congestion and enlarged pharyngeal tonsils

ABSTRACT Purpose The purpose of this study was to investigate the voice characteristics in patients with nasal congestion and enlarged pharyngeal tonsils. Materials and Methods Twenty-two children with an adenoidal-nasopharyngeal (AN) ratio of <0.5 and nasal cavity resistance of ≤0.25 Pa/cm3/s were assigned to the normal group. Twenty-five children with an AN ratio of <0.5 and nasal cavity resistance of ≥0.5 Pa/cm3/s were classified into the nasal congestion group. Nineteen children with an AN ratio of ≥0.63 and nasal cavity resistance of ≤0.25 Pa/cm3/s were defined as the enlarged pharyngeal tonsils group. The test sound /N/ has a characteristic antiformants (AF). The fourth formant (F4), the formant frequency, was calculated to relativize formant frequencies that vary with vocal tract length. The AF divided by F4 (AF/F4) was also calculated. Results The group with enlarged pharyngeal tonsils had the largest AF/F4. The nasal breathing group had the next largest AF/F4, and the normal group had the smallest AF/F4. Conclusion Stenosed vocal tracts with nasal congestion or enlarged pharyngeal tonsils showed an increased frequency due to obstruction of ventilation, and the AF/F4 ratio in the enlarged pharyngeal tonsils group was greater than that of the nasal congestion group. Voice analysis is a potential no-invasive method of distinguishing between nasal congestion and enlarged pharyngeal tonsils.

ADENOID HYPERTROPHY: A CORRELATION OF RADIOGRAPHIC PARAMETERS TO POSTOPERATIVE ADENOID VOLUME

Background: Various objective parameters of assessing adenoid size on x-ray have been proposed with no agreement on which is most suitable. In this study, the correlation of two radiographicparameters: adenoidal-nasopharyngeal ratio (ANR) and antroadenoid diameter (AA diameter) to postoperative adenoid volume were compared, with a view to determine which is more accurate. Objectives:To determine and compare the correlations of ANR and AA diameter to postoperative adenoid volume, in order to establish which parameter is more accurate in assessing adenoid size on x-ray. Methods: A cross-sectional analytical study conducted at the Moi Teaching and Referral Hospital, Kenya. 107 patients below fifteen years of age who had adenoid hypertrophy and underwent subsequent adenoidectomy were enrolled.Correlation was calculated using Pearsons correlation,controlling for the number of days between x-ray and surgery, which was a potential confounding factor. Comparison of the two correlation coefficients was carried out using Steigers Z-test. Results: The age of the participants ranged from 11 months to 11 years. The mean ANR was 0.70, mean AA diameter was 3.10mm while the mean postoperative adenoid volume was 2.83mL.Correlation of the ANR to the postoperative adenoid volume was0.661(p&lt;0.001) while that of the AA diameter was -0.222 (p=0.022).Null hypothesis was tested using Steigers Z-test and the difference between the two correlation coefficients found to be significant.The ANR is, therefore, determined to have a stronger correlation to postoperative adenoid volume than the AA diameter. Conclusion: ANR is a better predictor of adenoid volume than the AA diameter.

Cephalometric evaluation of adenoids and upper airway.

Abstract Cephalometric analysis performed on lateral X-ray allow orthodontists to evaluate soft tissues as well. Enlargement of adenoids, changes of the position of the tongue can be diagnosed parallel with skeletal assessment. Our purpose was to investigate the skeletal growth direction and the posterior airway depth in mouth breather patients and to underline the importance of a complex cephalometric analysis prior orthodontic treatment. 30 mouth breather patients were selected from our database (17 boys and 13 girls, age 10.8±1.2), in every case ENT examination confirmed the hypertrophy of adenoids. From the same database 30 patients with normal breathing pattern (17 boys and 13 girls, age 11.1±0.9) for the control group. For every patient, the size of the adenoids, the depth of the palate and the position of the tongue. After filtering out the outliers in GraphPad-InStat system, standard deviation (±SD) was calculated, descriptive analytical statistics were performed. Statistically significant differences were recorded regarding: 1.) the distance between adenoid vegetation and the palate (p=0.014, mouth breathers mean 9.76 ± SD 3.04; control group mean 14.38 ± SD 4.41), 2.) the distance between Sella and the adenoids (p=0.186, study group mean 33.39 ± SD 4.39; control group mean 28.38 ± SD 8.91), 3.) adenoidal-nasopharyngeal ratio (p = 0.05). Cephalometric evaluation of adenoids revealed considerable enlargement of this in mouth-breather children, meanwhile upper airway constriction will appear in the same group. Depth of the palatum will increase when breathing pattern is modified.

Comparison of Radiographic Parameters and Perioperative Quality of Life According to the Degree of Adenoid Extension to Choana

Background and Objectives The aims of this study were to clarify the impact of adenoidal extension toward the choana on the quality of life and to find differences in radiographic parameters between patients needing additional excision with a 90-degree tip and those who only require a 40-degree debrider tip.Subjects and Method Patients who underwent adenoidectomy with both 40-degree and 90-degree debrider tips were defined as the difficult-to-treat (DTT) group. Patients who underwent adenoidectomy using only a 40-degree debrider tip were defined as the control group. We measured the antroadenoidal distance, the adenoidal nasopharyngeal ratio (ANR), the length from the adenoid to hard palate, and reviewed the Korean Obstructive Sleep Apnea-18 (KOSA-18) scale scores.Results There was no difference in the quality of life due to OSA between the DTT and control groups, pre- and post-operatively. Correlation analysis between the antroadenoidal distance and the pre-operative KOSA-18 scale scores revealed a negative correlation. The antroadenoidal distance was shorter in the DTT group; however, a cut-off value could not be obtained. The ANR was a statistically discriminatory, but not effective, factor.Conclusion There was no difference in the KOSA-18 scale scores between the groups with the adenoidal extension toward the choana and the control. The ANR should be considered in the pre-operative radiographic evaluation but is not a diagnostic parameter for choanal extension. Further studies to find additional parameters are necessary.

Adenoidal-Nasopharyngeal Ratio in Healthy Adults on Cone Beam Computed Tomography.

This study aimed to quantify the adenoidal-nasopharyngeal ratio (ANR) in a cohort of healthy adults on cone beam computed tomography (CT) using the Fujioka method, which is a reproducible measure of adenoid size and nasopharyngeal patency. Electronic health records and maxillofacial cone beam CT in 202 consecutive patients aged 16 years and older were retrospectively reviewed. Patients with a history of adenoidectomy, sinonasal disease, lymphoproliferative disorders, and cleft palate were excluded from the study. The midsagittal reconstructed cone beam CT image was used to determine the ANR. Statistical analysis was conducted using 1-way analysis of variance. Of the 202 subjects, 131 were female and 71 were male. The mean ± SD subject age was 45.43 ± 20.79 years (range, 16-91 years). The mean ± SD ANR in all subjects was 0.22 ± 0.13 (range, 0.03-0.75) and in each decade of adult life was as follows: younger than 21 years, 0.39 ± 0.12; 21 to 30 years, 0.29 ± 0.11; 31 to 40 years, 0.21 ± 0.09; 41 to 50 years, 0.20 ± 0.07; 51 to 60 years, 0.16 ± 0.10; 61 to 70 years, 0.13 ± 0.05; 71 to 80 years, 0.12 ± 0.05; 81 to 90 years, 0.11 ± 0.04; and 91 years or older, 0.10 ± 0. The differences in mean ANR among the age subgroups were statistically significant ( P < 0.001). The mean ANR gradually decreased from 0.39 in the second decade of life to 0.16 in the sixth decade of life and plateaued at approximately 0.10 thereafter.

Efficacy and safety of fluticasone propionate nasal spray in treatment ofadenoidal hypertrophic snoring in children

This study investigatedthe efficacy and safety offluticasone propionate nasal spray in treatment of adenoidal hypertrophic snoring in children.Fifty-six children with adenoidal hypertrophic snoring were enrolled. According to adenoidal-nasopharyngeal ratio (ANR) in lateral nasal X-ray examination,the children were assigned in moderategroup (23 cases) and severegroup (33 cases).The fluticasone propionate nasal spray was used for all patientsfor 4 weeks.In 56 patients, after treatment, compared with before treatment, the snoring, sleep apneaand nasal obstruction scores in moderategroupand the nasal obstruction score in severegroupwere significantly decreased,respectively (P < 0.05).The decreases of snoring, sleep apnea, mouth breathing and nasal obstruction scores after treatment in moderate group were significantly higher than those in severe group, respectively (P <0.001).After treatment, in 18 patients with ateral nasal X-ray examination,the adenoid size was obviously reduced, and the nasopharynx airway was obviously enlarged. The meanANRdropped from 0.76±0.10 to 0.72±0.09(P <0.001).Duringtreatment, only 2 of 56 patients were reported with intranasal dryness and occasional epistaxis, which were self-healed without treatment.Fluticasone propionate nasal spray is effective and safe for treatment of children’s snoring caused by adenoidal hypertrophy.

Aerodynamic characteristics in upper airways among orthodontic patients and its association with adenoid nasopharyngeal ratios in lateral cephalograms

BackgroundAdenoid hypertrophy among orthodontic patients may be detected in lateral cephalograms. The study investigates the aerodynamic characteristics within the upper airway (UA) by means of computational fluid dynamics (CFD) simulation. Furthermore, airflow features are compared between subgroups according to the adenoidal nasopharyngeal (AN) ratios.MethodsThis retrospective study included thirty-five patients aged 9–15 years having both lateral cephalogram and cone beam computed tomography (CBCT) imaging that covered the UA region. The cases were divided into two subgroups according to the AN ratios measured on the lateral cephalograms: Group 1 with an AN ratio < 0.6 and Group 2 with an AN ratio ≥ 0.6. Based on the CBCT images, segmented UA models were created and the aerodynamic characteristics at inspiration and expiration were simulated by the CFD method for the two groups. The studied aerodynamic parameters were pressure drop (ΔP), maximum midsagittal velocity (Vms), maximum wall shear stress (Pws), and minimum wall static pressure (Pw).ResultsThe maximum Vms exhibits nearly 30% increases in Group 2 at both inspiration (p = 0.013) and expiration (p = 0.045) compared to Group 1. For the other aerodynamic parameters such as ΔP, the maximum Pws, and minimum Pw, no significant difference is found between the two groups.ConclusionsThe maximum Vms seems to be the most sensitive aerodynamic parameter for the groups of cases. An AN ratio of more than 0.6 measured on a lateral cephalogram may associate with a noticeably increased maximum Vms, which could assist clinicians in estimating the airflow features in the UA.

Adenoid measurement accuracy: A comparison of lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy (gold standard)

ObjectiveTo compare the accuracy of lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy in assessment of adenoid size. MethodsA cross-sectional study was conducted in 43 pediatric patients undergoing ENT surgery from July 2017 to December 2018. All patients underwent preoperative lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy. ResultsThe average adenoidal-nasopharyngeal (A/N) ratio obtained from lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy was 72.9, 79.5, and 81.6, respectively. There was a moderate correlation between A/N ratio from lateral skull film and intraoperative rigid endoscopy (Pearson's correlation: 0.567, p˂0.001). Whereas, the A/N ratio from flexible endoscopy compared to intraoperative rigid endoscopy showed a stronger correlation (Pearson's correlation: 0.791, p˂0.001). From linear regression analysis, the intraoperative adenoid measurement was estimated from the results of flexible endoscopy (intraoperative rigid endoscopy: 0.72 [flexible endoscopy] +24.47) and lateral skull film (intraoperative rigid endoscopy = 0.65 [lateral skull film] + 34) ConclusionFlexible endoscopy yields the most accuracy in the assessment of adenoid size and nasopharynx visualization, without radiation exposure or anesthesia. Despite less accuracy, lateral skull film is more availability in every hospital. The correlation of adenoid size measurement in this study can also be applied for the actual size of adenoid.

Effect of Rapid Maxillary Expansion on Upper Airway Morphology: A Retrospective Comparison of Normal Patients versus Patients with Enlarged Adenoid Tissue.

Objectives The present study evaluated the effect of rapid maxillary expansion (RME) on the morphology of the upper airway (UA) by calculating cross-sectional areas and volumes and comparing the effect in patients with a normal-sized adenoid with the effect in patients with an enlarged adenoid. Study design: Seventeen patients met the inclusion criteria. We constructed 3D models of the UA on cone-beam computed tomography images to calculate cross-sectional areas and volumes at the levels of the nasopharyngeal, retropalatal, and retroglossal airways. Patients were divided into two groups: group 1 was comprised of patients with an adenoidal nasopharyngeal (AN) ratio < 0.6 and group 2 with an AN ratio ≥ 0.6. Paired samples t-tests assessed any area and volumetric changes of the UA after RME. Changes in degree of nasal obstruction, calculated as the AN ratio, was then compared for the two groups. An independent samples t-test compared volumetric changes in the nasopharynx between the two groups before and after RME. Results Changes in cross-sectional areas and volumes of the UA due to RME were not significant. The effects of RME on AN ratio (11 % vs 0 %) and nasopharyngeal volume (36.8 % vs 5.97%) were somewhat larger in group 2 patients who had adenoid-associated nasal obstruction compared with group 1 patients with a normal-sized adenoid; however, the differences were not significant. Conclusions After RME, the patients with an enlarged adenoid had more increases in nasopharyngeal volume compared with those with normal adenoid, despite there was no significant difference.

Screening Severe Obstructive Sleep Apnea in Children with Snoring.

Efficient screening for severe obstructive sleep apnea (OSA) is important for children with snoring before time-consuming standard polysomnography. This retrospective cross-sectional study aimed to compare clinical variables, home snoring sound analysis, and home sleep pulse oximetry on their predictive performance in screening severe OSA among children who habitually snored. Study 1 included 9 (23%) girls and 30 (77%) boys (median age of 9 years). Using univariate logistic regression models, 3% oxygen desaturation index (ODI3) ≥ 6.0 events/h, adenoidal-nasopharyngeal ratio (ANR) ≥ 0.78, tonsil size = 4, and snoring sound energy of 801–1000 Hz ≥ 22.0 dB significantly predicted severe OSA in descending order of odds ratio. Multivariate analysis showed that ODI3 ≥ 6.0 events/h independently predicted severe pediatric OSA. Among several predictive models, the combination of ODI3, tonsil size, and ANR more optimally screened for severe OSA with a sensitivity of 91% and a specificity of 94%. In Study 2 (27 (27%) girls and 73 (73%) boys; median age, 7 years), this model was externally validated to predict severe OSA with an accuracy of 76%. Our results suggested that home sleep pulse oximetry, combined with ANR, can screen for severe OSA more optimally than ANR and tonsil size among children with snoring.

The effect of rapid maxillary expansion on the upper airway\u2019s aerodynamic characteristics

BackgroundThe effect of rapid maxillary expansion (RME) on the upper airway (UA) has been studied earlier but without a consistent conclusion. This study aims to evaluate the outcome of RME on the UA function in terms of aerodynamic characteristics by applying a computational fluid dynamics (CFD) simulation.MethodsThis retrospective cohort study consists of seventeen cases with two consecutive CBCT scans obtained before (T0) and after (T1) RME. Patients were divided into two groups with respect to patency of the nasopharyngeal airway as expressed in the adenoidal nasopharyngeal ratio (AN): group 1 was comprised of patients with an AN ratio < 0.6 and group 2 encompassing those with an AN ratio ≥ 0.6. CFD simulation at inspiration and expiration were performed based on the three-dimensional (3D) models of the UA segmented from the CBCT images. The aerodynamic characteristics in terms of pressure drop (ΔP), maximum midsagittal velocity (Vms), and maximum wall shear stress (Pws) were compared by paired t-test and Wilcoxon test according to the normality test at T0 and T1.ResultsThe aerodynamic characteristics in UA revealed no statistically significant difference after RME. The maximum Vms (m/s) decreased from 2.79 to 2.28 at expiration after RME (P = 0.057).ConclusionThe aerodynamic characteristics were not significantly changed after RME. Further CFD studies with more cases are warranted.

Inverse Relationship between Adenoid Size and Asthma or Atopy in Children: A Preliminary Study

Background and Objectives One of the most common surgical procedures in children is adenoidectomy, but the causes of adenoid hypertrophy are not fully understood. Some studies have found that allergies can be a risk factor for adenoid hypertrophy, asthma being one of these allergic diseases. This study aimed to investigate the relationship between adenoid size and asthma in a group of children.Subjects and Method This study reviewed a total of 2063 pediatric patients with or without atopy and asthma who visited the Otorhinolaryngology and Pediatric unit at a tertiary medical center from January 2011 to June 2016. We classified these patients into 4 groups according to the presence of asthma or atopy and randomly selected 100 patients from each group (to a total of 400 pts): group 1 (asthma-, atopy-); group 2 (asthma-, atopy+); group 3 (asthma+, atopy-) and group 4 (asthma+, atopy+). The presence of allergic sensitization (atopy) was evaluated by CAP test and total IgE. Asthma was diagnosed according to the diagnosis criteria in the Korean guideline for asthma. Adenoid size was evaluated with the adenoidal-nasopharyngeal ratio (A/N ratio) by the adenoid view.Results The four groups did not differ from each other significantly in age or sex. There was a negative correlation between adenoid size and atopic and asthmatic condition. Group 1 had a significantly larger A/N ratio than the other groups (group 1=0.534±0.138; group 2=0.469± 0.140; group 3=0.476±0.135; group 4=0.482±0.128, &lt;i&gt;p&lt;/i&gt;&lt;0.05). However, group 4 showed nearly identical results to groups 2 and 3, despite the combination of asthma and atopy in group 4.Conclusion Large adenoids were negatively associated with atopy and asthma. This finding may be explained by a decrease in adenoid stimulation by nasal obstruction and a difference in the immune system, including allergic immune reactions. Further studies are needed.

Comparison of Flexible Nasopharyngoscopy with Plain Radiograph in the Assessment of Children with Adenoid Hypertrophy.

Background:Obstructive adenoid hypertrophy is one of the commonest disorder seen in paediatric otorhinolaryngology clinics. It has a wide range of complications that can lead to cardiopulmonary and developmental problems; hence, early diagnosis and treatment are paramount in preventing the complications. Several modalities for the assessment of adenoid hypertrophy have been described in the literature, of which plain radiograph and flexible nasopharyngoscopy are the most popular. In this study, traditional method of evaluating adenoid hypertrophy (plain radiograph) has been compared with newer flexible nasopharyngoscopy.Materials and Methods:This is a cross-sectional study of randomly selected children with clinical diagnosis of obstructive adenoid disease. All eligible participants underwent clinical examinations, flexible nasopharyngoscopy and postnasal space X-ray. The findings were compared using the chi-square test and Pearson’s correlation test.Results:The age of the participants ranged between 2 and 10 years with mean of 4.5 ± 2.5 years. There were 79 (56.4%) males and 61 (43.6%) females. The adenoid hypertrophy observed using flexible nasopharyngoscopy among the participants ranged between 20 and 90% with mean of 67.4 ± 15.4%. The adenoid enlargement measured using adenoidal–nasopharyngeal ratio on plain radiograph ranged between 0.40 and 0.96 with mean of 0.7 ± 0.09. The Pearson’s correlation test revealed strong correlation between flexible nasopharyngoscopy and plain radiograph (r = 0.858, P = .000), and there was statistically significant association between the two methods (χ2 = 148.8, P = .000).Conclusion:There was a strong correlation between flexible nasopharyngoscopy and plain radiograph of the postnasal space in the assessment of obstructive adenoid disease in children.

Comparison of the Efficacy, Side Effects, and Cost of Modafinil and Intranasal Mometasone Furoate in Obstructive Sleep Apnea-Hypopnea Syndrome: A Preliminary Clinical Study

BackgroundObstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by repeated episodes of reduction in airflow due to the collapse of the upper airway during sleep. The aim of this study was to compare clinical outcome, side effects, and cost of treatment between modafinil and intranasal mometasone furoate in patients with OSAHS.Material/MethodsPatients with OSAHS (N=250) were divided into two groups: the modafinil group (MG) (N=125) were treated with 100 mg modafinil twice a day; the intranasal mometasone furoate group (IMFG) (N=125) were treated with 100 μg of intranasal mometasone furoate in the evening. Quality of life, grading of OSAHS, plain-film radiography, the adenoidal-nasopharyngeal ratio (AN ratio), side effects, cost of treatment, and beneficial effects after discontinuation of treatment were evaluated for all patients.ResultsDuration of sleep apnea was significantly reduced in the IMFG compared with the MG (p=0.0145, q=9.262). Modafinil and intranasal mometasone furoate both had moderate effects on improvement of the OSAHS score. The IMFG showed a significantly greater beneficial effect on the AN ratio when compared with the MG (p=0.0001, q=6.584). No adverse events of treatment with modafinil and intranasal mometasone furoate were reported. Cost of treatment and beneficial effect after discontinuation were both significantly greater for the IMFG compared with the MG.ConclusionsThe findings of this preliminary clinical study were that for patients diagnosed with OSAHS, night-time treatment with intranasal mometasone furoate was more effective than modafinil.

Adenoidal Nasopharyngeal Ratio and Its Correlation with Tympanometry in Children with Otitis Media with Effusion: A Prospective Clinical Study

Adenoidal Nasopharyngeal Ratio and Its Correlation with Tympanometry in Children with Otitis Media with Effusion: A Prospective Clinical Study