Adenoid-nasopharynx Ratio Research Articles

Does Adenoid Hypertrophy Increase the Risk of Orbital Complication in Children with Acute Sinusitis?

Adenoid hypertrophy (AH) plays a role as a reservoir for bacterial growth and decreases mucociliary clearance which might contribute to the development of an infection. To compare the presence of AH in the pediatric population presenting with orbital complications as a result of ABRS and the control group radiologically. Patients who were diagnosed with OC as a result of ABRS labeled as case group, and the patients who had undergone computed tomography (CT) for indications other than sinonasal diseases were assigned as control group. Both groups were retrospectively reviewed to measure the adenoid, nasopharynx, and adenoid/nasopharynx ratio (ANR) in the axial and mid-sagittal planes. We compared 52 patients from case group to 57 control group. In the CT axial plane, adenoid length was greater in the OC group compared to the control group, with a significant difference (p-value = 0.02) of 14.2 ± 3.5mm compared to 11.2 ± 7mm, respectively. The ANRs were 2.9 in the OC group and 2.8 in the control group, with a p-value of 0.089. In the mid-sagittal plane, only the anteroposterior length was significantly greater in the OC group, with a mean of 19.9 ± 5.3mm compared to 15.2 ± 8.8mm in the control group (p-value = 0.007). The process of inflammation increased the anteroposterior length of the adenoids. However, the ANR was similar between the two groups, indicating that adenoid hypertrophy is not directly related as a risk factor for OC in pediatric patients with ARBS.

The Role of Montelukast Sodium in Children with Adenoid Hypertrophy - A Comparative Study.

Background Adenoid Hypertrophy (AH) results in symptoms ranging from mild nasal obstruction to the dangerous obstructive sleep apnoea. Normally for such patients Adenoidectomy with or without Tonsillectomy is carried out. However complications like haemorrhage and recurrence of adenoid tissue are common. Thus, non-surgical therapies have attracted considerable attention as an alternative strategy. The present study is aimed at evaluating the effect of oral Montelukast, a cysteinyl- leukotriene receptor antagonist, in children with AH. Materials and Methods Sixty children aged between 6 and 12 years with adenoid hypertrophy were randomly divided into two groups of thirty each. The study group was prescribed Tablet Montelukast 5mg daily for 12 weeks while the control group received matching placebo. A questionnaire based upon the severity of the symptoms as well as the Adenoid Nasopharynx ratio (A/N), as measured via X-ray Adenoids and the Nasal endoscopic scores done before and after treatment (at 3 months) in the two groups were taken into consideration . Results The Mann Whitney Test which was used found no distinction in snoring, sleep discomfort and mouth breathing between the two groups before the start of treatment. But a significant difference was indeed observed between the two groups after treatment in case of snoring (P < 0.006), sleep discomfort(P < 0.001) and mouth breathing (P < 0.001). Conclusion Oral Montelukast therapy is seen to be effective not only in the reduction of the size of adenoids but also in improvement of the overall symptoms and can thus be considered as a viable alternative .

RELATIONSHIP BETWEEN CLINICAL SYMPTOM SEVERITY SCORE AND ADENOID-NASOPHARYNX RATIO IN PAEDIATRIC PATIENTS WITH ADENOID HYPERTROPHY

Objective: The aim of the study was to assess the clinical symptoms severity score of adenoid hypertrophy in paediatric patients, to determine the relation between the clinical symptoms severity score and Adenoid-nasopharynx ratio and to determine the adenoid nasopharynx ratio in relation to the age of the patient. Methodology It is an Observational, prospective based study. The chart of 41 patients who presented to GMCH, ENT OPD with complaint of nasopharyngeal obstruction due to the adenoid. All the children were clinically and radiologically assessed between (JAN 2020 to JUNE 2021). ResultsAmong 41 patients, female preponderance was observed. Majority of the patients were in the age group of 11-15 years. Snoring were observed to be the commonest type of lesions in both male and female. Mouth breathing was equally common in either sex. In our study, Apnea was seen in one patient each of male and female. The diagnosis based on clinical and radiological assessment were highly accurate. Conclusion: The A/N ratio has a strong relationship with actual adenoid measurement. Lateral neck radiography is a low-cost, readily available procedure with few side effects that could be used to treat adenoid hypertrophy.

Assessment of Friedman Classification by Measuring Actual Tonsil Size During Surgery

Background and Objectives: Adenotonsillar enlargement is a common cause of pediatric illnesses, including obstructive respiratory disease and recurrent airway infection. The current tonsil grading systems evaluate tonsil size, but the correlation with actual tonsillar size in a clinical setting has not been established.Materials and Method: Between May and July of 2018, we recruited 31 children who underwent adenotonsillectomy with no major craniofacial abnormalities. The actual size of the palatine tonsils, the long (L1) and short (S1) axes of the tonsil beyond the anterior pillar, and the real axes (L2 and S2) after tonsil extraction from the fossa were measured during surgery. Adenoid size was determined by measuring the adenoid-nasopharynx (AN) ratio through lateral view x-ray of the neck.Results: Though S1 was related to the Friedman scale (p&lt;0.001), measured real axes were not (L2: p=0.058, S2: p=0.056). Also, adenoid size and AN ratio did not relate statistically to the Friedman scale (p=0.565). One of the measured real tonsil size parameters (S2) was related to AN ratio (p=0.048).Conclusion: For pediatric patients undergoing tonsillectomy and adenoidectomy, the Friedman grading scale based on physical examination may not reflect the actual size of the tonsils. Therefore, for children with obstructive sleep disorder or recurrent tonsillitis, intraoperative measurement of tonsil size can be helpful.

Clinical observation of mometasone furoate nasal spray combined with montelukast sodium in the treatment of adenoid hypertrophy in children

Objective:To study the clinical effect of mometasone furoate nasal spray combined with montelukast in the treatment of adenoid hypertrophy in children.Method:One hundred and thirty eight cases with adenoid hypertrophy were randomly divided into two groups, 69 cases in each group; the control group were treated with mometasone furoate nasal spray alone; the observation group were treated with mometasone furoate combined with oral montelukast. Adenoid nasopharynx ratio (A/N), and the proportion of overall recurrence after treatment of nasal obstruction were compared, also with snoring, mouth breathing rate, life quality score before and after treatment in the two groups, and finally compared the clinical total effective ratio.Result:Compared with before treatment, A/N of two groups of patients were significantly decreased, and the observation group decreased more significantly, the difference between the two groups was significant (P< 0.05); nasal obstruction, snoring, mouth breathing rate of observation group were significantly lower than the control group, and the recurrence rate also lower than the control group, the difference was statistically significant (P< 0.05). The quality of life scores, sleep disorder scores, physical status score and daily function score in the two groups were significantly decreased after treatment, and in observation group the three scores were decreased more significantly, the difference between the two groups was statistically significant (P< 0.05). The total efficiency of the observation group was 94.1%, which was statistically higher than the control group (79.4%, P< 0.05).Conclusion:The clinical efficacy of mometasone furoate nasal spray combined with montelukast in the treatment of adenoid hypertrophy in children is significant, which can effectively reduce the adenoid nasopharynx ratio, improve the symptoms of snoring, mouth breathing, nasal congestion, improve the quality of life of patients, and the effective ratio was higher than single drug treatment, which was worthy to apply on clinic.

The frequency of sleep-disordered breathing in children with asthma and its effects on asthma control

ABSTRACTBackground: The presence of sleep-disordered breathing (SDB) in children with asthma may cause difficult to control asthma. Objectives: The aim of this study was to determine the frequency of SDB in children with asthma, to evaluate its effects on asthma control and to assess the risk factors associated with the presence of SDB. Methods: Parents of children who Sleep Questionnaire (PSQ) and the Childhood Asthma Control Test (C-ACT). Asthma control level was assessed according to Global Initiative for Asthma (GINA). Same ear–nose–throat (ENT) specialist evaluated all patients. A 4-point tonsil grading method and adenoid-nasopharynx ratio were used to categorize tonsil and adenoid size, respectively. Results: A total of 408 children (275 male, 67.4%) with a mean age of 8.1 ± 3.2 years were included. Nearly 40% of asthmatic children were not-well-controlled according to GINA and 34.6% of all patients had SDB according to PSQ. Multivariate logistic regression analysis revealed that coexistence of SDB [OR: 6.62, 95% CI (4.21–10.41); p < 0.001)] and tonsillar hypertrophy [OR: 3.47; 95% CI (1.05–11.5); p < 0.041] were independent risk factors for not-well-controlled asthma in asthmatic children after other established contributors to asthma control were adjusted. Conclusions: Our study showed that SDB is a strong risk factor for not-well-controlled asthma in asthmatic children independent of other confounders. In addition, tonsillar hypertrophy may have a role in the association between SDB and not-well-controlled asthma in childhood.

The clinical and radiological predictors of pulmonary hypertension in children with adenotonsillar hypertrophy.

Unrelieved upper airway obstruction from highly prevalent adenotonsillar hypertrophy (ATH) has the potential of producing structural remodelling of the pulmonary vascular bed with resultant pulmonary hypertension (PH) and cor pulmonale. This cross-sectional study aimed to determine the local prevalence of PH and examine its clinical and radiological pointers among children with ATH. The airway obstruction was evaluated clinically by grading the nocturnal and daytime symptoms of ATH. A Brodsky scale and adenoid-nasopharynx ratio (AN ratio) were used to categorize tonsil and adenoid size, respectively. Mean pulmonary artery pressure (mPAP), was measured noninvasively for each child using Doppler echocardiography and PH was defined by mPAP ≥25mmHg. Comparison of symptom scores, tonsil and adenoid size and demographic factors was made between children with mPAP ≥25mmHg and those mPAP <25mmHg using univariate and multivariate analysis. There was 22.8% (18/79) prevalence of PH among the 26 children with only adenoid hypertrophy and 53 with ATH. Significant risk factors identified by logistic regression analysis associated with PH were daytime mouth breathing, daytime stertor, and AN ratio >0.75 (P=0.002, 0.018, and 0.04, respectively), with more than sixfold and fourfold increase risk for daytime mouth breathing and daytime stertor, respectively. Obstructive breathing during sleep was significant only on univariate analysis. Prolonged symptom duration ≥24months, large tonsils (grades 3 and 4), snoring and mouth breathing during sleep were not significant. This study demonstrated that pulmonary hypertension remains prevalent in children with ATH. Daytime mouth breathing and stertor as well as AN ratio >0.75 are the prime predictors of pulmonary hypertension, with an AN ratio cut-off point of 0.73 on ROC analysis.

Usefulness of Adenotonsillar Size for Prediction of Severity of Obstructive Sleep Apnea and Flow Limitation

Adenotonsillar hypertrophy is considered the most common cause of pediatric obstructive sleep apnea syndrome (OSAS). This study aimed to evaluate the relationships between tonsil/adenoid size, parameters of polysomnography, and subjective sleep symptoms. Case-control studies. Tertiary care center. A 4-point tonsil grading method and adenoid-nasopharynx (AN) ratio were used to categorize tonsil and adenoid size, respectively. Sleep questionnaires (Korean version of the Obstructive Sleep Apnea-18 [KOSA-18]) and full-attended polysomnography were performed. The subjects (n = 70) were divided into a control group (n = 31, apnea-hypopnea index [AHI] <1) and an OSAS group (n = 39, AHI ≥ 1), which was subdivided into mild and moderate to severe groups. Tonsil/adenoid size showed a statistically significant difference between control and OSAS groups, but these differences had no clinical significance. In addition, tonsil/adenoid size did not differ significantly among 2 OSAS severity subgroups. Only adenoid size in the total and OSAS groups was related to quality of life (QOL) by the KOSA-18. The AN ratio was related to lowest oxygen saturation only in the OSAS group, especially in the moderate to severe OSAS group, but tonsil size was related to flow limitation in total and supine positions in the control group. In the control group, flow limitation was not associated with QOL. Tonsil/adenoid size did not predict the severity of AHI. Nevertheless, adenoid size might be related to lowest oxygen saturation, which is thought to be related to subjective symptoms. Although flow limitation was related to tonsil size but not to QOL in the control group, further research will be needed to understand the importance of flow limitation and upper airway resistance syndrome in the pediatric population.

Adenotonsillar hypertrophy: Correlation between obstruction types and cardiopulmonary complications

To evaluate the association of upper airway obstruction (UAO) type and cardiopulmonary complications in children. The effect of obstruction type on quality of life and severity of obstructive symptoms were also investigated. Cross-sectional study. A Brodsky scale and adenoid-nasopharynx ratio (ANR) were used to categorize tonsil and adenoid size, respectively. The patients were divided into four groups according to obstruction type: adenoid hypertrophy only (ANR ≥ 0.63, tonsil grade 1 or 2), adenoid and tonsil hypertrophy (ANR ≥ 0.63, tonsil grade 3 or 4), tonsillar hypertrophy only (ANR < 0.63, tonsil grade 3 or 4), and normal (ANR < 0.63, tonsil grade 1 or 2). Mean pulmonary artery pressure (MPAP), tricuspid annular plane systolic excursion (TAPSE), and right ventricle myocardial performance index (RVMPI) were evaluated for each patient. The obstructive sleep apnea questionnaire (OSA-18) and Brouilette symptom score questionnaire were completed by each child's parents. MPAP was higher in patients with adenoid hypertrophy and adenoid and tonsil hypertrophy in comparison with the normal group. The P values were .079 and .055, respectively, when comparing TAPSE and RVMPI measurents in adenoid and tonsil hypertrophy and normal patients. A significant correlation was found between ANR and MPAP, RVMP, and TAPSE. The patients in the adenoid and tonsil hypertrophy group had the highest Brouilette symptom and OSA-18 scores. Patients with adenoid and tonsil hypertrophy are at a higher risk for cardiopulmonary complications, poorer quality of life, and more severe UAO symptoms and should have priority for surgical treatment to prevent cardiopulmonary complications.

Comparative study on different imaging technologies in the diagnosis of children with adenoid hypertrophy

Objective To investigate the clinical value of different imaging technology [digital radiography (DR),computer tomography (CT) and magnetic resonance imaging (MRI)] in the diagnosis of children with adenoid hypertrophy.Methods 72 cases with adenoid hypertrophy were recruited.50 cases were examined by DR,12 cases were examined by CT examination,10 cases were examined by magnetic resonance imaging.The sizes of adenoid tonsils were estimated by adenoid-nasopharynx ratio(A / N)Results DR,CT and MRI can obtain clear images of nose pharynx ministry.The narrowed degree of nasopharynx lumen can be accurately evaluated by A/N.CT and MRI can directly display adenoid shape,size and complications.Conclusions DR of nose pharynx is a convenient and practical measuring for being easily accepted by children.DR has an important clinical value.CT and MRI are more accurate in measuring adenoid size and can display the complications to help preoperative examination.MR has no radiation,has high resolution of soft tissue and advantages of direct 3D imaging,and it's a first choice examination in preoperative. Key words: Adenoid hypertrophy; Digital radiography(DR); Computer tomography(CT); Magnetic resonance imaging(MRI); Adenoid-nasopharynx ratio

Correlation between adenoid–nasopharynx ratio and endoscopic examination of adenoid hypertrophy: A blind, prospective clinical study

Objective To determine the reliability of adenoid–nasopharynx (A/N) ratio that is calculated on lateral cephalometric graphies for measuring the adenoid tissue size. Methods 85 patients that had been examined in our clinic with a prediagnosis of adenoid hypertrophy between June 2007 and March 2008 were included in the study. Local ethics committee approved the study protocol. Patients who had a previous adenoidectomy history and anatomic anomaly or acute infection in nose, palate or nasopharynx were excluded. Endoscopic nasal examination was done in all patients in addition to the routine ear nose throat examination. Lateral cephalometric graphs were obtained from all patients. Digital images obtained during endoscopic examination were evaluated on computer and obstruction ratios of adenoid tissue to choanal opening were calculated. Each cephalometric graph was evaluated by a blinded author. A/N ratio was calculated by dividing the distance from the outermost point of convexity of adenoid shadow to basiocciput to the distance between sphenobasiocciput and posterior end of hard palate (Fujioka Method). A/N ratio of each patient was then compared with the obstruction ratio obtained in nasal endoscopy. Pearson correlation test was used for statistical analysis and a p-value of <0.05 was accepted as significant. Results There were 52 male and 33 female patients between the ages of 2 and 12 years (mean age, 5.0 ± 2.2; median, 4.5). In nasal endoscopy, adenoid tissue was determined to obstruct the choanal opening as 88.5 ± 12.0% (range, 51–99%) in an average. Mean adenoid nasopharynx ratio was found to be 0.87 ± 0.1. There was a statistical significant correlation between A/N ratio and nasal endoscopic examination findings ( r = 0.511; p < 0.0001). Conclusions A/N ratio is an easily applicable, noninvasive method that can correctly measure the size of the adenoid tissue in patients who are suspected to have adenoid hypertrophy.