Assessment Of Adenoid Hypertrophy Research Articles

Assessment of adenoid hypertrophy with clinical grading versus radiology and endoscopy- A cross-sectional study

Chronic adenoid hypertrophy is the most common presentation seeking medical advice in pediatric age group. Evaluation of adenoid enlargement is usually done clinically, but its reliability in young children is questionable. Although various diagnostic procedures have been proposed to diagnose adenoid hypertrophy, there is poor concordance on the ideal method by clinicians. The purpose of this study is to corroborate a clinical grading that could guide the clinicians in accurate diagnosis of adenoid hypertrophy and to warrant the cases needing adenoidectomy and to calibrate this clinical grading with endoscopic and x-ray findings.A cross-sectional study was conducted in a tertiary health care among 60 children aged between 3-14 years who presented with signs and symptoms of chronic adenoid hypertrophy are evaluated with clinical grading, endoscopy, lateral neck x-ray, and findings were documented. The proposed clinical grading comprised of nasal and paranasal symptoms, ear complaints, craniofacial abnormalities, and sleep disturbances.The statistical analysis was done with Pearsons Chi square test and the correlation between endoscopic and clinical grading is highly significant (p=0.0006), and there is also a strong correlation between radiological and endoscopic grading (p=0.0003), the correlation between clinical grading and radiological finding (p=0.04) was significant.Clinical grading was found to be a reliable parameter for assessment of the severity of adenoid hypertrophy. Though x-ray is a convenient procedure for diagnosing adenoid hypertrophy, it was found to be less accurate in assessing the clinical implications when compared to endoscopy.

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Which diagnostic method should be used in which age interval in the diagnosis of adenoid hypertrophy?

Aim: This study aims to determine the age interval for which the flexible nasopharyngoscopy (FNP) and lateral nasopharyngeal X-ray radiography (LNX) used in the diagnosis of adenoid hypertrophy more effectively in a pediatric population. Study Design: Prospective Cohort Study. Materials and Methods: 281 pediatric patients (1 to 15 years old) who were admitted to our ENT outpatient clinic with the complaints of nasal obstruction, snoring, sleep apnea through April 2016 and February 2017 and who were examined with FNP with the pre-diagnosis of adenoid hypertrophy were included in our study. All FNP examinations were evaluated by a single physician. The degree of choanal obstruction was recorded as percentage (%) with the help of the adenoid tissue image. The patients were divided into four groups according to the quality of the endoscopic examination performed during FNP examination; optimal assessment (group-1), assisted optimal assessment (group-2), assisted suboptimal assessment (group-3), and inability to assess despite assistance (group-4). LNX was performed for the re-evaluation of adenoid tissue in the patients in Group-3 and 4. Statistical analysis was performed among the groups according to the ages of the patients. Results: Optimal images were obtained with FNP in the patients aged between 1 and 2 years and 8-15 years and the expected images were obtained for choanal obstruction. However, no image could be obtained with FNP for assessment of choanal obstruction in more than 30% of patients between the ages of 3 and 8 years (31.2% and 33.3%, respectively), also in more than 50% of the patients who were 4,5,6 and 7 years old (60.6%, 56.7%, 55.8%, 66 , 6%, respectively). For this reason, their degrees of choanal obstruction were determined with LNX. Conclusion: For the optimal assessment of adenoid hypertrophy, we suggest that using LNX for the pediatric patients who are 4, 5, 6 and 7 years old and using FNP for the other age groups are more appropriate methods respectively in order not to disturb the polyclinic process of physician and for patient compliance.

Diagnostic Accuracy of Radiology and Endoscopy in the Assessment of Adenoid Hypertrophy

ABSTRACTAimTo clarify the diagnostic accuracy of the lateral X-ray of nasopharynx, and the flexible nasopharyngoscopy in the assessment of adenoid hypertrophy, with the preoperative rigid nasal endoscopic observation, as it was considered as a reference standard guide.Materials and methodsThis is a prospective observational study that included 80 children who planned to undergo adenoidectomy due to the symptoms found related to adenoid hypertrophy. All the children underwent a relevant clinical history and full ear, nose, and throat (ENT) examination, and the grading of adenoid hypertrophy was done preoperatively with the lateral X-ray of the nasopharynx and the flexible nasopharyngoscopy. These findings were analyzed and compared with the peroperative rigid nasal endoscopic assessment of adenoid hypertrophy, which was considered as a reference guide.ResultsThere were 44 boys (55%) and 36 girls (45%), with mean age of 5.176 (±1.873) years, and the highest frequency of adenoid hypertrophy was found in the age group of 4 to 6 years (62.45%); the most common grade of the adenoid size in all the types of the assessment was grade 3. The assessment of adenoid grading by both flexible and peroperative rigid nasal endoscopy versus radiology was statistically significant, with p value of 0.0001, while the adenoid grading between flexible and peroperative rigid nasal endoscopic assessment was almost comparable, as no significant difference was found, with p value of 0.46.ConclusionFlexible nasopharyngoscopy was a more reliable diagnostic tool in the assessment of the adenoid size than lateral nasopharyngeal X-ray, as it correlates well with peroperative rigid nasal endoscopic finding.How to cite this articleDawood MR, Khammas AH. Diagnostic Accuracy of Radiology and Endoscopy in the Assessment of Adenoid Hypertrophy. Int J Otorhinolaryngol Clin 2017;9(1):6-9.

The role of rhinomanometry after nasal decongestant test in the assessment of adenoid hypertrophy in children

IntroductionNasal respiratory obstruction is a very common otolaryngologic problem, often caused by adenoid hypertrophy (AH). Nasal fiberoptic endoscopy (NFE) represents the gold standard method to diagnose AH. Rhinomanometry represents a valid diagnostic support. ObjectiveThe aim of our study was to analyze the diagnostic value of rhinomanometry after nasal decongestant (ND) test for the evaluation of adenoid hypertrophy in children. Materials and methodsSeventy-one of 97 collaborative children, aged 6–12 years, affected by upper airways obstructive symptoms and diagnosed as ‘chronic oral breathers’ by a standardized questionnaire were included in the study. The first evaluation included a complete physical examination, anterior rhinoscopy and anterior active rhinomanometry. Patients with a positive rhinomanometry underwent a second rhinomanometry after the administration of the nasal decongestant (ND) xylometazoline. All children were evaluated using nasal fiberoptic endoscopy (NFE). ResultsAt rhinomanometry a normal nasal airflow was found in 19 (26.8%) of children while nasal obstruction was underlined in 52 (73.2%). These patients were tested also with rhinomanometry after ND which confirmed the presence of nasal obstruction in 29 (55.7%) of patients. All patients included in the study underwent a NFE: 34 (47.8%) of them presented severe AH with an occlusion >75% of the choanal opening (grade≥3) and 37 (52.2%) presented no or a mild form of AH (grade<3). When compared to NFE, rhinomanometry test after ND had 82.7% sensitivity and 82.6% specificity. Positive predictive value and negative predictive value were 85.7% and 79.2%, respectively. Two receiver operating characteristic (ROC) curves were derived using data related to rhinomanometry vs NFE, and to rhinomanometry after ND vs NFE. ConclusionsRhinomanometry after ND, compared to rhinomanometry, is more specific and useful to evaluate nasal obstruction due to AH in children, and it may be helpful to avoid unnecessary surgical procedures in children with temporary nasal obstruction.

The role of rhinomanometry after nasal decongestant test in the assessment of adenoid hypertrophy in children

The role of rhinomanometry after nasal decongestant test in the assessment of adenoid hypertrophy in children

Diagnostic efficacy of different methods in the assessment of adenoid hypertrophy

Objective This study was designed for better understanding of the role of different methods of nasal endoscopy in the assessment of adenoid hypertrophy and comparing them with lateral neck radiography and patients' symptoms. Subjects and method From August 2007 until January 2009, in the otolaryngology ward of a tertiary referral center, 89 patients who had symptoms related to chronic mouth breathing participated in this study. History of the symptoms related to adenoid hypertrophy was obtained from them. In addition, all patients underwent nasal endoscopy and lateral nasopharynx x-ray. The clinician who did nasal endoscopy was blinded to information about clinical data and x-ray and vice versa. Afterward, the relationship between symptoms and each diagnostic procedure was evaluated. Results Patients had a mean age of 9.47 ± 4.68 years. In the evaluation of the relationship between symptoms grading and grading in lateral neck radiography, this relationship was significant about snoring. Furthermore, there was a significant relationship between the endoscopic size of adenoid and number of the episodes of acute otitis media. The sum of symptoms grading had a significant relationship with the size of adenoid in lateral neck x-ray, but not in nasal endoscopy. Conclusion The results of the present study indicated that both radiography and nasal endoscopy could define the relationship between adenoid hypertrophy and associated symptoms and therefore are complementary. Between them, despite the popularity of nasal endoscopy, radiography can serve as a better planning tool.