Diagnosis Of Adenoid Hypertrophy Research Articles

Prevalence of middle ear effusion among children with adenoid hypertrophy at a national referral hospital in Tanzania

Introduction: Middle ear effusion (MEE) is a common childhood disorder that causes hearing impairment due to the presence of fluid in the middle ear which reduces the middle ear’s ability to conduct sound. Temporary or persistent hearing loss as a result of MEE causes speech, language and learning delays in children. There are few studies on MEE in Tanzania despite the huge burden of hearing loss among children with adenoid hypertrophy which is a known risk factor for MEE.
 Method: A cross-sectional study was conducted among 420 children aged nine years and below having adenoid hypertrophy with or without MEE. The diagnosis of adenoid hypertrophy was confirmed with a lateral view x-ray of the nasopharynx and tympanometry for cases with MEE. The primary objective of the study was to assess the prevalence of MEE among children with adenoid hypertrophy.
 Results: The prevalence of MEE among children with adenoid hypertrophy was 61.7%, with 218 (51.9%) males and 202 (48.1%) females. The most affected age group was 2-4 years with an incidence 193 (46%) and in this age group, males (53.9%) were more affected than females (46.1%). Generally, males, 134 (51.7%) were more affected by MEE than females, 125 (48.3%) of all 259 children with MEE. In terms of age group predominance by MEE, children aged 3-4 years, 107(41.3%) were more affected than all other age groups. Additionally, 4 (1.5%) children with MEE presented with hearing loss.
 Conclusion: There is a high prevalence of MEE among children with adenoid hypertrophy but no significant association with hearing loss.

Application of virtual endoscopy in the diagnosis of adenoid hypertrophy and the morphologic classification of adenoid

Objective:To discuss the application of virtual endoscopy in the diagnosis of adenoid hypertrophy and the morphologic classification of adenoid. Methods:The clinical data of 97 children with adenoid hypertrophy admitted to Department of Otorhinolaryngology Head and Neck Surgery, Shenzhen University General Hospital from July 2022 to December 2022 were collected. The virtual endoscopic reconstruction of the nasopharynx was performed by cone beam computed tomography. The results of virtual endoscopic adenoid size measurement were compared with the results of nasopharyngeal CT median sagittal position and nasopharyngeal endoscopy. Virtual endoscopic classification of adenoid based on the size of the adenoids and their relationship with the torus tubarius. Results:The t-test results of the size of adenoids measured by virtual endoscopy and nasopharyngeal CT were t=1.699 and P=0.093, and the results of intra-group correlation coefficient（ICC） analysis were ICC=0.921 and P<0.01. The proportion of adenoids measured by virtual endoscopy and nasopharyngeal CT was highly consistent. The t-test results of the size of adenoids measured virtual endoscopy and nasopharyngeal endoscopy were t=1.543 and P=0.15, and the results of intra-group correlation coefficient（ICC） analysis were ICC=0.900 and P<0.01. The proportion of adenoids measured by virtual endoscopy and nasopharyngeal endoscopy was highly consistent. Among the 97 children, the morphological classification results of adenoids were 48 cases of overall hypertrophy type, 47 cases of central bulge type, and 2 cases of flat thickening type. Conclusion:The diagnosis of adenoid hypertrophy by virtual endoscopy has high accuracy, which not only avoids the invasive operation of traditional nasopharyngeal endoscopy, but also can observe the adenoid condition and its relationship with the torus tubarius from multiple angles. And, the morphological classification of adenoids using virtual endoscopy has guiding significance for perioperative preparation.

A new method for the assessment of adenoid hypertrophy: Respirdynamicsgram (RDG)

Adenoid hypertrophy (AH) is a common cause of airway obstruction in children, which is the etiology of changes in facial growth, obstructive sleep apnea syndrome, and/or more serious problems. Most sequelae can be avoided or reversed by timely diagnosis and treatment. It is difficult to frequently assess the changes in adenoids among children using the commonly available diagnostic tools owing to invasiveness and radiation exposure. A new method called respirdynamicsgram (RDG) is proposed for the assessment and diagnosis of AH. Specifically, RDG is generated by visualizing the respiratory dynamics extracted from nasal airflow through dynamic learning. The morphology of RDG remarkably differs between children with adenoidal hypertrophy (irregular shapes) and healthy children (regular butterfly-like shapes). Three features are utilized to represent the morphology of RDG, including temporal heterogeneity, spatial heterogeneity, and wing shape. These morphology features of RDG are fed into the linear support vector machine for the AH classification task. As a result, the proposed method achieves a mean accuracy of 86.6% over 100 resample folds on a total of 74 subjects. It is shown that RDG has the capability of distinguishing children with AH from healthy children. As it is simple, non-invasive, and secure, it is hopeful that RDG may become an effective method for timely and frequent assessment and diagnosis of AH.

Evaluation of risk factors and clinical presentation of adenoid hypertrophy among children attending the pediatric outpatient department of tertiary care hospital in Dhaka division

Background: Adenoid hypertrophy (AH), also known as enlarged adenoid, refers to the unusual growth of the adenoids. AH and its consequences are common in the entire childhood period. The adenoids are small masses of lymphatic tissue located in the upper airway, between the nose and the back of the throat.Methods: This cross-sectional study was conducted from January 2021 to December 2021 over a period of 12 months. All the children aged 1-18 years attending the pediatric outpatient department (OPD) who had known risk factors or sign-symptoms of AH underwent a lateral nasopharyngeal x-ray to confirm the presence of an enlarged adenoid. Those children who had enlarged adenoids were analyzed in this study.Results: A total of 1289 children aged 1-18 years attended the pediatric OPD over 1 year of the study period, out of them, 118 had evidence of enlarged adenoid on lateral nasopharyngeal x-ray, giving a prevalence of 2.3%. Among the 118 radiologically proved AH cases, 112 (95%) were symptomatic and 6 (5%) were asymptomatic having risk factors only. The peak age of diagnosis of AH in this study was between 12-72 months (43.4%). The mean age of presentation was 100.6±58 months. There was a male predominance with male to female ratio of 1.6:1. AH may be presented without symptoms in 5% of cases or may be presented with complications such as OSA (27%), adenoid facies (14%), and otitis media with effusion with or without hearing impairment (13%).Conclusions: The prevalence of AH among children attending the pediatric outpatient department was 2%, of them 18% had an indication for adenoidectomy. The most common two clinical presentations were mouth breathing and nasal obstruction and the most common complication was obstructive sleep apnea.

Trans-oral endoscopic assisted radio-frequency for adenoid ablation; A randomized prospective comparative clinical study

ObjectiveThis study compared the efficacy and safety of conventional adenoidectomy using a curette and the Radio-frequency (RF) adenoid ablation using endoscope via the trans-oral technique. MethodsA randomized prospective comparative study was conducted in a tertiary care hospital. The study included 80 patients with a diagnosis of adenoid hypertrophy, which was confirmed by X-ray of a lateral view of the skull. The patients were submitted into two groups 40 for each: curettage group and Radiofrequency group. Patients with bleeding diathesis, congenital anomalies, previous adenoidectomy, and morbid illness were excluded from the study. We evaluated the time consumption, the adenoid tissue remnant by the endoscope, blood loss, and clinical correlations like pain by Visual Analog Scale, halitosis, and secondary bleeding in both study groups. ResultsIntra-operative blood loss was 20–40 ml in the Radio-frequency (RF) group, but in the curettage group was 36 – 55 ml. Post-operative pain in the (RF) group was lower than the curettage group. Secondary bleeding was reported mostly in the curettage group (15%). The duration of the operation in (RF) group was relatively long. Halitosis decreased mainly after curettage adenoidectomy. ConclusionThe endoscopic radio-frequency adenoid ablation surpassed the conventional method. We encourage using Radio-frequency in adenoid surgery as a replacement for the traditional method.

Role of mometasone furoate nasal spray versus saline nasal spray in treatment of adenoid hypertrophy: a prospective, randomized study

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Adenoid hypertrophy is a common disorder in the paediatric population, presenting with multiple signs and symptoms ranging from nasal obstruction to obstructive sleep apnoea. Most common symptom is usually nasal airway obstruction. This prospective, randomized study aims to evaluate the efficacy of mometasone furoate spray in reducing size and clinical symptoms in patients with adenoid hypertrophy compared to saline spray.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 60 patients in the age group of 3-11 years were enrolled in the study. Five symptoms were included that were hypo nasal speech, snoring, night cough, open mouth breathing and nasal obstruction which were scored as never=0, mild (sometimes)=1, moderate (less than 50% of times)=2, and severe (constant)=3. Diagnosis of adenoid hypertrophy was made on basis of nasal endoscopy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Significant improvement was seen in individual as well as overall symptom score in group A as compared to group B after 8 weeks of treatment (p&amp;lt;0.001). There was significant improvement in mean adenoid grade as per nasal endoscopy at 8 weeks post therapy (p&amp;lt;0.001) which was not seen after 4 weeks of therapy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Intranasal steroid sprays have good role in decreasing the symptoms of adenoid hypertrophy and has reduced number of adenoidectomies required. The long-term effects as well as optimal duration of therapy is still controversial and needs to be studied further.&lt;/p&gt;

Adenoid hypertrophy and nocturnal enuresis are associated with sleep disturbances

Objective: Adenoid hypertrophy and nocturnal enuresis, comorbidities that are quite prevalent among children, are both associated with sleep problems. However, limited research has specifically focused on sleep domains and their parameters. In the present study we thus aimed to investigate the impact of adenoid hypertrophy and nocturnal enuresis on sleep, both when the two disorders coexist and when they do not coexist. Methods: We investigated 178 children (mean age: 7.24±1.02 years, range=6-9 years), 50 (28.1%) of whom had only adenoid hypertrophy, 39 (21.9%) of whom had only nocturnal enuresis, 35 (19.7%) of whom had coexistence of adenoid hypertrophy and nocturnal enuresis, and 54 (30.3%) of whom were healthy-control children. Psychiatric disorders were diagnosed by a semi-structured diagnosis interview and the diagnosis of adenoid hypertrophy was confirmed by flexible fiberoptic nasopharyngoscopy. Sleep habits and disturbances were assessed via the Children’s Sleep Habits Questionnaire and Modified Epworth Sleepiness Scale. Results: Our results showed that the comorbid condition was the most severe form in terms of both adenoid hypertrophy and enuresis. Regarding sleep difficulties, the "Sleep-Disordered Breathing", "Night Wakings", "Sleep Onset Delay" and "Sleep Duration" parameters were closely associated with adenoid hypertrophy and its severity, while "Bedtime Resistance", "Parasomnias" and "Sleep Anxiety" domains of sleep were strongly related to nocturnal enuresis. Conclusion: Otorhinolaryngologists, child psychiatrists and pediatricians should be aware of the relationship between enuresis and adenoid hypertrophy, that both diseases are associated with impaired sleep patterns, and that children affected by the comorbidity of the two disorders experience more sleep disturbances.

Frequency of gastroesophageal reflux disease in children with adenoid hypertrophy

ObjectivesRecent studies have suggested that the reflux of gastric contents can cause adenoid hypertrophy (AH). The frequency of gastro-oesophageal reflux disease (GERD) in this AH population is unknown, but according to studies using pH-metry it may be as high as 65%. The aim of this study was to estimate the frequency of GERD among children with AH. MethodsThis was a cross-sectional, multicentre, prospective study of children with AH selected for adenoidectomy. The diagnosis of AH was made by a single laryngologist using a flexible fiberscope. All children had 24-hr multichannel intraluminal pH-impedance (MII/pH) assessment. A GERD diagnosis was made using BioVIEW software analysis after manual review by a single investigator. Results38 consecutive patients (21 males, mean age 6.58 years) were enrolled in the study. GERD was diagnosed in 5 (13.2%) patients. A total of 1462 gastro-oesophageal reflux events (GERs) were detected by MII/pH and the majority (60.9%) were acidic. The only significant differences between the GERD-positive and GERD-negative groups were the total number of GERs, and the number of acid GERs. ConclusionIt is first study using MII/pH to assess the frequency of GERD in children with AH. The data suggest that GERD in children with AH seems to be not as common as it was previously raised. Further studies are needed to confirm these results.

Evaluation of Adenoid Hypertrophy with Ultrasonography.

To determine the reliability of ultrasound in the diagnosis of adenoid hypertrophy in children. The subjects were divided into three groups: Group A: Pre-experiment group: 30 children who were hospitalized for adenoidal hypertrophy were selected, and preoperative ultrasound was used to measure adenoid thickness. Their re-confirmed Adenoidultrasound measurementthickness was obtained during surgeryunder the guidance of metal instruments; Group B: Ultrasound screening group: 1898 children aged 3-12 y were selected, and their adenoids were examined by ultrasonography to observe the size, shape, echo and blood flow of adenoids and the thickness of adenoids; Group C: Surgical resection group: 133 hospitalized patients were selected, and their adenoid ultrasound measurement thickness (AUT), the adenoid-nasopharynx (A/N) ratio was calculated based on nasopharyngeal lateral radiographs and obstruction ratio was obtained in electronic nasopharyngoscopy [extent of adenoid-posterior nostril occlusion (EANC)] were compared. In Group A, there was no statistical difference in the measurements of the adenoids between the preoperative ultrasound and the ultrasound measurements under the guidance of intraoperative metal instruments (P > 0.05). In Group B, the adenoids of 1898 children aged 3-12 y were measured and were found thickest at 6 y, with an average of 5.035 ± 0.0609mm. There was no statistical difference in adenoid thickness between boys and girls (P > 0.05). In Group C, there was a linear correlation between AUT and A/N ratio (r = 0.999, P = 0.01) and between AUT and EANC (r = 0.950, P = 0.000). In children between 3 and 12 y of age, AUT greater than 6mm may be considered for surgical resection of adenoid hypertrophy.

Adenoid hypertrophy causing obstructive sleep apnea in children after pharyngeal flap surgery.

Pharyngeal flap surgery used for treatment of velopharyngeal insufficiency (VPI) may be followed by obstructive sleep apnea (OSA) especially if the patient has developed adenoid hypertrophy. However, adenoidectomy may adversely affect speech in these patients. The aim of this study was to assess the effectiveness of transnasal endoscopic power-assisted adenoidectomy in relieving OSA in patients with adenoid hypertrophy who underwent pharyngeal flap surgery, and the impact of the procedure on their speech. Transnasal endoscopic power-assisted adenoidectomy for nine children presenting with adenoid hypertrophy was performed. The patients had previously undergone pharyngeal flap surgery for treatment of VPI. Flexible nasopharyngoscopy was used in the diagnosis of adenoid hypertrophy. Pre- and postoperative polysomnography with measurement of apnea-hypopnea index (AHI) was done. Additionally, auditory perceptual assessment of speech (APA) and nasalance scores was measured pre- and postoperatively. All patients were shown to have OSA by polysomnography, and a larger adenoid size was significantly associated with a higher AHI. We achieved a significant improvement in AHI after adenoidectomy. However, six patients still demonstrated OSA, albeit with a reduced severity. Speech was not adversely affected postoperatively as the APA and nasalance scores showed non-significant changes. Adenoid hypertrophy may be encountered in children who undergo pharyngeal flap surgery, which may cause OSA. Transnasal endoscopic power-assisted adenoidectomy is a safe and effective method for treatment of OSA in those patients without prejudicing the pharyngeal flap, and it has no adverse effect on speech.

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.

Detection of Helicobacter pylori in adenoid tissue by real-time polymerase chain reaction

This study aims to investigate the presence of Helicobacter pylori (H. pylori) using the real-time polymerase chain reaction (PCR) method in the adenoid tissues in children undergoing surgical operation due to adenoid hypertrophy. Adenoid tissues of 23 children (8 girls, 15 boys; mean age 6.2 years; range 3 to 9 years) who were operated with the diagnosis of adenoid hypertrophy, tonsil + adenoid hypertrophy or tonsil + adenoid hypertrophy + serous otitis media in our clinic between January 2012 and April 2012 were examined. Of 23 patients, H. pylori was detected in the adenoid tissues of two (8.7%). Regurgitation was present in seven patients. However, no regurgitation was found in H. pylori-positive patients. In this study the presence of H. pylori in patients with adenoid hypertrophy has been demonstrated using PCR method. To be able to support the hypothesis that H. pylori has a place in etiology of adenoid hypertrophy, multicenter studies are warranted.

Values of mean platelet volume in patients with chronic tonsillitis and adenoid hypertrophy

Chronic tonsillitis (CT)-adenoid hypertrophy (AH) is the most common cause of obstructive sleep apnea (OSA), which is one of the most common reasons of nocturnal hypoxia in children. However, there is limited information about the relationship between childhood OSA and atherosclerosis or cardiac diseases. In the present study, we evaluated the relationship between mean platelet volume (MPV) and CT-AH which is the most frequent cause leading OSA in children. Methodology : The medical records of 200 children, who underwent adenoidectomy or adenotonsillectomy with a diagnosis of adenoid hypertrophy and/or chronic tonsillitis between October, 2010 and June, 2012, and 240 healthy controls were evaluated. Subjects were classified into 3 groups. Group I consisted of patients who underwent adenoidectomy, whereas Group II consisted of patients who had adenotonsillectomy. Healthy children were employed as control group. White blood cell count (WBC), platelet count (PLT), hemoglobin (Hb) levels and mean platelet volume (MPV) values were recorded individually. MPV values were 6.6±0.8, 6.6±0.7 and 7.3±0.9 in Group I, Group II and control group, respectively. It was found that MPV values in groups I and II were significantly lower than control group. There was no significant difference between group I and II. Conclusion : Obstructive sleep apnea (OSA) caused by CT-AH is associated with low MPV values in childhood.

Reliability of subjective, linear, ratio and area cephalometric measurements in assessing adenoid hypertrophy among different age groups

To test the validity of four different types of lateral cephalometric radiograph (LCR) measurements as a diagnostic test of adenoid hypertrophy in different age groups of mouth-breathing children. Eighty-six mouth-breathing children (male 54.65%, mean age 7.0 ± 2.2 years) were randomly selected from a hospital population. Adenoid obstruction of the nasopharynx was evaluated by subjective, linear, ratio, and area LCR measurements. Each measurement was compared with flexible fiberoptic endoscopy diagnosis. Kendall correlation coefficients for agreement between tests were ≥ 0.67 and kappa scores were substantial (≥ 0.64). Higher correlation coefficients and agreement values were found in older age groups. When the sample was stratified by age, the 3- to 5-year-old age group showed lower correlation coefficients and agreement strength for subjective, linear, and ratio measurements. The sensitivity of LCR varied from 71% (ratio) to 84% (linear). The specificity varied from 83% (linear) to 97% (ratio). The positive predictive value varied from 88% (linear) to 97% (ratio). The negative predictive value varied from 70% (ratio) to 78% (linear). The validity of each measure was different among the age groups. LCR is a valid method for measuring adenoid hypertrophy in children from 6 to 12 years old. The diagnosis of adenoid hypertrophy, based on LCR measurements, in children with primary dentition (3-5 years old) should be made with caution. The combination of linear and ratio LCR measurements is a reliable screening tool to determine the need for an ear, nose, and throat evaluation.

Diagnóstico clínico y exploración física

In children, medical history and meticulous examination are essential to the diagnosis and future treatment of all the alterations contributing to sleep breathing disorders. Examination of the oropharynx aids assessment of hypertrophy of the palatine tonsils, while fiberoptic endoscopy assists in the diagnosis of adenoid hypertrophy. Among radiological examinations, only cephalometry has proved to be useful in the study of the facial skeleton. Lateral radiography of the nasopharynx to study adenoid vegetations has been surpassed by fiberoptic endoscopy in terms of diagnostic performance. All examinations facilitate an etiological and topographical diagnosis of patients with sleep breathing disorders. The diagnosis of respiratory problems that affect children's dentofacial development can begin at a very early age, since early detection is essential to preventing the effects of these alterations on orofacial morphology and function. This article reviews the basic and additional dental examinations that should be conducted in children with upper airway obstruction and a medical history of sleep breathing disorders.

Auriscopy in the diagnosis of adenoid hypertrophy in children

Objective To explore the application of auriscopic nose- nasopharyngeal examina tion in the diagnosis and treatment of adenoid hypertrophy in children. Methods Auriscopic nose-na sopharyngeal examination was performed in 412 children with the symptoms of upper airway obstruction to explore the relationship between the degree of adenoid enlargement and upper airway obstruction. Results The procedure was successfully performed in 395 of 412 children. Of the 395 children, 358 had adenoid hypertrophy, 14 had choanal polyp, 16 has allergic rhinitis, and the remaining 7 had chronic rhinitis. Accord ing to the degree of rear nasal passage blockage, in 358 children with adenoid hypertrophy, 43 (12%) was grade Ⅰ, 97 (27%) was Ⅱ, 103 (28.8%) was Ⅲ, and 115 (32.2%) was Ⅳ. Conclusions Auriscopic nose nasopharyngeal examination is an ideal procedure for nasopharyngeal adenoid hypertrophy in children. It is directly visual, accurate, and safe. Grade Ⅳ adenoids is the main etiology of upper airway obstruction in children, which is the indication of surgical treatment. Key words: Auriscopy; Children; Adenoidal hypertrophy; Treatment

Sensitivity and specificity of nasal flexible fiberoptic endoscopy in the diagnosis of adenoid hypertrophy in children

To evaluate nasal flexible fiberoptic endoscopy as a diagnostic test of adenoid hypertrophy in children with nasal obstruction. One hundred and thirty consecutive children aged 2-12 years were examined from May to October 2005. A questionnaire answered by parents or guardians was used to obtain a symptom score. Adenoid size was measured on radiographs of the nasal cavity using the Cohen and Konak method, and by nasal flexible fiberoptic endoscopy using the Wornald and Prescott classification. The criterion standard was the adenoid size demonstrated on radiograph. The sensitivity of nasal flexible fiberoptic endoscopy was 92% (95% CI, 0.90-0.93), and specificity, 71% (95% CI, 0.70-0.72). The area under the ROC curve was 0.83 (95% CI, 0.76-0.90) at a p<0.001 level of significance. Kappa values were 0.94 (p<0.001) for interobserver agreement, 0.95 (p<0.001) for intraobserver agreement, and 0.54 (p<0.001) for agreement between tests. Results suggest that nasal flexible fiberoptic endoscopy is a highly accurate diagnostic method. This examination can be performed easily in cooperative children; it is safe, objective and dynamic, and helps to establish diagnoses in difficult cases.

X-Rays in the evaluation of adenoid hypertrophy: It's role in the endoscopic era.

To evaluate the reliability of X-rays in the diagnosis of adenoid hypertrophy and to validate this with flexible nasopharyngoscopy which is the existing gold standard. Lateral radiograph of the neck and a flexible nasopharyngeal endoscopy was done to evaluate adenoid enlargement in children aged 3-12 years who were included in a S week randomized double-blind placebo controlled study for the effect of beclomethasone in adenoid hypertrophy. These were graded independently by both the co-investigor and investigator X-ray and nasal endoscopy for reevaluation of adenoid size was done at the completion of the study. Variables of both the procedures were scored at the beginning and end of the study. The agreement between the two groups was assessed using weighted kappa statistic. There were 26 patients in the study, 17 of them had complete correlation between the X-ray and endoscopy findings. The agreement between these findings was statistically significant (p<01) with the weighted kappa 0.51. This study shows that lateral X-rays of the neck, besides being a noninvasive procedure, still remains a very reliable and valid diagnostic test in the evaluation of hypertrophied adenoids.