Related Experiment Video
Updated: Aug 30, 2026
The Flexible Rhino-Laryngoscope for Awake Nasotracheal Intubation
Published on: August 2, 2024
Adenoid tissue rhinopharyngeal obstruction grading based on fiberendoscopic findings: a novel approach to therapeutic
Pasquale Cassano1, Matteo Gelardi, Michele Cassano
1Department of Otorhinolaryngology, University of Foggia, Italy.
Insights
A new grading system for adenoid hypertrophy in children categorizes obstructions into four degrees based on fiberendoscopy. This classification guides effective treatment, recommending conservative management for mild cases and surgery for severe obstructions.
Area of Science:
- Otorhinolaryngology
- Pediatric Surgery
- Respiratory Medicine
Background:
- Adenoid hypertrophy is a common cause of nasal obstruction in children.
- Effective therapeutic strategies require accurate assessment of obstruction severity.
Purpose of the Study:
- To develop a four-class grading system for adenoid hypertrophy based on fiberendoscopic findings.
- To establish an effective therapeutic program aligned with the proposed classification.
Main Methods:
- Ninety-eight children with chronic nasal obstruction underwent fiberendoscopy.
- Adenoid tissue obstruction was graded into four segments of the rhinopharyngeal cavity.
- Active anterior rhinomanometry was performed in 78 patients.
Main Results:
- First degree (<25% obstruction): 8.2% of patients.
- Second degree (<50% obstruction): 20.4% of patients.
- Third degree (<75% obstruction): 64.3% of patients.
- Fourth degree (near total obstruction): 7.14% of patients.
Conclusions:
- Conservative management is recommended for first and second-degree obstructions.
- Surgery is advised for fourth-degree obstructions.
- Third-degree obstructions present therapeutic challenges, influenced by associated complications like otitis, sinusitis, and sleep apnea.
Objective:
A grading into four classes of hypertrophied adenoid rhinopharyngeal obstructions in children on the basis of fiberendoscopic findings to outline an effective therapeutic program according to this classification.
Methods:
Ninety-eight children with chronic nasal obstruction and oral respiration were examined by anterior rhinoscopy, and fiberendoscopy. During the investigation, the fiberendoscopic images of the choanal openings were divided into four segments from the upper choanal border to the nasal floor. In view of clinical findings, 78 patients also underwent active anterior rhinomanometry.
Results:
In eight patients (8.2%), the fiberendoscopic imaging revealed that the adenoid tissue occupied only the upper segment in the rhinopharyngeal cavity (< 25%). Therefore, choanal openings were free (first degree obstructions). In 20 patients (20.4%), the adenoid tissue was confined to the upper half (< 50%) of the rhinopharyngeal cavity (second degree obstructions) and in 63 patients (64.3%) the tissue extended over the rhinopharynx (< 75%) with obstruction of choanal openings and partial closure of tube ostium (third degree obstructions). Only in seven cases (7.14%), the obstruction was almost total. As a consequence, both the tube ostium and the lower choanal border could not be observed (fourth degree obstructions).
Conclusions:
In the first two classes of obstructions, characterized by moderate or discrete adenoid hypertrophy, adenoidectomy should not be performed. In these conditions, the causes of possible nasal obstructions are usually due to either dysmorphic, allergic or phlogistic pathologies. For the fourth degree adenoid obstructions, surgery is always recommended. The most important therapeutic problems occur in the third degree obstructions which include most patients who suffered from hypertrophied adenoids. Moreover, the therapeutic strategy can be conditioned not only by nasal respiratory difficulties but also by frequent concomitant complications such as otitis, sinusitis, sleep apnea, etc. These disorders may be caused by both nasal obstruction and/or phlogistic problems (adenoiditis).
Related Concept Videos
01:30Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques
01:29Suctioning the Nasopharyngeal Airway
Equipment Required
01:23Chronic Pharyngitis
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
01:30Endoscopic Studies I: Bronchoscopy and Thoracoscopy
Bronchoscopy
Description
Bronchoscopy is a procedure that involves direct visualization of the larynx, trachea, and bronchi for diagnostic and therapeutic purposes. A flexible fiber optic or rigid bronchoscope is used to carry out the procedure. The fiber-optic bronchoscope is more frequently used due to...