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Measuring the correlation between adenoidal-nasopharyngeal ratio (AN ratio) and tympanogram in children
Erol Egeli1, Fatih Oghan, Ozcan Ozturk
1Department of Otorhinolaryngology and Head and Neck Surgery, Duzce Faculty of Medicine, University of Abant Izzet Baysal, AIBU, Duzce Tip Fakultesi KBB AD, 81620 Konuralp, Duzce, Turkey.
Insights
This study found that a higher adenoidal-nasopharyngeal ratio (AN ratio) in children correlates with eustachian tube dysfunction and lower middle ear pressure. While antibiotics reduce adenoid size, they may not fully restore middle ear function in cases of effusion.
Area of Science:
- Otolaryngology
- Pediatric Audiology
- Radiology
Background:
- Enlarged adenoids can cause nasal obstruction and eustachian tube dysfunction in children.
- The adenoidal-nasopharyngeal (AN) ratio is a radiographic measure used to assess adenoid hypertrophy.
Purpose of the Study:
- To investigate the relationship between the AN ratio and tympanometric findings in children with symptoms of nasal obstruction.
- To evaluate the effectiveness of medical therapy on adenoid size and middle ear function.
Main Methods:
- A prospective study of 64 children (aged 6-9 years) with nasal symptoms.
- Calculation of AN ratio from lateral neck radiographs and comparison with tympanometric values.
- Statistical analysis using chi-square and Wilcoxon tests to assess correlations and treatment effects.
Main Results:
- Children with AN ratios > 0.71 showed significantly lower middle ear pressures and a higher incidence of C-type tympanograms, indicating eustachian tube dysfunction.
- Medical treatment significantly reduced adenoid size but did not lead to significant improvements in tympanometric values.
- Middle ear effusions were associated with AN ratios > 0.71.
Conclusions:
- A high AN ratio (> 0.71) is linked to eustachian tube dysfunction and middle ear issues in children.
- Antibiotic therapy can reduce adenoid size, potentially improving eustachian tube function, but may be insufficient for persistent middle ear effusions.
- Ventilation tube insertion is a viable alternative for middle ear effusions unresponsive to medical treatment.
Objective:
To evaluate the correlation between adenoidal-nasopharyngeal ratio (AN ratio) and tympanogram in children.
Study Design:
A prospective clinical study from June 2002 to May 2003.
Method:
A total of 64 children, aged 6-9 years who presented with nasal obstruction, snoring, mouth breathing, and hyponasal speech were examined and AN ratio was calculated by using the lateral neck radiograms and compared with the tympanometric values. The relationship between AN ratio and middle-ear pressure was evaluated, regarding the AN ratio of 0.71. The chi-square test was used to analyze the correlation between AN ratio and middle ear pressures and Wilcoxon test was used to compare the changes between the mean AN ratio values, and mean middle ear pressures (including A and C type tympanograms) before and after medical therapy.
Results:
Middle-ear effusions and C type tympanograms in impedance audiometry were both related to eustachian tube dysfunction resulting from enlargement of the adenoids with AN ratios higher than 0.71. Middle ear pressures were found lower in children with AN ratio greater than 0.71 than in children AN ratio less than 0.71 and the difference was highly significant (p<0.001). Although medical treatment of large adenoids was rather effective to shrink the adenoid tissue (p<0.001), it did not cause a statistically significant change in tympanometric values (p>0.05).
Conclusions:
Antibiotherapy is effective in reducing adenoid size without signs and symptoms of infection. The reduction of the adenoids in size after 3 weeks of antibiotherapy has an positive effect on recovery of eustachian tube function but is not sufficient in patients with middle ear effusion. Early ventilation tube insertion may be an alternative therapy for the middle ear effusions not improving by 3 weeks medical therapy.
