How frequent is adenoid obstruction? Impact on the diagnostic approach

The rate of adenoidectomy has increased over the past years. The initial assessment methods are sometimes overused. The aims of the present study were to evaluate the use of these methods, estimate the incidence of obstructive adenoid and refine the approach to this problem.

This is a prospective observational study. All children referred for chronic nasal obstruction had anterior rhinoscopy and a routine physical examination. The palatal airway was assessed on lateral nasopharyngeal roentgenograms when these were requested. The degree of obstruction was measured on endoscopy when performed. The efficacy of each method was evaluated, as well as its necessity. The incidence of obstructive adenoid was calculated.

A total of 213 patients aged 6 months-13 years (mean 5.1 years, median 4 years) were enrolled. One hundred patients had radiological evaluation while 65 had endoscopy during their initial assessment. Endoscopy was the most efficacious in reaching a proper diagnosis (100%) followed by clinical assessment (84.2%), and radiology (75%). The necessity of endoscopy, however, was 63.1% and that of radiology 63% within their respective groups. The incidence of obstructive adenoid was 57.7% (1.6% choanal). Clinical assessment, therefore, could have been sufficient in 41.8%, radiology in 44.1%; and endoscopy in 12.2% of the studied population to reach a proper diagnosis.

Clinical assessment is crucial to evaluate chronic nasal obstruction. The lateral nasopharyngeal roentgenogram provides objective evaluation of the adenoid but its limitations should be considered. Nasal endoscopy may substitute for radiology but should be reserved for unusual cases.