Comparison of adenoid assessment by flexible endoscopy and mirror exam

Assessment of adenoid hypertrophy can be completed through various methods including flexible endoscopy and intraoperative mirror exam. The objective of this study was to compare the effect of adenoid size on the accuracy of these techniques.

Patients younger than 18 years old who underwent adenoidectomy at Boston Medical Center from October 2012 to December 2018 and had documented preoperative and intraoperative adenoid sizes were included. Cases were identified through Current Procedural Terminology (CPT) codes 42,830 and 42,831 with exclusion of CPT 42820 for tonsillectomy and adenoidectomy. Patients who had less obstruction (75% or less obstruction) and more obstruction (>75%) were compared using Chi-square analysis and t-tests.

Of 276 patients who underwent adenoidectomy from October 2012 to December 2018, 84 patients had adenoid size determined both preoperatively by flexible endoscopy and intraoperatively. Thirty-eight (45.2%) patients had intraoperative adenoids that were characterized as less obstructive hypertrophy and 46 (54.8%) had intraoperative adenoids that were characterized as more obstructive hypertrophy. In patients with less obstruction, the mean preoperative adenoid obstruction size of 72% was significantly higher than the mean intraoperative adenoid obstruction size of 63% (p = 0.0212). However, in patients with more obstruction, the mean preoperative adenoid size of 86% was not significantly different from the mean intraoperative adenoid size of 90% (p = 0.1237).

Adenoid assessment by flexible endoscopy and intraoperative mirror exam may not correlate as closely in patients who have less obstructive hypertrophy.