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Endoscopic Grading, Radiological Grading and Clinical Features in Children with Chronic Adenoid Hypertrophy: A
Nawal Thazhathe Peedikakkal1, D R Surya Prakash1, C Chandrakiran1
1Department of Otorhinolaryngology and Head and Neck Surgery, Ramaiah Medical College Hospital, Bangalore, Karnataka 560054 India.
Insights
Nasal endoscopy is more accurate than X-rays for assessing chronic adenoid hypertrophy in children. Endoscopic grading correlates better with clinical symptoms and severity than radiographic measurements.
Area of Science:
- Pediatric Otorhinolaryngology
- Pediatric Radiology
- Medical Diagnostics
Background:
- Chronic adenoid hypertrophy significantly impacts children's health, causing symptoms like nasal obstruction and recurrent rhinitis.
- Accurate assessment of adenoid hypertrophy is crucial for effective treatment planning.
- Existing diagnostic methods, including X-rays and nasal endoscopy, have varying degrees of correlation with clinical presentation.
Purpose of the Study:
- To correlate endoscopic findings, radiological assessments, and clinical features in children with symptomatic chronic adenoid hypertrophy.
- To determine the most accurate method for evaluating the severity and clinical significance of adenoid hypertrophy in pediatric patients.
Main Methods:
- A cross-sectional study involving 42 pediatric patients (3-14 years) with symptomatic chronic adenoid hypertrophy.
- Data collection included history taking, ENT examination, rigid nasal endoscopy (ACE grading), and lateral X-ray nasopharynx (Adenoid-Nasopharyngeal ratio).
- Correlation analysis was performed between endoscopic, radiological, and clinical findings.
Main Results:
- Male predominance was observed, with mouth breathing, snoring, and nasal obstruction as common symptoms.
- Endoscopic grading showed a stronger correlation with clinical grading than X-ray grading.
- While X-ray's Adenoid-Nasopharyngeal ratio correlated with endoscopic grading and choanal obstruction, nasal endoscopy proved more accurate for assessing clinical significance and Eustachian tube involvement.
Conclusions:
- Nasal endoscopy is the gold standard for assessing clinically significant adenoid hypertrophy in children.
- Endoscopic grading is more reliable than X-ray measurements for evaluating adenoid size and its impact on symptoms.
- Clinical correlation is better with endoscopic findings, highlighting its superiority in diagnostic accuracy.
Abstract:
To obtain a correlation between endoscopic findings, radiological findings and clinical features in children with symptomatic Chronic Adenoid hypertrophy. A cross sectional study was conducted in 42 pediatric patients (3-14 years) who visited the Department of Otorhinolaryngology in a tertiary care centre from November 2019 to April 2021 (18 months). The patients were subjected to complete history taking; ENT examination, Rigid nasal endoscopic examination, a lateral X-ray nasopharynx were performed prior to surgery after obtaining consent from the parents of the patients. The endoscopic findings were assessed using ACE grading system and the X-ray nasopharynx was assessed using Adenoid- Nasopharyngeal ratio. A male predominance was noted with mouth breathing, snoring, nasal obstruction and recurrent rhinitis as common presentation. Grade 3 hypertrophy was the most common finding in X-ray Nasopharynx (Mean ANR-0.682). Children with Grade 3 adenoid hypertrophy with more than 50% choanal obstruction and Eustachian tube abutment in nasal endoscopy were noted to be the most symptomatic clinically. A positive correlation between reduced hearing (p value-0.004) and blocked ear sensation (p value- < 0.01) with eustachian tube abutment was noted. The children with more symptoms did not show higher-grade adenoid hypertrophy radiographically in our study. The adenoid- nasopharyngeal ratio on X-ray correlated with endoscopic grading of adenoid hypertrophy (p value-0.006) and degree of choanal obstruction (p value-0.003) but not with the abutment of the eustachian tube. The endoscopic grading correlated with clinical grading, but not the X-ray grading. Hence, endoscopic grading appears to be more accurate in assessing the adenoid size and endoscopic grading is nearer to clinical grading than X-ray grading. Though, the digital X-ray nasopharynx lateral view is a more convenient method, nasal endoscopy is the gold standard method to determine whether the adenoid hypertrophy is clinically significant or not.
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