Vomer-to-nasopharyngeal widths and post-adenoidectomy outcomes in children: A prospective blinded study

The vomer is an essential component of the nasopharynx. Although variations in vomer width(VW) and nasopharyngeal width(NW) can be observed, their clinical significance on post-adenoidectomy outcomes in children with sleep-disordered breathing and obstructive sleep apnea(SDB-OSA) remains uncertain. The primary outcome was to investigate the association between VW and post-adenoidectomy clinical improvement. Secondary outcomes were to investigate the variability and interplay between VW and NW.

This prospective, blinded cohort study was conducted at a tertiary hospital between 6/2022 and 7/2023. Children who underwent adenoidectomy for SDB-OSA were included. VW and NW were measured using a transoral endoscope. A calibrated ruler was positioned at the inferior aspect of the vomer for direct visualization, and the NW was calculated as the distance between the medial edges of the torus tubarius. Clinical improvement was collected using the OSA-18 survey.

Of the 29 children (mean age:3.5 years, IQR: 2-4, 16[55 %] males), 26(89.6 %) showed a clinical improvement 1-month post-adenoidectomy (ΔOSA-18 score: 24.6,95 % confidence interval: 31-(-14),p = 0.001). The mean VW was 3.88 mm (IQR: 3-4), and the mean NW was 13.76 mm (IQR:13-14). In the univariable analysis, clinical improvement was associated with age <3 years(p = 0.05), non-obese children(p = 0.01), large adenoids(p = 0.01), preoperative OSA-18 score>60(p = 0.05), and lower VW/NW(p = 0.013). The odds ratio for clinical improvement was decreased by 1.08 for each 0.01 increase in VW/NW (95%CI:1.05-1.11,p = 0.01).

Lower VW/NW were associated with better clinical outcome 1-month post-adenoidectomy. Further randomized, prospective studies are needed to validate these findings and and explore whether interventions in this area could serve as a potential therapeutic target.