A new modified endoscopic evaluation system and its diagnostic accuracy of adenoid hypertrophy in children

In recent years, nasopharyngeal endoscopy has been widely used in the diagnosis of adenoid hypertrophy. A novel, modified evaluation system was introduced to investigate the correlation between adenoid hypertrophy and obstructive sleep apnea (OSA), including ear complications. The diagnostic efficacy of this system was based on and compared with three commonly employed endoscopic adenoid hypertrophy evaluation systems.

This study was a prospective, single-center, observational study. A total of 184 children were recruited from the outpatient department of Otorhinolaryngology Head and Neck Surgery, Shanghai Children's Hospital from January 2023 to December 2023. The adenoid grade was assessed using four endoscopic grading systems: percentage of 4-grade system, Parikh's grading system, airway/choana/eustachian tube (ACE) grading system, and anatomical adjacent of 5-grade system (modified Parikh's grading system). Receiver operating characteristic (ROC) curves obtained from the four endoscopic grading systems were analyzed and compared, and the diagnostic efficacy indexes (such as sensitivity, specificity, and accuracy) were calculated. Furthermore, we assessed the consistency among these results in determining surgical indications and occurrence/development of secretory otitis media within a six-month observation period.

Among the different grading systems evaluated, the anatomical adjacent of 5-grade system (modified Parikh's grading system) demonstrated superior specificity, accuracy, and area under the curve (AUC) when compared to surgical indications as the reference standard. The diagnostic efficiency of this 5-grade system in determining the need for surgery in children with OSA was significantly better than either the percentage of 4-grade system or Parikh's grading system (P<0.05). The anatomical adjacent of 5-grade system showed no statistical difference compared with the ACE grading system (P=0.053). When using secretory otitis media as the reference standard, incorporating the anatomical adjacent of 5-grade system for evaluation resulted in increased sensitivity, specificity, accuracy, and AUC, however, no significant difference was observed compared to Parikh's grading system (P=0.49).

The anatomical adjacent of the 5-grade system (modified Parikh's grading system) enables a more accurate quantitative evaluation of adenoid hypertrophy during adenoid endoscopy, showing potential for improved diagnosis of progressive otitis media.