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Development and Evaluation of the Adenoid/Nasopharynx Area Ratio on Lateral Cephalograms: Correlation With Nasal

Jiaming Zhu1,2, Le Chen2, Xiaoli Zhou2

  • 1Department of School of Health Science and Engineering University of Shanghai for Science and Technology Shanghai China.

OTO Open
|June 30, 2026
PubMed

Insights

A new radiographic index, Adenoid/Nasopharynx Area Ratio (ANAR), shows promise for assessing childhood adenoid hypertrophy. ANAR offers a reproducible method to evaluate nasopharyngeal obstruction, aiding dental and medical professionals.

Area of Science:

  • Otolaryngology
  • Pediatric Dentistry
  • Radiology
  • Medical Imaging

Background:

  • Clinical assessment of adenoid hypertrophy in children faces challenges with objective, reproducible nasopharyngeal obstruction measurement.
  • A reliable radiographic metric is needed for interdisciplinary communication between dental/orthodontic providers and otolaryngologists.

Purpose of the Study:

  • To evaluate the diagnostic performance of a novel radiographic index, the Adenoid/Nasopharynx Area Ratio (ANAR).
  • To assess ANAR's utility in estimating nasopharyngeal obstruction from lateral cephalometric radiographs.

Main Methods:

  • Retrospective cohort study involving children aged 2 to 14 years with suspected adenoid hypertrophy.
  • Analysis of lateral cephalometric radiographs to derive the ANAR index.
  • Comparison of ANAR with endoscopic grades and the traditional A/N ratio.

Main Results:

  • ANAR demonstrated a higher correlation with endoscopic grades (r=0.649) compared to the A/N ratio (r=0.603).
  • For severe obstruction, ANAR achieved 70.9% sensitivity and 82.3% specificity (AUC 0.834).
  • ANAR measurement showed good inter-rater reliability (ICC=0.924).

Conclusions:

  • The Adenoid/Nasopharynx Area Ratio (ANAR) is a practical and reproducible radiographic index for opportunistic upper airway assessment.
  • ANAR can complement nasal endoscopy, particularly when imaging is obtained for dental/orthodontic care.
  • Additional radiographs solely for adenoid evaluation are not recommended; ANAR can be derived from existing cephalograms.
Abstract

Keywords:
A/N ratioadenoid hypertrophyadenoids/nasopharynx area ratio (ANAR)lateral cephalometric radiographynasal endoscopypediatric airway obstruction

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