Endoscopic Grading, Radiological Grading and Clinical Features in Children with Chronic Adenoid Hypertrophy: A Correlational Study

• Published in: Indian journal of otolaryngology, and head, and neck surgery Vol. 75; no. 2; pp. 725 - 731
• Main Authors: Peedikakkal, Nawal Thazhathe, Prakash, D. R. Surya, Chandrakiran, C., Patil, Sanjay B., Reddy, Harshavardhan N.
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01.06.2023; Springer Nature B.V
• Subjects: Correlational studies; Endoscopy; Head and Neck Surgery; Medicine; Medicine & Public Health; Original Article; Otolaryngology; Otorhinolaryngology; Nasal endoscopy; Adenoid hypertrophy; ACE grading; Plain X-ray nasopharynx; Adenoid- nasopharyngeal ratio
• DOI: 10.1007/s12070-022-03438-x
• ISSN: 2231-3796

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.