Endoscopy in the assessment of children with nasal obstruction

Abstract

Nasal obstruction is common in children, and is often attributed to adenoid enlargement. This prospective study was performed to determine whether routine nasal endoscopy is of value for children undergoing surgery for nasal obstruction. Forty-eight children aged two to nine years undergoing adenoidectomy, and six normal controls, were examined under general anaesthesia with a 4 mm rigid endoscope. A video of the endoscopy was subsequently assessed independently by an observer blinded to the original findings and the presence of nasal symptoms. The endoscopist and independent assessor were in agreement regarding 86 per cent of the findings. Three quarters of the children had abnormalities on endoscopy in addition to enlarged adenoids, and in 23 per cent these were potentially of major clinical significance (unsuspected foreign body, gross septal deviation, gross hypertrophy of the turbinates). Endoscopy produced no post-operative complications and was possible in children as young as two years of age, without decongestants. Nasal endoscopy is a safe, objective and useful means of identifying potentially significant abnormalities in children with nasal obstruction.

Avaliação da radiografia cefalométrica lateral como meio de diagnóstico da hipertrofia de adenoide

“…Cassano et al 6 ; Kubba, Bingham 15 e Tuncer et al 30 defenderam que a causa mais importante e mais frequente para a obstrução das vias aéreas superiores é a hipertrofia adenoideana. De acordo com Trotman, McNamara e Dibbets 29 , a via aérea superior de uma criança é estreita e a redução de apenas 1mm em seu diâmetro pode diminuir o espaço aéreo efetivo em 65%, produzindo uma obstrução crítica.…”

“…Segundo Kubba e Bingham 15 , o correto diagnóstico da hipertrofia de adenoide é essencial para a determinação do plano de tratamento adequado, que pode, inclusive, ser cirúrgico. No entanto, apesar das limitações e das controvérsias que envolvem o exame radiográfico, esse ainda é o método mais utilizado pelos cirurgiões-dentistas no diagnóstico de seus pacientes e na realização de pesquisas acerca da respiração bucal.…”

Adenoid Assessment in Paediatric Patients: The Role of Flexible Nasal Endoscopy

“…Nasal obstruction in children is usually due to enlarged adenoidal tissue, but other causes should be considered: allergic rhinitis may also produce the "adenoidal face" usually attributed to adenoid hypertrophy [3]. Rhinosinusitis is a quite common finding in children; also nasal polyposis should be considered, though it is uncommon in the paediatric age and it is often related to cystic fibrosis [4,5]. A significant septal deviation has been found in 18% of children complaining nasal obstruction [6].…”

“…The first nasal endoscopy in humans was performed by Hirschmann in 1901, with an Hopkins rigid scope. The development of the flexiblescopesmade the inspectionof the nasal cavities possible also in children, and provided the detection ofthe obstructive factors, such as adenoid hypertrophy, septal deviation, rhinitis, choanal atresia, polyps and sinonasal tumors [4,5]. The rigid endoscopy is now established as the "gold standard" for nasal examination in adults, as it provides a better quality of the image, but it may be difficult to perform in awake children.…”

“…On the other hand, the flexible fiberoptic scope is a safe instrument to explore the nasal cavities. Some authors suggest that nasal flexible fiberoptic endoscopy is the best method to evaluate the nasopharynx in children [5,10,11].…”