Lateral Neck Radiography versus Direct Video Rhinoscopy in Assessing Adenoid Size

Abstract

Objective: To evaluate the usefulness of adynamic lateral neck radiographs and dynamic video rhinoscopy in assessing adenoid size and the relationship of these methods to associated symptoms and thus the severity of the disease. Methods: Children with suspected adenoid hypertrophy underwent standard lateral neck soft tissue radiographs: the percentage of airway occlusion, adenoid to nasopharynx (AN) ratio, airway to soft palate ratio, and adenoid thickness were assessed by a radiologist. The percentage of airway closure was assessed by direct fibre-optic rhinoscopy in an ear, nose, and throat clinic. Associated clinical symptoms were assessed by parents using a standardized questionnaire, evaluating the severity of symptoms (snoring, sleep apnea, mouth breathing, and otitis media) to give a total symptom score out of 16. Results: Nonparametric statistical analysis using Spearman's correlation coefficients was performed on 32 patients. There was a weak correlation, which approaches significance, between the percentage of airway occlusion assessed by fibre-optic rhinoscopy and the total symptom score (r = .344, p = .054). However, this correlation becomes significant when the frequency of otitis media is omitted (r = .367, p = .039). There was also a significant correlation between airway occlusion assessed by rhinoscopy and the percentage of airway occlusion as determined by lateral neck radiography (r = .431, p = .014). There was no correlation between any of the measurements taken by lateral soft tissue neck radiography and total symptom score. Conclusion: Dynamic video rhinoscopy is more accurate at assessing adenoid hypertrophy, and the percentage of airway occlusion, as estimated by video rhinoscopy, is better correlated to the severity of symptoms than are values obtained by lateral neck radiography. Sommaire Objectif: Evaluer l'utilité de la radiographie latérale du cou adynamique et de la vidéo-rhinoscopie dynamique pour mesurer le volume adénoidien et la relation entre ces méthodes et les symptômes et la sévérité de la maladie. Méthode: Nous avons fait passer à 32 enfants, un rayon-X standard des tissus mous du cou et un radiologiste a procédé aux mesures suivantes : le pourcentage d'occlusion des voies respiratoires, le rapport entre les adénoides et la nasopharynx (AN), le rapport entre les voies respiratoires et le palais mou et l'épaisseur des adénoides. Le pourcentage d'obstruction a aussi été évalué par rhinoscopie directe par fibre optique à la clinique externe. Finalement les parents ont évalué sur 16 la sévérité des symptômes en remplissant un questionnaire standardisé évaluant les aspects suivants : ronflement, apnée du sommeil, respiration buccale et une histoire d'otites moyennes. Résultats: Nous avons trouvé une faible corrélation (Spearman) presque significative entre la rhinosocopie par fibre optique et le score de symptômes (r = .344, p = .054). Cette corrélation devient significative quand on omet l'aspect otites moyennes (r = .367, p = .039). On note aussi une corrélation entre l'obstruc...

Assessment of adenoid size: A comparison of lateral radiographic measurements, radiologist assessment, and nasal endoscopy

“…Among them is the adenoid-to-nasopharyngeal (A/N) ratio described by Fujioka et al [15], which is a ratio of the measurement of the adenoid tissue (defined by the distance between the basiocciput region and the convex most part of the adenoid pad) and the nasopharyngeal aperture (defined by the distance between the sphenobasiocciput to the posterior edge of the hard palate). Despite the limitations of lateral airway radiography, which include anatomic alterations based on rotation, respiratory cycle, and lack of cooperation of the child [3,6], studies have noted that the A/N ratio correlates in varying degrees with other methods of direct visualization of the nasopharynx [4,6,7,15].…”

“…Endoscopic nasopharyngoscopy is thought to be among the most accurate methods of assessment of the nasopharynx [3][4][5][6][7][8], as it provides a direct view of the adenoid pad [5]. Some investigators consider endoscopic nasopharyngoscopy the current standard [5,17].…”

“…Methods for evaluating adenoid size that involve direct visualization of the nasopharynx have been viewed favorably [3][4][5][6][7][8]. Endoscopic nasopharyngoscopy is thought to be among the most accurate methods of assessment of the nasopharynx [3][4][5][6][7][8], as it provides a direct view of the adenoid pad [5].…”

“…There is currently no clear, cost effective, age specific guideline to help direct a physician who is evaluating a child with suspected adenoid hypertrophy. Multiple modalities to quantify adenoid tissue and its relationship to the nasopharyngeal airway have been devised; acoustic rhinometry [4,10,11], rhinomanometry [12], endoscopy [3][4][5][6][7][8], intra-operative mirror nasopharyngoscopy [13], and radiographic assessments [3,[5][6][7][8] have all been studied with varying degrees of success. Nasal endoscopy and lateral neck films are the most commonly used pre-operative modalities in clinical practice [7].…”

“…Hypertrophy of adenoid tissue is one of the most common conditions in the pediatric population [1][2][3][4][5][6][7][8]. Adenoid hypertrophy has been associated with nasal obstruction, snoring, sleep apnea, recurrent otitis media, and craniofacial changes [3][4][5][6][7][8]. Adenoidectomy is one of the most commonly performed procedures in the pediatric population [3].…”