Update of endoscopic classification system of adenoid hypertrophy based on clinical experience on 7621 children

Abstract

SUMMARY Introduction Nasal endoscopy is likely to be the method of choice to evaluate nasal obstruction and adenoid hypertrophy (AH) in children given its excellent diagnostic accuracy and low risk for the patient. The aim of this study was to update the previous classification of AH to guide physicians in choosing the best therapeutic option. Materials and methods This is a retrospective observational study including 7621 children (3565 females; mean age 5.92; range: 3-14 years) who were managed for adenoid hypertrophy at our institution between 2003 and 2018. All patients were initially treated with medical therapy and then with surgery if not adequately controlled. We performed a specific analysis based on the presence or absence of comorbidities. Results In 1845 (24.21%) patients, adenoid obstruction was classified as Grade I when the fiberoptic endoscopy showed adenoid tissue occupying < 25% of choanal space. In 2829 of 7621 (37.12%) patients, the adenoid tissue was scored as Grade II since it was confined to the upper half of nasopharynx, with sufficiently pervious choana and visualisation of tube ostium. In 1611 of 7621 (21.14%) cases, adenoid vegetation occupied about 75% of the nasopharynx with partial involvement of tube ostium and considerable obstruction of choanal openings, and was classified as Grade III. Finally, 1336 of 7621 (17.53%) patients were scored as Grade IV due to complete obstruction with adenoid tissue reaching the lower choanal border without allowing the visualisation of the tube ostium. Based on resolution of symptoms in Grade III obstruction after medical therapy (that was mostly seen in patients without comorbidities), we divided patients in two subclasses: Grade IIIA was not associated with comorbidities, while Grade IIIB was correlated with important comorbidities. Conclusions These results can be useful to guide medical or surgical therapeutic intervention. In patients with class IIIB AH, surgical treatment offered adequate control not only of nasal symptoms but also of associated comorbidities.

Impact of the COVID-19 pandemic on paediatric otolaryngology: a nationwide study

“…Medical management of severe obstructive sleep apnoea during the COVID-19 pandemic, including continuous positive airway pressure therapy in severe cases, showed that this kind of treatment is poorly tolerated, and that surgery remains the gold standard 12 . Normally, stratification of patients according to the endoscopic classification of adenoid hypertrophy is the method of choice to indicate medical or surgical therapy 13 . However, considering that otolaryngologists are at high risk of contagion because of the proximity to superior airways during physical examination and of the aerosolisation of many common procedures including nasopharyngeal fibre-endoscopy 14 , according to our responders, the number of outpatient procedures requiring fibreoptic evaluation significantly decreased during the COVID-19 period.…”

Reliability of nasofibroscopy for the evaluation of adenoid hypertrophy and its correlation with clinical symptoms

“…Thus, adenoidectomy should be indicated based on persistent respiratory symptoms refractory to clinical treatment, corroborated by the nasofibroscopic finding of adenoid hypertrophy. 18 , 19 …”

“…It is important to note that Cassano et al's study included patients with other conditions that can impact sleep quality, such as tonsil hypertrophy and nasal secretions. 18 …”

Different techniques of adenoidectomy and its impact on middle ear pressure: a randomized controlled study

“…If adenoid tissue occupies about 75% of the nasopharynx with partial involvement of the tube ostium and considerable obstruction of choanal openings was classified as grade 3. If adenoid tissue reaches the lower choanal border without allowing visualization of the tube ostium (> 75%) was classified as grade 4 [ 7 ].…”