A New Clinical Scoring System for Adenoid Hypertrophy in Children

Document Type: Original

Authors

1 Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran.

2 Otolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran.

3 Postgraduate, Tehran University of Medical Sciences.

4 Azad University of Dentistry. Tehran, Iran.

Abstract

Introduction:
Chronic nasal obstruction due to adenoid hypertrophy is a very common disorder. Although the clinical assessment of adenoid hypertrophy is essential, its real value in young children is difficult to evaluate. The purpose of this prospective study was to validate a simple clinical score to predict the severity of adenoid obstruction and to evaluate the relationship between this method of clinical scoring with radiography and nasopharyngeal endoscopy.
 
Materials and Methods:
Ninety symptomatic children were enrolled into this study. The clinical score included difficulty of breathing during sleep, apnea, and snoring. We investigated the relationship between clinical scoring, nasal endoscopy, and radiographic findings.
 
Results:
The clinical score correlated very well with endoscopic findings (P<0.000), but the correlation between the clinical score and radiologic findings (P>0.05) and endoscopic findings and imaging (P>0.05) was weak. 
 
Conclusion: 
Clinical findings could be used to select children for adenoidectomy, especially when endoscopic examination is not available or cannot be performed.

Keywords

Main Subjects


1. Mlynarek A, Tewfik MA, Hager A, Manoukian JJ, Schloss FMD, Tewfik FTL,et al. Lateral neck radiography versus direct video rhinoscopy in assessing adenoid size. J Otolaryngol 2004; 33(6):360–5.

2.  Lourenco EA, Lopes Kde C, Pontes A Jr, Oliveira MHde, Umemura A, Vargas L, et al. Comparison between radiological and nasopharyngolaryngoscopic assessment of adenoid tissue volume in mouth breathing children. Braz J Otorhinolaryngol 2005; 71(1):23–7.

3. Saedi B, Sadeghi M, Mojtahedi M, Mahboubi H. Diagnostic efficacy of different methods in the assessment of adenoid hypertrophy. Am J Otolaryngol 2011; 32(2):147–51.

4. Lertsburapa K, Schroeder JW, Sullivan C.  Assessment of adenoid size: A comparison of lateral radiographic measurements, radiologist assessment, and nasal endoscopy. Int J Pediatr Otorhinolaryngol 2010; 74(11):1281–5.

 5. Brouilette R, Hanson D, David R, Klemka L, Anna S, Fernbach S, et al. A diagnostic approach to suspected obstructive sleep apnea in children. J Pediatr 1984;105(1):10–14.

6. Cohen D, Konak S. The evaluation of radiographs of the nasopharynx. Clin Otolaryngol Allied Sci 1985; 10(2):73–8.

 7. Bitar MA, Rahi A, et al. A suggested clinical score to predict the severity of adenoid obstruction in children. Eur Arch Otorhinolaryngol 2006; 263 (10):924–8.

 8. Major MP, Flores-Mir c, Major PW. Assessment of lateral cephalometric diagnosis of adenoid hypertrophy and posterior upper airway obstruction: a systematic review. Am J Orthod Dentofacial Orthop 2006; 130(6):700–8.

 9. Caylakli F, Hizal E, Yilmaz I. Correlation between adenoid-nasopharynx ratio and endoscopic examination of adenoid hypertrophy: a blind, prospective clinical study. Int J Pediatr Otorhinolaryngol 2009; 73(11):1532–5.

10. Wormald PJ, Prescott CA. Adenoids: comparison of radiological assessment methods with clinical and endoscopic findings. J Laryngol Otol 1992; 106(04):342–4.

11. Ysunza A, Pamplona MC, Ortega JM, Prado H, et al. Video fluoroscopy for evaluating adenoid hypertrophy in children. Int J Pediatr Otorhino- laryngol 2008; 72(8):1159–65.

12. Pardise JL, Bernard BS, Colborn DK, et al. Assessment of adenoidal obstruction in children: clinical signs versus roentgenographic findings. Pediatrics 1998; 101(6):979–86.

13. Chisholm EJ, Lew-Gor S, Hajioff D, et al. Adenoid size assessment: a comparison of palpation, nasendoscopy and mirror examination. Clin Otolaryngol 2005; 30(1):39–41.

14. Kubba H, Bingham BJ. Endoscopy in the assessment of children with nasal obstruction. J Laryngol Otol 2001; 115(05):380–4.

15. Cassano P, Gelardi M, Cassano M, Fiorella ML, Fiorella R. Adenoid tissue rhinopharyngeal obstruction grading based on fiberendoscopic findings: a novel approach to therapeutic management. Int J Pediatr. Otorhinolaryngol 2003; 67(12):1303–9.