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

Abstract

Adenoid hypertrophy is the most common cause of nasal obstruction in paediatric patients. Over the years, various methods to assess the adenoid size were proposed such as the posterior rhinoscopy and the radiological examination of the nasopharynx. Nasal endoscopy was introduced for children in the 80's, and nowadays this is a known and diffuse method in routine practice. The purpose of this article is to describe the personal experience in the assessment of the adenoid size in children, with a particular regard to the flexible nasal endoscopy, and to analyse the literature reports. The personal technique is described in performing nasal endoscopy in paediatric patients, reporting advantages and possible disadvantages of the procedure. A retrospective analysis was conducted on 6036 children since 1999 to 2010. In most cases children fully collaborated to complete the exam. No major or minor complications (such as nose bleedings or other traumatic injuries) were observed. No topical intranasal decongestant, local or general anaesthesia were used in our series. In our opinion, nasal endoscopy in children is a reliable, safe, accurate, easily tolerated and dynamic diagnostic method to assess the adenoid size.

Nasopharyngeal fiberendoscopy in children: a survey of current Italian pediatric otolaryngological practices

“…The only items indicating almost unanimous agreement concerned the recommended type of endoscope (flexible), the position of the patient during NFE (sitting alone or on a parent’s lap), and restraint (with the parent blocking the movement of the child sitting on his/her lap). Various means of carrying out NFE examinations have been proposed [ 3 , 4 , 16 – 19 ], but our own experience confirms that the methods indicated by the answers of our respondents are effective and well-tolerated by almost all children [ 15 ]. Some authors [ 18 – 21 ] advocate the use of a rigid nasal endoscope, but this may be less well tolerated as it is associated with a failure rate of up to 12 % of children undergoing endoscopy in a supine position even after the administration of topical nasal anesthetics and decongestants [ 18 , 19 ].…”

“…Furthermore, nearly one-third of the respondents (males aged >50 years) stated that they cannot complete an NFE examination in up to 25 % of patients. However, our experience [ 15 ] and that of others [ 3 ] indicates that NFE is feasible and tolerable in almost all children when it is carried out by a skilled otolaryngologist using a small-calibre flexible endoscope, and if every effort is made to find the best approach on the basis of the child’s age.…”

“…Thirty-eight percent excluded the possibility of using outpatient NFE in “children with a genetic syndrome” or “children aged <18 months in whom severe disease is highly suspected”. To the best of our knowledge, no specific guidelines have yet been published but, on the basis of our experience [ 15 ] and that of Pagella [ 3 ], we consider that NFE can generally be used in an outpatient setting even in young non-syndromic children.…”

Adenoids in children: Advances in immunology, diagnosis, and surgery

“…In 2011, we reported our personal 11‐year experience (1999–2010) with nasal endoscopy performed on 6036 pediatric patients, the largest series reported in the literature. In our experience, nasal endoscopy is a reliable, safe, accurate, easily tolerated, and dynamic diagnostic method for assessing adenoid size in children if the correct endoscopes are used under appropriate conditions (Pagella et al, ).…”

Versatility and Benefits of 4.0mm Flexible Nasal Endoscopy in 118 Children up to 10 Years of Age

“…Although there are many reasons for a young child to develop symptoms of snoring, mouth breathing, apnoeic episodes, and nasal discharge, enlarged adenoids by far remain the most common cause [ 1 , 2 ]. The diagnosis is often based on a parents' account of symptoms and clinical examination that does not involve assessing the post-nasal space.…”