Comparison between radiological and nasopharyngolaryngoscopic assessment of adenoid tissue volume in mouth breathing children

Abstract

The pharyngeal tonsil (adenoid) constitutes the upper portion of the Waldeyer's ring and is located at the top of the nasopharynx, next to the auditory tube and choana. It plays an important role in recurrent otitis of the middle ear and many times its enlargement is responsible for upper airway obstruction. Tonsillectomy is often the treatment of choice for tonsillar diseases. So far, it is the most frequent and one of the oldest surgical procedures performed in children and young adults. The criteria for tonsillectomy, its effect on patient's immunological integrity and the surgical risks are widely controversial. Image study using paranasal sinuses x-ray is a very simple, easy and comfortable method to evaluate the sizes of adenoids and the grade of upper airway obstruction. Cohen et al. supported that paranasal sinuses x-ray is the best way to determine pharyngeal tonsil hypertrophy. On the other hand, nasopharyngolaryngoscopy can provide more accurate data on the nasopharynx, as it can dynamically reveal its structures and the obstruction status of the upper airway. This study compared the grade of adenoid hypertrophy, as well as upper airway obstruction, using the above-mentioned approaches in children ranging from 3 to 10 years old. The study came to the conclusion that nasopharyngolaryngoscopy is a much more accurate diagnostic procedure than radiological evaluation of the nasopharynx.

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

“…Adenoid tissue is thought to play a significant role in the immune system due to its position at the entry of the upper aerodigestive tract; however, its complete function is not fully understood [1,2]. 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].…”

“…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].…”

“…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].…”

“…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].…”

Evaluación adenoídea mediante nasofaringolaringoscopía: Validación del método

“…Éste juega un importante rol patogénico en la efusión y las otitis medias recurrentes, siendo su hiperplasia responsable de síntomas de obstrucción respiratoria alta y ronquido 1 , afectando de manera importante la calidad de vida personal y familiar 2 . El manejo terapéutico principal de la hiperplasia adenoídea sintomática es su remoción, siendo la adenoidectomía con, o sin, amigdalectomía uno de los procedimientos quirúrgicos más comunes en la edad pediátrica 1 . En nuestro servicio se realiza un promedio de 260 cirugías que incluyen adenoidectomía por año, correspondiendo al 32% del total anual.…”