Effectiveness of Evaluation of Adenoid Hypertrophy in Children by Flexible Nasopharyngoscopy Examination (FNE), Proposed Schema of Frequency of Examination: Cohort Study

Abstract

Objectives: To demonstrate the effectiveness of endoscopic assessment of the pharyngeal tonsil in defining the size of the adenoid hypertrophy in endoscopic examination that would be equivalent to intraoperative assessment as a large adenoid, and to determine the lowest necessary frequency of tests to assess the variability of its size. Methods: The study is based on an analysis of two groups of children diagnosed and treated in a children’s ENT outpatient clinic and ENT department. In the first group, adenoid size was assessed based on flexible endoscopy, and then with a consequent adenoid surgery with assessment of the intraoperative size of the adenoid, we compared the size of the adenoid. The second part of the study included a group of 81 children. We analyzed performed flexible nasopharyngoscopy examinations (FNE) of each child, and compared the change of adenoid size in a minimum of two subsequent examinations over a period of 1 year or more. Results: The sensitivity of flexible endoscopic examination in the assessment of the pharyngeal tonsil was determined at 97.3%, and specificity at 72.7%. The ROC curve shows the value of adenoid-to-choana (A/C) ratio as 75% or more in the preoperative FNE, indicating that the tonsil during surgery is assessed as large. Among the children, 26.3% had a change in adenoid size of more than 15% in the A/C ratio in 1 year of observation, and 45% of the children had A/C ratio changed above 15% in a period of 3 years of observation. Conclusions: FNE examination is highly effective in assessing the size of the pharyngeal tonsil. We proposed a schema for frequencies of FNE examinations and treatment dependent on A/C ratio and worsening of ailments.

Elaboration of selected respiratory system diseases in children in the pediatric hospital Bielsko-Biala In years 2015-2022

“…Tonsils are an integral part of the lymphatic system. Their main role is to recognize surrounding antigens, activate the local and general defense line, and neutralize and destroy antigens as a result of the development of cellular and humoral responses (28).…”

“…B oraz tkanki międzygrudkowej, w której dominują grasiczozależne limfocyty T. Migdałki stanowią integralną część układu chłonnego. Główną ich rolą jest rozpoznawanie otaczających antygenów, uruchamianie miejscowej i ogólnej linii obrony oraz neutralizacja i niszczenie antygenów w wyniku rozwoju odpowiedzi komórkowej i humoralnej (28).…”

The Link Between Adenoids and Nasopharyngeal Carcinoma

“…Early diagnosis is therefore necessary to control symptoms and enhance treatment modalities. Zwierz et al grouped the various diagnostic methods into two categories: namely, invasive and imaging [54]. They further grouped techniques such as rigid or flexible fibreoptic nasopharynx endoscopy (FFNE), video fluoroscopy, acoustic rhinomanometry, physical examination by the finger or a mirror through the mouth as invasive.…”

“…These procedures come with high costs, the need for ENT specialists and cutting-edge expensive equipments. Though Zwierz et al [54] reported that FFNE is invasive, Baldassari and Choi [109] highlighted that FFNE is minimally invasive and reliable among the paediatric population due to its effective and dynamic approach. Several other studies have also reported that FFNE is the gold standard for examining the nasopharynx which is less expensive as compared to the image techniques [50,[110][111][112][113][114][115][116].…”

Siblings’ Risk of Adenoid Hypertrophy: A Cohort Study in Children

“…Yamada showed that an overgrowth of adenoids occurred in preschool children, but there were no significant changes in the adenoid size from 8–12 years of age [ 7 ]. A previous study based on flexible endoscopic examinations revealed that adenoid involution proceeds rather slowly; only 7.9% of preschool children (aged 3–7 years) underwent a change in the adenoid size by >15% on the adenoid to choana (A/C) ratio over one year of observation, 21.6% over a period of 2 years, and 45% over a period of 3 years [ 8 ]. The growth and development patterns of the nasopharyngeal lymphoid tissues vary for each individual; accordingly, we believe that in studies comparing the adenoid size in a pair of siblings, the permissible age difference should not exceed 12 months.…”