Comparison of adenoid size in lateral radiographic, pathologic, and endoscopic measurements

Sina Talebian, Gholamreza Sharifzadeh, Iraj Vakili, Seyyed Hassan Golboie, Sina Talebian, Gholamreza Sharifzadeh, Iraj Vakili, Seyyed Hassan Golboie

Abstract

Background: Otitis media (OM) is a major health problem that usually results from adenoid hypertrophy. Diagnosis is based on symptoms like mouth breathing and imaging studies like lateral neck radiography (LNR). Adenoid-nasopharyngeal ratio (A/N ratio) is one of the most important and most widely used criteria in LNR study that could estimate the real size of adenoid gland measurements. However, there are huge controversies regarding LNR rules in the management of patients with OM.

Objective: This study aimed to determine Adenoid Nasopharyngeal Ratio (A/N ratio) in children with otitis media with effusion (OME) and its relation with different factors.

Methods: This was a cross-sectional study on OME suspected children who needed adenoidectomy. The study was conducted from the fall to winter of 2016 on patients referred to ENT clinics of Mashhad University of Medical Sciences. Before surgery, all children underwent standard LNRs and indirect laryngoscopy to assess adenoidal size, and nasopharyngeal length, and A/N ratio. After adenoidectomy, pathologic analysis was performed for assessment of pathologic size. SPSS 21 was used for data analyzing using Pearson's correlation, independent t test and Mann-Whitney U test (p<0.05 was considered significant).

Results: A total of 27 children were enrolled. Most of the patients were male (70.4%, mean age=7.81±2.52 year). All patients in the study were symptomatic and the most frequent symptom was mouth breathing (100%). The mean A/N ratio, pathologic adenoid size, and laryngoscopic adenoid size were 0.825±0.099, 18.22±5.97, and 5.33±19.15 mm. There was a significant correlation between the A/N ratio laryngoscopic adenoid size (r=+0.46, p=0.01) and pathologic adenoid size (r=+0.44, p=0.02).

Conclusions: The results of this study showed that A/N ratio can be used to estimate the actual size of the adenoid gland and the necessity of adenoidectomy. Considering the reasonable costs and availability of this diagnostic method, researchers recommend using this procedure in assessment of patients with OME.

Keywords: Adenoid hypertrophy; Effusion; Otitis media; Rhinoscopy.

Conflict of interest statement

Conflict of Interest: There is no conflict of interest to be declared.

Figures

Figure 1
Figure 1
Estimation of the A/N ratio (Fujioka Method). The distance between the outermost point of convexity of adenoid shadow and spheno/basiocciput (A) is divided by the distance between spheno/basiocciput and posterior end of the hard palate

References

    1. Mahadevan M, Navarro-Locsin G, Tan HK, Yamanaka N, Sonsuwan N, Wang PC, et al. A review of the burden of disease due to otitis media in the Asia-Pacific. Int J Pediatr Otorhinolaryngol. 2012;76(5):623–35. doi: 10.1016/j.ijporl.2012.02.031.
    1. Prakash R, Juyal D, Negi V, Pal S, Adekhandi S, Sharma M, et al. Microbiology of Chronic Suppurative Otitis Media in a Tertiary Care Setup of Uttarakhand State, India. N Am J Med Sci. 2013;5(4):282–7. doi: 10.4103/1947-2714.110436.
    1. Wu JF, Jin Z, Yang JM, Liu YH, Duan ML. Extracranial and intracranial complications of otitis media: 22-year clinical experience and analysis. Acta Otolaryngol. 2012;132(3):261–5. doi: 10.3109/00016489.2011.643239.
    1. Farajzadah Sheikh A, Saki N, Roointan M, Ranjbar R, Yadyad MJ, Kaydani A, et al. Identification of Alloiococcus otitidis, Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae in Children With Otitis Media With Effusion. Jundishapur J Microbiol. 2015;8(3):e17985. doi: 10.5812/jjm.17985.
    1. Kong K, Coates HL. Natural history, definitions, risk factors and burden of otitis media. The Medical journal of Australia. 2009;191(9 Suppl):S39–43.
    1. Baum HL. Pneumonic Otitis Media. Archives of Otolaryngology. 1935;21(1):96–7. doi: 10.1001/archotol.1935.00640020103013.
    1. Bluestone CD. Pathogenesis of otitis media: role of eustachian tube. The Pediatric infectious disease journal. 1996;15(4):281–91. doi: 10.1097/00006454-199604000-00002.
    1. Hartzell LD, Dornhoffer JL. Timing of tympanoplasty in children with chronic otitis media with effusion. Current opinion in otolaryngology & head and neck surgery. 2010;18(6):550–3. doi: 10.1097/MOO.0b013e32833febc4.
    1. Craig JC, Williams GJ, Jones M, Codarini M, Macaskill P, Hayen A, et al. The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses. BMJ. 2010;340:c1594. doi: 10.1136/bmj.c1594.
    1. Dolen WK, Spofford B, Selner JC. The hidden tonsils of Waldeyer’s ring. Annals of allergy. 1990;65(4):244–8.
    1. Wang DY, Bernheim N, Kaufman L, Clement P. Assessment of adenoid size in children by fibreoptic examination. Clinical otolaryngology and allied sciences. 1997;22(2):172–7. doi: 10.1046/j.1365-2273.1997.00002.x.
    1. T-Ping C, Weckx LL. ENT care of children and adolescents in the Brazilian public healthy system in three different municipalities. Braz J Otorhinolaryngol. 2008;74(4):571–8. doi: 10.1016/S1808-8694(15)30605-4.
    1. Brietzke SE, Brigger MT. Adenoidectomy outcomes in pediatric rhinosinusitis: a meta-analysis. International journal of pediatric otorhinolaryngology. 2008;72(10):1541–5. doi: 10.1016/j.ijporl.2008.07.008.
    1. Peltomäki T. The effect of mode of breathing on craniofacial growth—revisited. European Journal of Orthodontics. 2007;29(5):426–9. doi: 10.1093/ejo/cjm055.
    1. Macassey E, Dawes P. Biofilms and their role in otorhinolaryngological disease. J Laryngol Otol. 2008;122(12):1273–8. doi: 10.1017/s0022215108002193.
    1. van den Aardweg MTA, Schilder AGM, Herkert E, Boonacker CWB, Rovers MM. Adenoidectomy for otitis media in children. Cochrane Database Syst Rev. 2010;(1):CD007810. doi: 10.1002/14651858.CD007810.pub2.
    1. Wallace IF, Berkman ND, Lohr KN, Harrison MF, Kimple AJ, Steiner MJ. Surgical treatments for otitis media with effusion: a systematic review. Pediatrics. 2014;133(2):296–311. doi: 10.1542/peds.2013-3228.
    1. Park K. Otitis media and tonsils--role of adenoidectomy in the treatment of chronic otitis media with effusion. Advances in oto-rhino-laryngology. 2011;72:160–3. doi: 10.1159/000324781.
    1. Mlynarek A, Tewfik MA, Hagr A, Manoukian JJ, Schloss MD, Tewfik TL, et al. Lateral neck radiography versus direct video rhinoscopy in assessing adenoid size. The Journal of otolaryngology. 2004;33(6):360–5. doi: 10.2310/7070.2004.03074.
    1. Kemaloglu YK, Goksu N, Inal E, Akyildiz N. Radiographic evaluation of children with nasopharyngeal obstruction due to the adenoid. The Annals of otology, rhinology, and laryngology. 1999;108(1):67–72. doi: 10.1177/000348949910800110.
    1. Sharifkashani S, Dabirmoghaddam P, Kheirkhah M, Hosseinzadehnik R. A New Clinical Scoring System for Adenoid Hypertrophy in Children. Iranian Journal of Otorhinolaryngology. 2015;27(78):55–61.
    1. Wormald PJ, Prescott CA. Adenoids: comparison of radiological assessment methods with clinical and endoscopic findings. J Laryngol Otol. 1992;106(4):342–4. doi: 10.1017/S0022215100119449.
    1. Chami FA. Avaliaçäo nasofibroscópica e rediológica de pacientes com hiperplasia da amígdla faríngea. Rev bras med otorrinolaringol. 1998;5(4):118–28.
    1. Aboudara CA, Hatcher D, Nielsen IL, Miller A. A three-dimensional evaluation of the upper airway in adolescents. Orthod Craniofac Res. 2003;6(Suppl 1):173–5. doi: 10.1034/j.1600-0544.2003.253.x.
    1. Fujioka M, Young LW, Girdany BR. Radiographic evaluation of adenoidal size in children: adenoidal-nasopharyngeal ratio. AJR American journal of roentgenology. 1979;133(3):401–4. doi: 10.2214/ajr.133.3.401.
    1. Cho JH, Lee DH, Lee NS, Won YS, Yoon HR, Suh BD. Size assessment of adenoid and nasopharyngeal airway by acoustic rhinometry in children. J Laryngol Otol. 1999;113(10):899–905. doi: 10.1017/S0022215100145530.
    1. Caylakli F, Hizal E, Yilmaz I, Yilmazer C. Correlation between adenoid-nasopharynx ratio and endoscopic examination of adenoid hypertrophy: a blind, prospective clinical study. International journal of pediatric otorhinolaryngology. 2009;73(11):1532–5. doi: 10.1016/j.ijporl.2009.07.018.
    1. Kolo ES, Ahmed AO, Kazeem MJ, Nwaorgu OG. Plain radiographic evaluation of children with obstructive adenoids. European journal of radiology. 2011;79(2):e38–41. doi: 10.1016/j.ejrad.2010.09.027.
    1. Lertsburapa K, Schroeder JW, Jr, 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. doi: 10.1016/j.ijporl.2010.08.005.
    1. Al-Kindy SA, Obaideen AO. The value of radiological examination in the management of adenoidal hypertrophy in a pediatric population. Saudi medical journal. 2003;24(5):504–6.
    1. Gangadhara S, Rajeshnari A, Mahaveera J. Significance of Adenoid Nasopharyngeal Ratio in the Assessment of Adenoid Hypertrophy in Children. Research in Otolaryngology. 2012;1(1):1–5.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅