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.

Figure 1

Plain x-ray paranasal sinuses profile.

Figure 2

Scheme illustrating Cohen & Konak method, which compares the soft palate thickness (one centimeter below the hard palate or half centimeter in children younger 3 years old) presenting the air column between this spot in the palate and the highest convexity spot of adenoid (blue line). In the present example, it is a large adenoid.

Figure 3

Sample of a selected image printed by Videoprinter Sony®.

Figure 4

Sample of a scanned image by Corel Scan 7.0, further processed by Corel Photo Paint 7.0 in bitmap file.

Figure 5

Sample of image analyzed by Corel Trace 7.0 as a vector figure.

Graph 1

Correspondence of number of patients with radiologically small adenoids (n = 7) at nasofibroscopy.

Graph 2

Correspondence of number of patients with radiologically medium adenoids (n = 6) at nasofibroscopy.

Graph 3

Correspondence of number of patients with radiologically large adenoids (n = 7) at nasofibroscopy.