Correlative Multicentric Analysis of Dimensions of Nasopharynx and Adenoid Size, and its Burden in Otitis Media with Effusion: An Indian Scenario

Abstract

Diseases of adenoids are commonly observed in children. It indirectly leads to pathology in the middle ear cleft. It has been demonstrated both by radiological techniques and middle ear pressure studies that adenoids can and do obstruct the Eustachian Tube. The Adenoid-Nasopharyngeal Ratio (ANR), can offer a simple arithmetic measure of nasopharyngeal obstruction. Coupled with tympanometry, it also predicts the degree to which the middle ear is affected. Multicentric study done at two centres in India. 230 patients were studied. Children were in the age group of 5-14 years. The nasopharyngeal and adenoid dimensions were measured separately using the Fujioka method. The adenoid-nasopharyngeal ratio was derived by the arithmetic method. All patients were also subjected to tympanometry. ANR decreased from 0.728 to 0.663 with an increase in age from 5 to 12 years. ANR between 0.701-0.800 had maximum number of Type B (140) and Type C (71) Tympanogram whereas between 0.801 and 0.900, all Tympanogram were found to be of Type B or Type C with none belonging to Type A. Using ANR and Tympanometry, the effects of the adenoids on the middle ear can be quantified indirectly. Both these modalities are easily available, economical, safe and can be performed at the Out Patient Level. This aids in timely and appropriate management thus preventing discomforting symptoms caused by the adenoids locally and also the morbidity caused to the middle ear in the long term.

Keywords: Adenoid nasopharyngeal ratio; Fujioka method; Tympanometry.

Fig. 1

Digital X-ray film showing adenoidal measurements using the Fujioka model [6]. “A” represents distance from A¹, point of maximal convexity, along inferior margin of adenoid shadow to line b₁ b₂, drawn along straight part of anterior margin of basi-occiput. “A” is measured along line perpendicular from point A¹ to its intersection with b₁ b₂ (“Radiographic Evaluation Of Adenoidal Size In Children: Adenoidal-Nasopharyngeal Ratio,” by Fujioka M., Young L.W., Girdany B.R., 1979, American journal of roentogenol, 133: 401–404. Copyright 1979 by the American Roentgen Ray Society.)

Fig. 2

Digital x ray film showing Nasopharyngeal measurements using the Fujioka model [6]. “N” is distance between C¹, posterior superior edge of hard palate and D1 antero-inferior edge of sphenobasioccipital synchondrosis. When synchondrosis is not clearly visualized, point D¹ can be determined as site of crossing posteroinferior margin of lateral pterygoid plates P and floor of bony nasopharynx (“Radiographic Evaluation Of Adenoidal Size In Children: Adenoidal-Nasopharyngeal Ratio,” by Fujioka M., Young L.W., Girdany B.R., 1979, American journal of roentogenol, 133: 401–404. Copyright 1979 by the American Roentgen Ray Society.)

Fig. 3

Graph showing symptom Distribution

Fig. 4

Photograph of child with adenoid facies

Fig. 5

Graph showing the tympanic membrane status

Fig. 6

Showing Type B Tympanogram