EVALUATION OF ADENOIDAL HYPERTROPHY BY LATERAL PLAIN X-RAY NASOPHARYNX: IN ENDOSCOPY ERA

Abstract

Adenoid, the hyperplasia of nasopharyngeal lymphoid tissue is one of the main cause of nasal obstruction and mouth
breathing in school age children and also leading to snoring and nasal obstruction. Accurate diagnosis of this alteration
is important for proper therapeutic planning. Accurate assessment of adenoid size and its relationship to post nasal
space is difficult to achieve clinically which can be misleading when a decision for adenoidectomy has to be taken. It
is common practice to request for lateral radiograph for post nasal space to visualize enlarged adenoid when adenoidal
hypertrophy is suspected in child with upper air way obstruction. Recently with introduction of nasal endoscope has
made the examination of nasal cavity and nasopharynx in children possible and considered to be gold standard but
has disadvantage of invasive procedure. The aim of this study is to evaluate the reliability of X-ray in diagnosis of
adenoid hypertrophy and to validate this with endoscopy of nasopharynx in evaluation of adenoid size. This is a
prospective study conducted in E.N.T. department at Misrata Medical Center, of one year duration from June 2015 to
May 2016 included 77 patients admitted for adenoidectomy of age group ranging from 1.3 years to 15 years with
symptoms of upper air way obstruction had a standard lateral soft tissue neck X-ray and rigid endoscopic examination
of nasopharynx to evaluate adenoid size, and size was graded independently. The variable of both procedures were
scored and the agreement between two methods assessed using weighted kappa statistics. Adenoidal hypertrophy
according to plain X-ray of naso pharynx 41patients (53.24%) had adenoid grade III (commonest grade). According
to endoscopic assessment the commonest grade of adenoid size was grade III seen in 53 patients(68.83%) and Numerical score to determine each size of adenoid in increasing level in which 1 point was credit to small adenoid,
2 point for medium adenoid and 3 point for large adenoid. Mean score for average size of adenoid in a scale 1-3 score
it was 1.81 on X-ray while through endoscopy was 2.12, It indicates that endoscopy is more reliable than X-ray to
assess the size and shape of adenoid. Out of 77 patients in this study, 40 of them had complete correlation between Xray and endoscopic findings. The observed agreement is 40/77(51.95 % of observation) on linear weighted kappa =
0.209, is a fair agreement between these findings. The study revealed that result of X-ray has tendency to under estimate the size of adenoid. Evaluation by endoscopy was more accurate than evaluation by X-ray, though the result is
not statistically significant (the chi square statistics is 9, 3871 (p- value is 0.05212,) using pearson`s chi square at .05
level of significance. Evaluation by endoscope was more accurate than evaluation by X-ray. Hence, the children with
symptoms of nasal obstruction even adenoid hypertrophy not revealed on X-ray suggested to be submitted to nasoendoscopy for diagnostic accuracy, which is very relevant for indication of adenoidectomy.