Evaluation of adenoidal obstruction in children: clinical symptoms compared with roentgenographic assessment.

BACKGROUND

Obstructive adenoid enlargement is commonly implicated as the major cause of chronic nasal obstruction in children. Although clinical assessment is considered essential, there is little consensus over its reliability. This study was conducted to determine the correlation between graded symptomatology assessment and roentgenographic assessment of adenoidal obstruction.

METHOD: Symptoms assessed included snoring, mouth-breathing and obstructive breathing during sleep. Each symptom was rated on a four-point scale (absent = zero, mild = one, moderate = two and severe = three). We summed the ratings for each child to obtain the symptomatology score. We used an adenoidal-nasopharyngeal ratio parameter to classify roentgenographic assessment into minimal, moderate or marked obstruction.

RESULTS

Sixty-four children, 42 boys and 22 girls, aged one to 12 years were enrolled. The clinical symptomatology scores correlated significantly with the roentgenographic ratings of nasopharyngeal airway obstruction (r = 0.419; p = 0.001). The correlation was significant at roentgenographic ratings of minimal obstruction (p < 0.05) and gross obstruction (p < 0.001). Both the symptomatology score and the roentgenographic rating showed significant correlations with patient age (r = -0.657, p < 0.01 and r = -0.340, p < 0.01, respectively).

CONCLUSION

Clinical rating of adenoidal symptoms in children provides a reasonably reliable assessment of the presence and severity of nasopharyngeal airway obstruction. This technique of assessment is easy to use and is particularly valid when obstruction is either minimal or gross.