Inter-observer variability in the clinical and radiological assessment of adenoid size, and the correlation with adenoid volume.

Forty-six children were independently assessed with respect to size of adenoids and other clinical features by 3 observers of differing experience. Similar assessment was made of adenoid area and post-nasal-space airway from lateral cephalometric X-rays. The inter-observer agreement for these findings has been calculated. Absolute agreement between observers for the assessments is poor and in some instances this is related to clinical experience. In relative terms the agreement is more satisfactory. A nasal obstruction score due to adenoid enlargement has been derived from assessment of mouth breathing and speech hyponasality and this is shown to correlate with the nasopharyngeal radiology score derived from visual assessment of the radiological adenoid area and post-nasal-space airway. The radiology score correlates well with measurements of the nasopharyngeal area made by planimetry. Both the radiology score and the nasal obstruction score correlate with the volume of adenoid tissue removed at adenoidectomy. This study provides the basis for a scoring system for the clinical and radiological assessment of adenoids in order to detect preoperatively those children most likely to benefit from adenoidectomy.