X-Ray, Nasal Endoscopy and Adenoid Hypertrophy in Children

Background

Upper airway (UA) obstruction is a common complaint in children presenting to otolaryngology clinics. In such children, adenoid hypertrophy is often suspected. There are numerous ways to determine adenoid size, including palpation, mirror examination, endoscopic examination, lateral neck roentgenogram (X-ray), MRI, and acoustic rhinometry. Pediatric patient cooperation limits the utilization of palpation and mirror examination, while acoustic rhinometry and MRI are not practical in the clinical setting. Thus, flexible fiberoptic nasal endoscopy (FNE) and lateral neck X-ray are the most common diagnostic tools used to assess for adenoid hypertrophy. The aim of this review is to determine whether X-ray or endoscopy is superior in assessing adenoid hypertrophy in pediatric patients presenting with UA obstruction.

Best Practice

FNE is well tolerated in most children and has the advantage of allowing for direct visualization of the adenoid. Adenoid hypertrophy diagnosed on flexible nasal endoscopy correlates with airway obstruction symptomatology. While A/N ratio on lateral neck X-ray frequently correlates with adenoid size, lateral neck films can be impacted by patient positioning and involve radiation exposure. Furthermore, the cost of FNE and lateral neck X-ray are comparable. Thus, in children presenting with UA obstruction and suspected adenoid hypertrophy, FNE is the best initial choice for evaluation of adenoid size. Clinicians may consider lateral neck X-ray in those children who need an objective assessment of their adenoid size and are unable to cooperate with FNE. Future research is necessary to determine whether initial adenoid size noted on FNE or lateral neck X-ray correlates with improvement in airway obstruction symptoms following surgical removal of the adenoid (Laryngoscope. 2014;124:1509-1510).