The lateral neck radiograph in adenotonsillar hyperplasia

doi:10.1016/S0165-5876(85)80058-6

International Journal of Pediatric Otorhinolaryngology

Volume 10, Issue 1, October 1985, Pages 67-73

https://doi.org/10.1016/S0165-5876(85)80058-6 Get rights and content

Summary

In this study we have considered whether the lateral neck radiograph is useful in predicting the degree of airway obstruction, and whether supine and erect views are more useful than a single film. We evaluated the supine and erect lateral neck radiographs of 50 patients with upper airway obstruction due to enlarged tonsils and adenoids. Our results show that the supine radiograph, which is technically easier to perform, is entirely satisfactory for appraising the size of the tonsils and adenoids, but that neither view tells us much about the degree of airway obstruction during sleep.

References (3)

FelmanA.H. et al.
Upper airway obstruction during sleep in children
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(1979)

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Cited by (54)

The effect of adenoid hypertrophy on hearing thresholds in children with otitis media with effusion
2019, International Journal of Pediatric Otorhinolaryngology
Otitis media with effusion is common middle ear mucosa disease that can cause hearing loss in children. Adenoid hypertrophy can cause recurrent acute otitis media in addition to otitis media with effusion as a result of eustachian tube dysfunction and primary infection focus. The aim of this study was to investigate the effect of adenoid hypertrophy on the hearing threshold in children suffering from otitis media with effusion.
Children of school age with otitis media with effusion were included in the study. The size and location of the adenoid tissue were determined by examination with a flexible endoscope. Four adenoid size groups were determined according to the percentage of choanal closure. The coverage was 0–25% in the first group, 26–50% in the second group, 51–75% in the third group and 76–100% in the 4th group. The location of the adenoid tissue in the nasopharynx was divided into three groups. In group A, the adenoid tissue was not in contact with torus tubarius. In group B, the adenoid tissue was in contact with the torus tubarius but did not cover it. In group C, the adenoid tissue covered the torus tubarius completely. Bone and air conduction thresholds were determined using standard procedures. The statistical relationship between the size and location of adenoid tissue and the hearing thresholds was investigated.
The study was conducted with the 88 ears of 50 children aged 5–15 years. The median values of mean air conduction thresholds at 500 Hz, 1000 Hz, and 2000 Hz in the adenoid tissue size groups 1–4 were 22 dB HL, 20 dB HL, 15 dB HL, and 20 dB HL respectively. The median values of the mean air conduction thresholds were 20 dB HL, 20 dBHL and 18 dB HL in the adenoid location group A-C, respectively. No significant correlation was found between the groups (p:0.213) and the relevant hearing values (p:0.670). Type B tympanogram was identified in 46 ears and type C tympanogram in 42 ears. The mean hearing thresholds were significantly higher in the ears with a type B tympanogram in the otitis media with effusion cases. (P < 0.001).There was no significant correlation between the duration of effusion and the adenoid size (p:0.931), adenoid location (p:0.626) and hearing threshold (p:0.815).
We concluded that adenoid tissue size and location have no effect on hearing thresholds and the duration of effusion in otitis media with effusion. We suggest caution before deciding on adenoidectomy in otitis media with effusion cases. Adenoidectomy should not be performed in children over 4 years of age unless there is a definite indication such as nasal obstruction or chronic adenitis.
Update on pathophysiology and treatment of childhood obstructive sleep apnea syndrome
2017, Paediatric Respiratory Reviews
Citation Excerpt :
Marcus has suggested, however, that because patients with OSAS do not obstruct during wakefulness, that neuromotor abnormalities must play a role in the pathogenesis [15]. Several studies have demonstrated no significant correlation between adenotonsillar size and OSAS [16–18]. Additional evidence for the involvement of other processes besides soft tissue obstruction is found in work by Guilleminault and colleagues which showed resolution of childhood OSAS following tonsillectomy in a cohort of children, but recurrence in adolescence [19].
Obstructive sleep apnea syndrome (OSAS) is common in childhood and is characterized by recurrent upper airway obstructive events during sleep that produce significant neurocognitive and cardiovascular sequelae. The pathophysiology of childhood OSAS is complex and involves mechanical airway obstruction often secondary to adenotonsillar hypertrophy. However, neuromotor abnormalities and instability of central ventilatory control are also implicated. Several surgical and non-surgical treatment options for childhood OSAS are available, and will be discussed. Some of these include adenotonsillectomy, lingual tonsillectomy, supraglottoplasty, continuous positive airway pressure (CPAP), rapid maxillary expansion, oral appliance therapy, anti-inflammatory treatments, and supplemental oxygen.
Mouth breathing in children with learning disorders
2013, Brazilian Journal of Otorhinolaryngology
Citation Excerpt :
Stage III - Hypertrophic pharyngeal tonsil; and Stage IV - Total obstruction7. To establish the anatomical configuration of the nasal cavity and nasopharynx, all the students underwent echo-rhinometry.
Given the importance of studying the causes of learning disorders, we designed this case-control study to assess the nasal cavity volume, pharyngeal and palatine tonsils in children with and without learning disabilities.
A total of forty-eight children were enrolled in the study: twenty-four coming from the Center for Evaluation and Early Stimulation (CADEP), in which the criterion is the school failure of at least two consecutive years; and twenty-four students with normal learning - which made up the control group. The children were submitted to ENT examination (history, physical examination) and specific tests (acoustic rhinometry, cavum radiography).
The results showed that students with learning disabilities have a higher prevalence of pharyngeal tonsil hypertrophy: p < 0.001, and palatine tonsil hypertrophy: p < 0.001. The average volume of the nasal cavities showed no statistically significant association with learning difficulties (p = 0.75).
Based on this study, we concluded that children with adenotonsillar hypertrophy have more learning difficulties when compared to children without such hypertrophy.
Imaging of pediatric neck masses
2011, Radiologic Clinics of North America
Citation Excerpt :
Lymphoid hyperplasia within Waldeyer's ring is a common finding in the pediatric population and a frequent cause of upper airway obstruction.1
Correlation between adenoid-nasopharynx ratio and endoscopic examination of adenoid hypertrophy: A blind, prospective clinical study
2009, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
It was reported that soft tissue images may be affected from positional changes and respiration movements of the patient [25]. However, A/N ratio was shown to be not affected from horizontal or vertical position changes [23]. The only soft tissue shadow that is used in calculation of the A/N ratio belongs to the adenoid convexity.
To determine the reliability of adenoid–nasopharynx (A/N) ratio that is calculated on lateral cephalometric graphies for measuring the adenoid tissue size.
85 patients that had been examined in our clinic with a prediagnosis of adenoid hypertrophy between June 2007 and March 2008 were included in the study. Local ethics committee approved the study protocol. Patients who had a previous adenoidectomy history and anatomic anomaly or acute infection in nose, palate or nasopharynx were excluded. Endoscopic nasal examination was done in all patients in addition to the routine ear nose throat examination. Lateral cephalometric graphs were obtained from all patients. Digital images obtained during endoscopic examination were evaluated on computer and obstruction ratios of adenoid tissue to choanal opening were calculated. Each cephalometric graph was evaluated by a blinded author. A/N ratio was calculated by dividing the distance from the outermost point of convexity of adenoid shadow to basiocciput to the distance between sphenobasiocciput and posterior end of hard palate (Fujioka Method). A/N ratio of each patient was then compared with the obstruction ratio obtained in nasal endoscopy. Pearson correlation test was used for statistical analysis and a p-value of <0.05 was accepted as significant.
There were 52 male and 33 female patients between the ages of 2 and 12 years (mean age, 5.0 ± 2.2; median, 4.5). In nasal endoscopy, adenoid tissue was determined to obstruct the choanal opening as 88.5 ± 12.0% (range, 51–99%) in an average. Mean adenoid nasopharynx ratio was found to be 0.87 ± 0.1. There was a statistical significant correlation between A/N ratio and nasal endoscopic examination findings (r = 0.511; p < 0.0001).
A/N ratio is an easily applicable, noninvasive method that can correctly measure the size of the adenoid tissue in patients who are suspected to have adenoid hypertrophy.
Surgery for Pediatric Sleep Apnea
2007, Otolaryngologic Clinics of North America
Sleep-related breathing disorders (SRBD) in children are caused by a diverse group of anatomic and physiologic pathologies. These disorders share a common clinical presentation as stertor or sonorous breathing, occasionally accompanied by apneic events of variable duration. Successful management depends on accurate identification of the site of obstruction and the severity of obstruction. Intervention, both surgical and nonsurgical, is tailored to the disorder. In children with SRBD, such intervention may alter behavior and cognition, improve sleep and feeding, or even save a life.

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PaperThe lateral neck radiograph in adenotonsillar hyperplasia

Summary

Upper airway obstruction during sleep in children

Am. J. Roentgenol.

Paper
The lateral neck radiograph in adenotonsillar hyperplasia