New Anatomical Adenoid Grading Method-A Nasopharyngoscopic Grading System for Adenoids and Its Clinical Correlation.

Abstract

To propose a new method for grading adenoids under fiberoptic nasopharyngoscopy and discuss its relationship with related clinical symptoms. The participants underwent fiberoptic nasopharyngoscopy performed by an experienced technician, and several clear images were obtained. The images had to include the nasopharynx from both nostrils and clearly expose the relevant anatomical structures. Two otolaryngologists, one senior and one junior, who were unaware of the children's conditions, graded the adenoid hypertrophy from the images using both the new anatomical adenoid grading method (NAAGM) and the traditional percentage 4°-grading method. Six months later, the same two physicians reassessed the cases. Inter-observer and intra-observer consistency and the relationship between the grading methods and relevant clinical symptoms were observed. A total of 285 children were evaluated by clinical physicians. The inter-observer and intra-observer consistency of the NAAGM was higher than that of the traditional percentage 4°-grading method. Additionally, the NAAGM demonstrated significantly better predictive ability for moderate-severe obstructive sleep apnea (OSA), otitis media with effusion (OME), and nighttime minimum oxygen saturation compared to the percentage 4°-grading method. The NAAGM proposed in this study is more straightforward, more reliable, and easier to use. It clearly describes the relationship between adenoids and anatomical structures and better predicts related clinical symptoms. Consequently, it may serve as a more suitable method for evaluating adenoid size.