Rhinology
Published: 2022-04-08
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Update of endoscopic classification system of adenoid hypertrophy based on clinical experience on 7621 children

Unit of Otolaryngology, University of Foggia, Foggia, Italy
Otorhinolaryngology and Head-Neck Surgery Unit, “A. Gemelli” Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
Unit of Otolaryngology, University of Foggia, Foggia, Italy
Unit of Otolaryngology, University of Foggia, Foggia, Italy
Unit of Otolaryngology, University of Foggia, Foggia, Italy; Unit of Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
Unit of Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy
Unit of Otolaryngology, University of Foggia, Foggia, Italy
Otorhinolaryngology and Head-Neck Surgery Unit, “A. Gemelli” Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
Unit of Otolaryngology, University of Foggia, Foggia, Italy
Unit of Otolaryngology, University of Foggia, Foggia, Italy
adenoid hypertrophy classification nasal endoscopy

Abstract

Introduction. Nasal endoscopy is likely to be the method of choice to evaluate nasal obstruction and adenoid hypertrophy (AH) in children given its excellent diagnostic accuracy and low risk for the patient. The aim of this study was to update the previous classification of AH to guide physicians in choosing the best therapeutic option. Materials and methods. This is a retrospective observational study including 7621 children (3565 females; mean age 5.92; range: 3-14 years) that were managed for adenoid hypertrophy at our institution between 2003 and 2018. All patients were initially treated with medical therapy and then with surgery if not adequately controlled. We performed a specific analysis based on the presence or absence of comorbidities.
Results. In 1845 (24.21%) patients, adenoid obstruction was classified as Grade I when the fiberoptic endoscopy showed adenoid tissue occupying < 25% of choanal space. In 2829 of 7621 (37.12%) patients, the adenoid tissue was scored as Grade II since it was confined to the upper half of nasopharynx, with sufficiently pervious choana and visualisation of tube ostium. In 1611 of 7621 (21.14%) cases, adenoid vegetation occupied about 75% of the nasopharynx with partial involvement of tube ostium and considerable obstruction of choanal openings, and was classified as Grade III. Finally, 1336 of 7621 (17.53%) patients were scored as Grade IV due to complete obstruction with adenoid tissue reaching the lower choanal border without allowing the visualization of the tube ostium. Based on resolution of symptoms in Grade III obstruction after medical therapy (that was mostly seen in patients without comorbidities), we divided patients in two subclasses: Grade IIIA was not associated with comorbidities, while Grade IIIB was correlated with important comorbidities.
Conclusions. These results can be useful to guide medical or surgical therapeutic intervention. In patients with class IIIB, surgical treatment offered adequate control not only of nasal symptoms but also of associated comorbidities.

Affiliations

Michele Cassano

Unit of Otolaryngology, University of Foggia, Foggia, Italy

Eugenio De Corso

Otorhinolaryngology and Head-Neck Surgery Unit, “A. Gemelli” Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy

Valeria Fiore

Unit of Otolaryngology, University of Foggia, Foggia, Italy

Rossana Giancaspro

Unit of Otolaryngology, University of Foggia, Foggia, Italy

Antonio Moffa

Unit of Otolaryngology, University of Foggia, Foggia, Italy; Unit of Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy

Manuele Casale

Unit of Integrated Therapies in Otolaryngology, Campus Bio-Medico University, Rome, Italy

Eleonora Maria Consiglia Trecca

Unit of Otolaryngology, University of Foggia, Foggia, Italy

Dario Antonio Mele

Otorhinolaryngology and Head-Neck Surgery Unit, “A. Gemelli” Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy

Pasquale Cassano

Unit of Otolaryngology, University of Foggia, Foggia, Italy

Matteo Gelardi

Unit of Otolaryngology, University of Foggia, Foggia, Italy

Copyright

© Società Italiana di Otorinolaringoiatria e chirurgia cervico facciale , 2022

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