Bitar Mohamed A, Birjawi Ghina, Youssef Marwan, Fuleihan Nabil
Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, American University of Beirut School of Medicine, Beirut, Lebanon.
Pediatr Int. 2009 Aug;51(4):478-83. doi: 10.1111/j.1442-200X.2008.02787.x.
The rate of adenoidectomy has increased over the past years. The initial assessment methods are sometimes overused. The aims of the present study were to evaluate the use of these methods, estimate the incidence of obstructive adenoid and refine the approach to this problem.
This is a prospective observational study. All children referred for chronic nasal obstruction had anterior rhinoscopy and a routine physical examination. The palatal airway was assessed on lateral nasopharyngeal roentgenograms when these were requested. The degree of obstruction was measured on endoscopy when performed. The efficacy of each method was evaluated, as well as its necessity. The incidence of obstructive adenoid was calculated.
A total of 213 patients aged 6 months-13 years (mean 5.1 years, median 4 years) were enrolled. One hundred patients had radiological evaluation while 65 had endoscopy during their initial assessment. Endoscopy was the most efficacious in reaching a proper diagnosis (100%) followed by clinical assessment (84.2%), and radiology (75%). The necessity of endoscopy, however, was 63.1% and that of radiology 63% within their respective groups. The incidence of obstructive adenoid was 57.7% (1.6% choanal). Clinical assessment, therefore, could have been sufficient in 41.8%, radiology in 44.1%; and endoscopy in 12.2% of the studied population to reach a proper diagnosis.
Clinical assessment is crucial to evaluate chronic nasal obstruction. The lateral nasopharyngeal roentgenogram provides objective evaluation of the adenoid but its limitations should be considered. Nasal endoscopy may substitute for radiology but should be reserved for unusual cases.
在过去几年中，腺样体切除术的发生率有所上升。最初的评估方法有时被过度使用。本研究的目的是评估这些方法的使用情况，估计阻塞性腺样体的发生率，并完善解决该问题的方法。
这是一项前瞻性观察性研究。所有因慢性鼻阻塞前来就诊的儿童均接受了前鼻镜检查和常规体格检查。当需要时，通过鼻咽侧位X线片评估腭气道。在内镜检查时测量阻塞程度。评估了每种方法的有效性及其必要性。计算了阻塞性腺样体的发生率。
共纳入213例年龄在6个月至13岁（平均5.1岁，中位数4岁）的患者。100例患者在初次评估时进行了影像学评估，65例进行了内镜检查。内镜检查在做出正确诊断方面最有效（100%），其次是临床评估（84.2%）和影像学检查（75%）。然而，在内镜检查组中，其必要性为63.1%，在影像学检查组中为63%。阻塞性腺样体的发生率为57.7%（后鼻孔闭锁为1.6%）。因此，在41.8%的研究人群中，临床评估可能就足够做出正确诊断，在44.1%的人群中影像学检查足够，而在内镜检查组中，仅12.2%的人群需要内镜检查来做出正确诊断。
临床评估对于评估慢性鼻阻塞至关重要。鼻咽侧位X线片可对腺样体提供客观评估，但应考虑其局限性。鼻内镜检查可替代影像学检查，但应仅用于特殊情况。
