Department of Maternal and Pediatric Sciences, University of Milan, Milan, Italy.
Otolaryngol Head Neck Surg. 2010 Feb;142(2):237-41. doi: 10.1016/j.otohns.2009.10.027.
To evaluate the accuracy of clinical assessment of adenoidal obstruction based on a standardized score of the degree of mouth breathing and speech hyponasality (nasal obstruction index [NOI]) in comparison to nasal fiberoptic endoscopy.
Cross-sectional study with planned data collection.
Outpatient clinics of the Departments of Maternal and Pediatric Sciences and Specialized Surgical Sciences, University of Milan, Italy.
Children aged three to 12 years with adenoidal obstruction suspected on the grounds of persistent/recurrent otitis media or perceived obstructive nasal breathing were eligible. Ear, nose, and throat examination, allergy testing, NOI measurement, and nasal fiberoptic endoscopy to assess the degree of adenoidal hypertrophy were performed. Agreement between the NOI and adenoidal hypertrophy grade was assessed in the patients as a whole and by clinical subgroups.
A total of 202 children were enrolled: 54.9 percent had otological diseases and 45.1 percent had perceived obstructive nasal breathing. Most of the children (79.2%) showed mild or moderate clinical nasal obstruction. Adenoidal hypertrophy ranged from no obstruction (18%) to severe obstruction (38%). There was no substantial agreement between the NOI and the degree of adenoidal obstruction in the population as a whole and in all the clinical subgroups. False positive findings were significantly more frequent among allergic children (50%) than non-allergic children (22.4%, P = 0.009).
Clinical assessment based on the NOI is incapable of accurately predicting the degree of adenoidal obstruction. In children with clinical nasal obstruction not explainable by adenoidal size, the clinician should consider, among causes of more anterior obstruction, nasal allergy.
评估基于张口呼吸程度和言语鼻音低沉度（鼻音梗阻指数[NOI]）标准化评分的临床评估对腺样体阻塞的准确性，并与鼻纤维内镜检查进行比较。
有计划数据收集的横断面研究。
意大利米兰大学母胎与儿科科学系和专业外科科学系的门诊。
有腺样体阻塞嫌疑的 3 至 12 岁儿童，其依据为持续性/复发性中耳炎或感知到的阻塞性鼻呼吸。进行耳部、鼻部和喉部检查、过敏测试、NOI 测量和鼻纤维内镜检查以评估腺样体肥大程度。评估 NOI 和腺样体肥大程度之间的一致性，评估对象为所有患者和按临床亚组分类的患者。
共纳入 202 名儿童：54.9%患有耳科疾病，45.1%有感知到的阻塞性鼻呼吸。大多数儿童（79.2%）表现为轻度或中度临床鼻部阻塞。腺样体肥大从无阻塞（18%）到严重阻塞（38%）不等。在整个人群和所有临床亚组中，NOI 与腺样体阻塞程度之间没有实质性一致。在过敏儿童（50%）中，假阳性发现明显比非过敏儿童（22.4%）更常见（P = 0.009）。
基于 NOI 的临床评估无法准确预测腺样体阻塞的程度。对于无法用腺样体大小解释的临床鼻部阻塞儿童，临床医生应考虑鼻过敏等更靠前的阻塞原因。
