基于鼻减充血试验后鼻声反射测量的儿童腺样体肥大和阻塞分级评估。
The evaluation of adenoid hypertrophy and obstruction grading based on rhinomanometry after nasal decongestant test in children.
机构信息
Department of Pediatrics, Allergology and Immunology Division, Sapienza University, Rome, Italy.
出版信息
Eur Rev Med Pharmacol Sci. 2013 Nov;17(21):2962-7.
OBJECTIVES
Adenoid hypertrophy (AH) is a very common problem in children. Nasal Fiberoptic Endoscopy (NFE) represents the gold standard method to diagnose AH. Rhinomanometry represents a valid diagnostic support. The aim of our study was to analyze the grade of nasal obstruction caused by AH, in a group of children, with rhinomanometry standard and after ND test versus NFE.
PATIENTS AND METHODS
Two hundred and eighty-four of 300 collaborative children, diagnosed as chronic oral breathers, were enrolled. All children underwent a complete physical examination, anterior active rhinomanometry and a second rhinomanometry after the administration of the nasal decongestant (ND) xylometazoline. All children were evaluated using Nasal Fiberoptic Endoscopy (NFE).
RESULTS
At rhinomanometry nasal obstrucion was found of grade 1 in 102 (35.9%) children, of grade 2 in 41 (14.4%), of grade 3 in 52 (18.3%), of grade 4 in 37 (13%) and of grade 5 in 52 (18.3%). Those patients were tested also with rhinomanometry after ND: grade 1 in 108 (38%) children, grade 2 in 52 (18.3%), grade 3 in 56 (19.7%), grade 4 in 23 (8.1%) and grade 5 in 45 (15.8%). At NFE: 83 (29.2%) patients presented a grade 0, 73 (28.7%) a grade 1, 51 (17.9%), 34 (11.9%) a grade 3 and 43 (15.1%) a grade 4. Comparing the grade of nasal obstruction in NFE and in RM after ND we found a great correlation for grade 1 and grade 5 (respectively 84.3% and 79,1%, p < 0.001) and low correlation for the others grades of obstruction. When compared to NFE, rhinomanometry test after ND had 81.1% sensitivity and 84.3% specificity. Operating Characteristic (ROC) curves were derived using data related to rhinomanometry vs NFE, and to Rhinomanometry after ND vs NFE.
CONCLUSIONS
Rhinomanometry after ND, compared to rmhinomanometry, is more specific and useful to evaluate nasal obstruction due to AH in children. RM after ND is a great tool to assess the severity of nasal obstruction. In fact, the minimum and maximum degrees of obstruction to the RM after ND correlate significantly (p < 0.01) with those of NFE.
目的
腺样体肥大（AH）是儿童中非常常见的问题。鼻纤维内镜检查（NFE）是诊断 AH 的金标准方法。鼻阻力测量是一种有效的诊断支持。我们的研究目的是通过鼻阻力测量标准和 ND 试验后与 NFE 比较，分析一组儿童因 AH 引起的鼻腔阻塞程度。
患者和方法
对 300 名协作儿童中的 284 名慢性口腔呼吸者进行了研究。所有儿童均接受了全面的体格检查、前鼻主动鼻阻力测量和鼻腔减充血剂（ND）盐酸羟甲唑啉给药后的第二次鼻阻力测量。所有儿童均接受鼻纤维内镜检查（NFE）评估。
结果
鼻阻力测量发现，102 例（35.9%）儿童为 1 级阻塞，41 例（14.4%）为 2 级阻塞，52 例（18.3%）为 3 级阻塞，37 例（13%）为 4 级阻塞，52 例（18.3%）为 5 级阻塞。这些患者还接受了 ND 后鼻阻力测量：108 例（38%）为 1 级，52 例（18.3%）为 2 级，56 例（19.7%）为 3 级，23 例（8.1%）为 4 级，45 例（15.8%）为 5 级。在 NFE 中：83 例（29.2%）患者为 0 级，73 例（28.7%）为 1 级，51 例（17.9%）为 3 级，34 例（11.9%）为 4 级，43 例（15.1%）为 4 级。比较 NFE 和 ND 后 RM 中的鼻腔阻塞程度，我们发现 1 级和 5 级具有很大的相关性（分别为 84.3%和 79.1%，p<0.001），而其他阻塞程度的相关性较低。与 NFE 相比，ND 后鼻阻力测量的敏感性为 81.1%，特异性为 84.3%。使用与鼻阻力测量与 NFE 相关的数据以及与 ND 后鼻阻力测量与 NFE 相关的数据，得出了工作特征（ROC）曲线。
结论
与鼻阻力测量相比，ND 后鼻阻力测量对评估儿童因 AH 引起的鼻腔阻塞更为特异和有用。ND 后 RM 是评估鼻腔阻塞严重程度的重要工具。事实上，ND 后最小和最大程度的鼻腔阻塞与 NFE 显著相关（p<0.01）。
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