Moideen Sanu P, Mytheenkunju Regina, Govindan Nair Arun, Mogarnad Mohan, Afroze M Khizer Hussain
1Department of Pediatric ENT, Christian Medical College & Hospital, Vellore, Tamilnadu 632004 India.
2Department of Pediatrics, Academy of Medical Sciences, Pariyaram, Kannur, Kerala India.
Indian J Otolaryngol Head Neck Surg. 2019 Oct;71(Suppl 1):469-473. doi: 10.1007/s12070-018-1359-7. Epub 2018 Apr 24.
Most of the time, pediatrician is the first to see children with adenotonsillar hypertrophy (AH) and they mostly rely on clinical assessment with or without some investigation to refer these children to otorhinolaryngologist. Numerous methods have been described for evaluation of AH, but many of these methods are not possible to follow in busy pediatric outpatient unit either because of lack of cooperation from child or due to limited availability of test or due to cost constraints. This study has been conducted to determine the diagnostic accuracy of lateral neck X-ray (LNX) for assessing AH and to assess the correlation between adenoid size in LNX and clinical symptoms in a pediatric unit. Prospective study conducted in Department of ENT, Pathmavathy Medical Foundation, Kollam, Kerala, India from January 2015 to March 2016. 60 consecutive children of both genders, between the age group of 5 to 14 years, attending Department of Pediatrics with a provisional diagnosis of AH were included in the study. The symptom scores, radiographic ratio of adenoid to nasopharynx and endoscopic scorings were calculated. Lateral neck X-ray with calculation of adenoid-to-nasopharynx ratio is found to have significant correlation with patient reported symptoms and findings in nasal endoscopic examination (NE). LNX can be considered as a useful objective tool in evaluation of children with adenoid hypertrophy. Primary care physicians or pediatricians can confidently use lateral neck X-ray for making clinical decisions and can consider nasopharyngoscopy when clinical picture remains unclear or more evaluation is needed.
大多数情况下，儿科医生是最先诊治腺样体扁桃体肥大（AH）患儿的，他们大多依靠临床评估，无论有无相关检查，将这些患儿转诊给耳鼻喉科医生。已经描述了许多评估AH的方法，但由于患儿不配合、检查设备有限或成本限制等原因，在繁忙的儿科门诊很难采用其中的许多方法。本研究旨在确定颈部侧位X线片（LNX）评估AH的诊断准确性，并评估儿科病房中LNX所示腺样体大小与临床症状之间的相关性。2015年1月至2016年3月在印度喀拉拉邦科拉姆的帕特马瓦蒂医学基金会耳鼻喉科进行了一项前瞻性研究。研究纳入了60名年龄在5至14岁之间、因初步诊断为AH而就诊于儿科的连续患儿，男女不限。计算了症状评分、腺样体与鼻咽部的影像学比例以及内镜评分。发现计算腺样体与鼻咽部比例的颈部侧位X线片与患者报告的症状以及鼻内镜检查（NE）结果具有显著相关性。LNX可被视为评估腺样体肥大患儿的一种有用的客观工具。基层医疗医生或儿科医生可以放心地使用颈部侧位X线片来做出临床决策，当临床表现不明确或需要进一步评估时，可以考虑进行鼻咽镜检查。
