Department of Radiology, Pamukkale University School of Medicine, Denizli, Turkey.
Department of Otolaryngology-Head and Neck Surgery, Pamukkale University School of Medicine, Denizli, Turkey.
J Ultrasound Med. 2021 Sep;40(9):1795-1801. doi: 10.1002/jum.15559. Epub 2020 Nov 17.
To develop a new method for the objective evaluation of airway obstruction due to tonsillar hypertrophy using ultrasound (US) in children.
The oropharynx was examined in patients, and tonsil grades were evaluated according to the staging system of Brodsky et al (Int J Pediatr Otorhinolaryngol 1987; 13:149-156). The narrowest intertonsillar distance (ITD) and widest transverse length of the tongue base (TLTB) were then measured by US, and their ratio was calculated. The clinical value of US was investigated for the classification of tonsillar hypertrophies as nonobstructive or obstructive by matching the patients' clinical grades with the US data.
A total of 102 patients (age range, 2-12 years) were included in the study. According to the Brodsky staging system, 44.1% and 55.9% of the patients were in nonobstructive (stages I and II) and obstructive (stages III and IV) tonsillar hypertrophy groups, respectively. The area under the curve was 0.991 (95% confidence interval, 0.977-0.999) according to a receiver operating characteristic curve analysis between the Brodsky staging and the ITD/TLTB ratio. The optimal cutoff value for the ITD/TLTB ratio for the diagnosis of obstructive tonsillar hypertrophy was found to be 0.3 or less, which had 96.5% sensitivity and 95.6% specificity.
The degree of airway obstruction due to tonsillar hypertrophy can be objectively determined by US in children. An ITD/TLTB ratio of 0.3 or less was found to be compatible with obstructive tonsillar hypertrophy. This new and easily applicable evaluation method may provide considerable value and guidance for tonsillectomy decisions.
利用超声（US）为儿童扁桃体肥大导致的气道阻塞提供一种新的客观评估方法。
在患者的口咽部进行检查，并根据 Brodsky 等人的分期系统（Int J Pediatr Otorhinolaryngol 1987；13：149-156）评估扁桃体分级。然后通过 US 测量扁桃体间最窄距离（ITD）和舌基最宽横径（TLTB），并计算其比值。通过将患者的临床分级与 US 数据相匹配，研究 US 对扁桃体肥大非阻塞性或阻塞性分类的临床价值。
共有 102 例患者（年龄 2-12 岁）纳入本研究。根据 Brodsky 分期系统，44.1%和 55.9%的患者分别为非阻塞性（I 期和 II 期）和阻塞性（III 期和 IV 期）扁桃体肥大组。受试者工作特征曲线分析显示，Brodsky 分期与 ITD/TLTB 比值之间的曲线下面积为 0.991（95%置信区间，0.977-0.999）。ITD/TLTB 比值诊断阻塞性扁桃体肥大的最佳截断值为 0.3 或更小，其具有 96.5%的敏感性和 95.6%的特异性。
US 可客观确定儿童扁桃体肥大导致的气道阻塞程度。ITD/TLTB 比值小于等于 0.3 与阻塞性扁桃体肥大相符。这种新的易于应用的评估方法可能为扁桃体切除术决策提供重要的参考价值。
