Narang Ved P, Loroch Anna, Sambiagio Giovanni
Otolaryngology - Head and Neck Surgery, University Hospital Monklands, Airdrie, GBR.
Ear Nose and Throat (ENT), NHS Greater Glasgow and Clyde (GGC), Glasgow, GBR.
Cureus. 2022 Feb 27;14(2):e22656. doi: 10.7759/cureus.22656. eCollection 2022 Feb.
Purpose This retrospective study looked at the feasibility of using adult 4.0 mm flexible nasendoscopes (FNE) examination under local anesthetic (LA) in children three to 10 years old to diagnose adenoid hypertrophy (AH) and other conditions. We also looked for a correlation between the adenoid size on FNE and a) tonsil size, b) the typical symptoms of snoring, mouth breathing, impaired hearing, and apnoeic episodes c) the management options of otitis media with effusion (OME) and d) the adenoid size intraoperatively. Methods A retrospective, observational study of 118 children in an NHS pediatric otolaryngology clinic led by a single consultant. One hundred ten consecutive patients with suspected AH were divided into two groups of three to five years and six to 10 years. We compared the acceptance rate to FNE in two subgroups (three to five years and six to 10 years old) and examined the correlation between various parameters as outlined above, using the Chi-square test. Eight children underwent FNE for other reasons of change of voice and epistaxis. Results FNE was successfully performed in 86% of the patients without restraint. Thirty-three percent of patients had non-obstructive adenoids (OA) and did not require surgical intervention. The intraoperative adenoid size, symptoms of snoring, mouth-breathing, and apnoeic episodes positively correlated with OA; however, no correlation was seen with the tonsil size (p=0.1143). All patients with OA and type B tympanogram needed adenoidectomy and grommet insertion (p=0.0119), and those with type C curves recovered with adenoidectomy alone. Conclusions 4.0 mm adult scope helped reach a definitive diagnosis for AH in most children above three years of age, thus proving cost-effective. The symptoms of snoring, mouth-breathing, and apnoeic episodes had a positive correlation to the presence of OA; however, the tonsil size was seen to be independent of adenoid size. Primary surgical management can be considered the treatment of choice for all patients with OA and type B tympanogram without a trial of conservative therapy.
目的 本回顾性研究探讨了在局部麻醉下使用成人4.0毫米软性鼻内镜（FNE）对3至10岁儿童进行检查以诊断腺样体肥大（AH）及其他病症的可行性。我们还研究了FNE检查时腺样体大小与以下因素之间的相关性：a）扁桃体大小；b）打鼾、张口呼吸、听力受损及呼吸暂停发作等典型症状；c）分泌性中耳炎（OME）的治疗选择；d）术中腺样体大小。方法 对一家由单一顾问主导的NHS儿科耳鼻喉科诊所的118名儿童进行回顾性观察研究。110例疑似AH的连续患者被分为3至5岁和6至10岁两组。我们比较了两个亚组（3至5岁和6至10岁）对FNE检查的接受率，并使用卡方检验研究上述各项参数之间的相关性。另外8名儿童因声音改变和鼻出血等其他原因接受了FNE检查。结果 86%的患者在无约束情况下成功完成了FNE检查。33%的患者腺样体无阻塞（OA），无需手术干预。术中腺样体大小、打鼾、张口呼吸及呼吸暂停发作症状与OA呈正相关；然而，与扁桃体大小无相关性（p = 0.1143）。所有OA且鼓室图为B型的患者均需要行腺样体切除术及鼓膜置管术（p = 0.0119），而鼓室图为C型曲线的患者仅行腺样体切除术即可康复。结论 4.0毫米成人鼻内镜有助于对大多数3岁以上儿童的AH做出明确诊断，因此证明具有成本效益。打鼾、张口呼吸及呼吸暂停发作症状与OA的存在呈正相关；然而，扁桃体大小与腺样体大小无关。对于所有OA且鼓室图为B型的患者，可不进行保守治疗试验，直接考虑将手术作为主要治疗选择。
