Correlation between Adenoidal–nasopharyngeal Ratio and Otitis Media with Effusion: A Cross-sectional Study
Naveen Sharma, Surender Kumar, Deepak Verma, Uma Garg, M Hareesh
Adenoid hypertrophy, Adenoidal–nasopharyngeal ratio, Otitis media with effusion, Tympanogram, X-ray nasopharynx
Citation Information :
Sharma N, Kumar S, Verma D, Garg U, Hareesh M. Correlation between Adenoidal–nasopharyngeal Ratio and Otitis Media with Effusion: A Cross-sectional Study. Int J Otorhinolaryngol Clin 2023; 15 (1):9-13.
Background: Adenoid hypertrophy is one of the most common health problems affecting the pediatric population. This study aims to correlate the adenoidal–nasopharyngeal ratio (ANR) with otitis media with effusion (OME). If OME is left undiagnosed it can lead to long-term consequences like hearing impairment, learning and speech disabilities, and even chronic otitis media in children. The current study was a cross-sectional study conducted at a tertiary care center in Haryana, India. ANR was determined by dividing adenoidal depth with nasopharyngeal depth on the plain lateral radiographs and OME was diagnosed by tympanometry.
Results: The study consists of 70 children in the age group of 3–12 years with symptoms of adenoid hypertrophy. The children were almost similar in number in the three age groups we had selected with male preponderance. Otoscopy and tympanogram results were matching in our study. Types B and C tympanograms indicate middle-ear effusion seen in either one ear or both. In our study, type-A curves (non-diseased) were well correlated with low ANR, and types B and C curves (diseased) were well correlated with high ANR.
Conclusion: Adenoidal–nasopharyngeal ratio obtained from the X-ray will give an arithmetic measurement of adenoid mass with respect to available nasopharyngeal space. The simple outpatient tympanometry provides objective evidence of OME. The present study proved the positive correlation between ANR and OME by correlating ANR with tympanogram findings.
Hamza SB, Ranjith VT. Radiographic evaluation of adenoidal size in children having otitis media with effusion. J Med Sci Clin Res 2019;7(2):208–210. DOI: 10.18535/jmscr/v7i2.39.
Sarwar SM, Rahman M, Ali MI, et al. Correlation of enlarged adenoids with conductive hearing impairment in children under twelve. Bangla J otorhinolaryngol 2015;21(2):62–68. DOI: 10.3329/bjo.v21i2.27641.
Aman, Singh J, Goel A, et al. Changes in auditory steady-state response and tympanometry post adenotonsillectomy in otitis media with effusion. J Otolaryngol Rhinol 2019;5(2):059. DOI: 10.23937/2572-4193.1510059.
Fujioka M, Young LW, Girdany BR. Radiographic evaluation of adenoidal size in children: Adenoidal–nasopharyngeal ratio. Am J Roentgenol 1979;133(3):401–404. DOI: 10.2214/ajr.133.3.401.
Baldassari CM, Choi S. Assessing adenoid hypertrophy in children: X-ray or nasal endoscopy? Laryngoscope 2014;124(7):1509–1510. DOI: 10.1002/lary.24366.
Nwosu C, Ibekwe MU, Onotai LO. Tympanometric findings among children with adenoid hypertrophy in Port Harcourt, Nigeria. Int J Otolaryngol 2016;2016:1276543. DOI: 10.1155/2016/1276543.
Vijayan A, Ramakrishnan VR, Manjuran TJ. Relationship between adenotonsillar hypertrophy and otitis media with effusion. Int J Contemp Med Res 2018;5(2):B1–B5. PMID: 35282481.
Orji FT, Ezeanolue BC. Evaluation of adenoidal obstruction in children: Clinical symptoms compared with roentgenographic assessment. J Laryngol Otol 2008;122(11):1201–1205. DOI: 10.1017/S0022215108001916.
Talebian S, Sharifzadeh G, Vakili I, et al. Comparison of adenoid size in lateral radiographic, pathologic, and endoscopic measurements. Electron physician 2018;10(6):6935–6941. DOI: 10.19082/6935.
Kumar A, Belaldavar BP, Havaldar RR. Correlative multicentric analysis of dimensions of nasopharynx and adenoid size, and its burden in otitis media with effusion: An Indian scenario. Indian J Otolaryngol Head Neck Surg 2022;74(Suppl. 1):153–159. DOI: 10.1007/s12070-020-01938-2.
Karma PH, Penttila MA, Sipila MM, et al. Otoscopic diagnosis of middle ear effusion in acute and non-acute otitis media. I. The value of different otoscopic findings. Intl J Pediatr Otorhinolaryngol 1989;17(1):37–49. DOI: 10.1016/0165-5876(89)90292-9.
Adedeji TO, Amusa YB, Aremu AA. Correlation between adenoidal nasopharyngeal ratio and symptoms of enlarged adenoids in children with adenoidal hypertrophy. Afr J Paediatr Surg. 2016;13(1):14–19. DOI: 10.4103/0189-6725.181701.
Egeli E, Oghan F, Ozturk O, et al. Measuring the correlation between adenoidal–nasopharyngeal ratio (AN ratio) and tympanogram in children. Int J Pediatr Otorhinolaryngol 2005;69(2):229–233. DOI: 10.1016/j.ijporl.2004.09.003.
Toros SZ, Kılıçoğlu G, Noşeri H, et al. Does adenoid hypertrophy really have effect on tympanometry? Int J Pediatr Otorhinolaryngol 2010;74(4):365–368. DOI: 10.1016/j.ijporl.2009.12.019.
Takahashi H, Honjo I, Fujita A, et al. Effects of adenoidectomy on sinusitis. Acta Otorhinolaryngol Belg 1997;51(2):85–87. PMID: 9241373.