Proposed Definitive Grading System Tool for the Assessment of Adenoid Hyperplasia

Department of Surgery, Division of Pediatric Otolaryngology-Head and Neck Surgery, Nemours Children's Clinic, Jacksonville, Florida, USA.
The Laryngoscope (Impact Factor: 2.14). 01/2011; 121(1):187-93. DOI: 10.1002/lary.21215
Source: PubMed


To propose a definitive standard grading scale in the assessment of adenoid tissue in relation to size, position, and proximity to surrounding anatomic structures. This will allow for better clinical communications among practitioners when treating this pathology, a better understanding of its relationship and how it effects neighboring structures (eustachian tube and choanae), and allow for a more precise description of this tissue for the purpose of research data collection and analysis.
A prospective evaluation of adenoid tissue during adenoidectomy was obtained documenting its size and descriptive relationship to adjacent structures (eustachian tube and choanae).
A convenience sample of 150 children undergoing adenoidectomy alone or concurrently with tonsillectomy and/or myringotomy and tubes were prospectively evaluated. Mirror nasopharyngeal exam was performed in all cases. Size of the adenoid, as well as its relationship to the choanae and eustachian tube were recorded. A descriptive grading system tool was created accounting for these relationships. Statistical analysis was performed to offer a preliminary validation of the tool.
Adenoid grading scores were assigned to 150 pediatric patients, 74 males and 76 females, who underwent surgery for adenoidectomy with or without tonsillectomy and/or myringotomy and tube placement. Seven patients were found to have no adenoid tissue in the nasopharynx as they had previous adenoidectomy and received a grade of 0A-. The mean age was 5.71 years (range, 1-17 years). Of the 150 scores, 107 patients had an associated diagnosis of chronic hypertrophic adenoids and/or tonsils (CHAT) accounting for 71.3% of the sample. There was a significant increasing trend of CHAT with an increasing size and increasing blocking of the choanae. However, there is no relationship of this morbidity with blocking of the eustachian tube (ET). There is a strong inverse relationship between blocking of the choanae and chronic and recurrent adenotonsillitis. The percentage of patients with this morbidity significantly decreases with increasing blocking of the choanae. A total of nine patients with chronic sinusitis were found to have no relationship between size, blocking of the choanae, and abutting of the eustachian tube. Eustachian tube dysfunction (ETD) was significantly related to blocking of the eustachian tube (ET) in this study, as 54.3% experienced ETD in the presence of blocked ET compared to only 15% in the absence of a blocked ET. Among the components of the adenoid score, the diagnosis given preoperatively, and the surgical treatments performed, there were strong correlations found giving merit to the descriptive nature of this grading tool proposed.
This grading system is simple, reliable, and easily used. It offers standardization for clinicians and researchers in facilitating communications, and allowing interpretation of adenoid tissue observed with its relationship to and effect on adjacent anatomic structures. This will allow more detailed information of findings during adenoid surgery to assist in future clinical research studies and outcomes analysis.

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    • "In this study, flexible nasal endoscopy correlated highly with the standard intraoperative nasopharyngoscopy (Lertsburapa et al., 2010). Various methods for grading adenoid hypertrophy have been reported in the literature (Cassano et al., 2003; Josephson et al., 2011). The classification proposed by Parikh et al. (2006) is effective for evaluating the degree of obstruction of adenoid tissue over the posterior choanae in the nasopharynx: grade 1 for adenoid tissue not in contact with adjacent structures; grade 2 for adenoid tissue in contact with the torus tubarius; grade 3 for adenoid tissue in contact with the vomer; and grade 4 for adenoid tissue in contact with the soft palate (at rest; Parikh et al., 2006). "
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    • "Pharyngeal and laryngeal abnormalities can be classified based on the level of mucosal alteration (personal communication Dr. A. Keilmann). Grading systems based on adenoid hypertrophy and obstruction of the choanal opening and tubal ostium exist to evaluate nasal cavity obstruction (Cassano et al 2003; Josephson et al 2011; Parikh et al 2006). "
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