Correlation Between Radiological and Endoscopic Grading of Adenoid Hypertrophy in Children: A Prospective Observational Study

Background: Adenoid hypertrophy is a common cause of nasal obstruction in children. While clinical evaluation of palatine tonsils is straightforward, assessment of adenoid size is challenging due to its location in the nasopharynx15,16. Both radiological and endoscopic methods are commonly used, but their correlation remains debated. The objective is to evaluate the relationship between radiological grading (Adenoid–Nasopharyngeal Ratio) and endoscopic grading of adenoid hypertrophy in children. Material and Methods: This prospective observational study was conducted in the Department of ENT at Pushpagiri Institute of Medical Sciences, Thiruvalla, over a period of 1.5 years. A total of 66 children aged 4–14 years with symptoms of adenoid hypertrophy were included. All patients underwent lateral nasopharyngeal X-ray (graded using Fujioka method)25 and diagnostic nasal endoscopy (graded using Clemens classification)27. Correlation and agreement between the two methods were analyzed statistically. Results: The mean age was 7.14 ± 2.46 years, with male predominance (66.7%). The most common symptoms were snoring and mouth breathing (100%). The mean Adenoid–Nasopharyngeal Ratio (ANR) was 0.76 ± 0.10. Grade IV adenoids were most common in both radiological (57.6%) and endoscopic (57.6%) assessments. A strong positive correlation (r = 0.98, p < 0.01) was observed between ANR and endoscopic grading. Kappa agreement between the two methods was 85%. Conclusion: There is a strong correlation between radiological and endoscopic grading of adenoid hypertrophy. Lateral nasopharyngeal X-ray, being non-invasive and cost-effective, can serve as a reliable alternative in settings where endoscopy is not feasible.

Keywords: Adenoid hypertrophy, nasopharyngeal X-ray, nasal endoscopy, ANR, pediatric ENT.