- Paradise JL,
- Bernard BS,
- Colborn DK,
- Janosky JE
Purpose of the Study
To investigate the reliability and correlation of standardized clinical assessments and x-ray assessments of adenoidal obstruction.
Children were studied as part of a comprehensive, prospective study of the indications for tonsillectomy and adenoidectomy that was carried out at the Children's Hospital of Pittsburgh between 1971 and 1991.
The patient's degree of mouth breathing and speech hyponasality were rated on a 4-point scale and scores were averaged to obtain an overall Nasal Obstruction Index. Lateral x-rays of the nasopharynx were also performed and the adenoid size and degree of nasopharyngeal obstruction were rated. Correlations between clinical assessments and roentgenographic findings were then calculated, as were predictive values for the clinical ratings using the roentgenographic ratings as the gold standard.
An assessment of intraobserver agreement with regard to the clinical and x-ray assessments revealed overall excellent agreement between observers. The concordance between the Nasal Obstruction Index and the roentogenographic ratings in a sample of 1033 children revealed a value of 0.51. It was found the concordance was best at the lower and upper extremes of the Nasal Obstruction Index.
Standardized clinical ratings of the degree of mouth breathing and speech hyponasality provide reliable and reasonably valid assessments of the presence and degree of adenoidal obstruction of the nasopharyngeal airway. These clinical assessments are particularly valid at the extremes of either marked obstruction or no obstruction.
This is an extremely practical study of a common clinical question. Pediatricians are frequently asked to guess about the importance of adenoid hypertrophy in the assessment of a child's nasal symptoms or recurrent infections and this study helps to guide us in those decisions. As most experienced pediatricians already knew, the two most useful markers of adenoidal obstruction are mouth breathing and the quality of the voice. Dr Paradise and company strike again with another outstanding study in pediatric ear, nose, and throat disease.