Correlation between clinical and radiological findings in pediatric adenoid hypertrophy at the Kenyatta national hospital.

Abstract

INTRODUCTION / BACKGROUND Adenotonsillectomy is one of the commonest ENT procedures at KNH . It is done in children with ATH to resolve obstructive symptoms and prevent complications like cor pulmonale. Children with ATH commonly present with mouth breathing and other obstructive symptoms such as: difficulty in breathing, sleep apnea and snoring. The post nasal space radiograph is used for evaluation of these children, and various methods are used for its assessment. OBJECTIVE The aim of this dissertation was to investigate the clinical and radiological assessment in adenoid hypertrophy, correlate them and obtain a simple, reproducible and accurate method that can be used for objective radiograph interpretation. METHODOLOGY A total of 55 children were enrolled into the study. Clinical assessment in this study utilized the assessment of the aforementioned symptoms and radiological assessment was performed using the Fujioka and Cohen methods. Comparison of the clinical and radiological methods was performed using SPSS version 19. RESULTS All 55 children underwent clinical and radiological evaluation. The ratio of male to female was 2:1 (67% were male and 33% were female). Patient age or sex and clinical symptoms had no statistically significant association. Sleep apnea was present in 87.5%. Majority (47.3%) of the children had grade 2 difficulty in breathing, of these, 40% were equally likely to have grade 2 or grade 3 snoring. Majority (90.3%) of the children had moderate mouth breathing. A strong positive correlation existed between the Fujioka method and clinical assessment. The Fujioka method showed high sensitivity and specificity in mild, moderate and severe AH. A strong negative correlation existed between the Cohen method and the clinical assessment. The Cohen method demonstrated a high sensitivity and specificity in mild and moderate AH. However, in severe AH, the specificity was high (96.7%) but the sensitivity was more modest at (52 – 56%). CONCLUSION Our study demonstrated two simple radiological assessment methods that are reproducible in every clinical setting. The Fujioka method showed better accuracy than the Cohen method in the classification of moderate and severe AH. In keeping with Naushaba’s conclusion (1). The Cohen method on the other hand showed better specificity and NPV than the Fujioka method in the moderate and severe AH. Both methods were excellent for mild AH.