X-Rays in the evaluation of adenoid hypertrophy: It's role in the endoscopic era

  • Mary Kurien
  • Anjali Lepcha
  • John Mathew
  • Arif Ali
  • L. Jeyaseelan
Main Article



To evaluate the reliability of X-rays in the diagnosis of adenoid hypertrophy and to validate this with flexible nasopharyngoscopy which is the existing gold standard.


Lateral radiograph of the neck and a flexible nasopharyngeal endoscopy was done to evaluate adenoid enlargement in children aged 3–12 years who were included in a S week randomized double-blind placebo controlled study for the effect of beclomethasone in adenoid hypertrophy. These were graded independently by both the co-investigor and investigator X-ray and nasal endoscopy for reevaluation of adenoid size was done at the completion of the study. Variables of both the procedures were scored at the beginning and end of the study. The agreement between the two groups was assessed using weighted kappa statistic.


There were 26 patients in the study, 17 of them had complete correlation between the X-ray and endoscopy findings. The agreement between these findings was statistically significant (p<01) with the weighted kappa 0.51.


This study shows that lateral X-rays of the neck, besides being a noninvasive procedure, still remains a very reliable and valid diagnostic test in the evaluation of hypertrophied adenoids.

Key Words

Lateral neck radiograph flexible nasopharyngoscopy reliability validity 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Cowan DL, Hibbert J. Tonsils and adenoids.In Scott Browns Pediatric Otolaryngology (Vol 6) 6th edn Editors Kerr AG, Adams DA, Cinnamond MJ Butterworth Heinemann Oxford, 1997, p.4–8.Google Scholar
  2. 2.
    Bershop JE, Sweeney JP, Jafek BW. The Tonsil and adenoids, Diagnostic Imaging of Waldeyer's ringIn Otolaryngologic Clinics of North America AD Kornblut (Editor) WB Saunders Philadelphia: 1987, p.229–34Google Scholar
  3. 3.
    Hibbert J, Whitehouse GM. The assessment of adenoid size by radiological means. Clin Otolaryngol 1978:3:43–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Fujioka M, Young LW, Girdony BR. Radiological evaluation of adenoid size in children: adenoid to nasopharyngeal ratio. Am J Roentgenol 1979:133:401–4.Google Scholar
  5. 5.
    Jeans WD, Fernando DC, Maw AR. How should adenoid enlargement be measured? A radiological study based on inter-observer agreement. Clin Radiol 1981:32:337–40.PubMedCrossRefGoogle Scholar
  6. 6.
    Crof CB, Thomson HG, Samuels MR, Southall DP. Endoscopic evaluation and treatment of sleep associated upper airway obstruction in infants and young children. Clin Otolaryngol 1990:15:209–16.CrossRefGoogle Scholar
  7. 7.
    Wang DY, Clement P, Kauffman L, Derde MP. Fibioptic evaluation of nasal cavity and nasopharynx in children. Int J Pediatr Otolaryngol 1992:24:35–44.CrossRefGoogle Scholar
  8. 8.
    Wang DY, Berheim N, Kauffman L, Clement P, Derde MP. Fibroptic evaluation of the nasal and nasopharyngeal anatomy in children with snoring. J Otol Laryngol 1994:23:57–60Google Scholar
  9. 9.
    Cohen J. Acoefficient of agreement for nominal scales. Educ Psychol Measure 1960:20:37–47CrossRefGoogle Scholar
  10. 10.
    Goldman RL. The kappa statistic. JAMA 1992:11:2513–4Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Mary Kurien
    • 2
  • Anjali Lepcha
    • 2
  • John Mathew
    • 2
  • Arif Ali
    • 2
  • L. Jeyaseelan
    • 1
  1. 1.Department of Biostatistics & Clinical EpidemiologyChristian Medical College and HospitalVelloreIndia
  2. 2.Dept. of ENT Speech & HearingChristian Medical College & HospitalVelloreIndia

Personalised recommendations