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Adenoidal imaging sitting or supine?
International Congress Series 1240 (2003) 1433 – 1435
Adenoidal imaging sitting or supine? K.S. Mangat a, S.V. Chavda a,*, A.L. Pahor b b
a Department of Radiology, City Hospital, Dudley Road, Birmingham, UK Department of Otorhinolaryngology, City Hospital, Dudley Road, Birmingham, UK
Abstract Assessment of adenoidal size pre-operatively remains controversial but includes clinical examination, endoscopic and radiological assessment. The radiology utilized is a lateral soft tissue plain radiograph of the postnasal space (PRPNS). The guidelines used to obtain these have been documented in most radiology textbooks. There is however no definitive protocol as to whether the patient should be standing, sitting or supine. The aim of the present study was to assess any significant change in the size of adenoids with change in position, which may alter the measurement of adenoidal hypertrophy, and hence affect the decision for operative intervention. After appropriate consent PRPNS were obtained in supine and sitting position in patients referred to the radiology department for assessment of adenoidal hypertrophy. Over a year this study prospectively studied a total of 18 children aged 5 – 9 years. Our findings confirm the disparity between supine and sitting measurements of adenoidal encroachment on the postnasal space, with the latter underestimating such encroachment. We recommend that assessment of symptomatic adenoidal hypertrophy with plain X-rays be undertaken in the supine position, as this gives a more accurate reflection of the presenting pathophysiology. D 2003 International Federation of Otorhinolaryngological Societies (IFOS). All rights reserved. Keywords: Adenoids; Radiograph; Postnasal space
1. Introduction Assessment of the degree of adenoidal hypertrophy is difficult. Methods include clinical assessment of mouth breathing and hypo nasality [1], endoscopic and radiological. Abbreviations: Plain Radiograph of the Postnasal space, PRPNS. * Corresponding author. Tel.: +44-121-554-3801x5707; fax: +44-121-523-5041. E-mail address: [email protected] (S.V. Chavda). 0531-5131/ D 2003 International Federation of Otorhinolaryngological Societies (IFOS). All rights reserved. doi:10.1016/S0531-5131(03)00799-4
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K.S. Mangat et al. / International Congress Series 1240 (2003) 1433–1435
Fig. 1. Fujioka method of A/N ratio measurement. Line b running along the anterior surface of the basiocciput. Line A runs perpendicularly from a point on line b to the point of maximum adenoid convexity. Line N runs from the posterior aspect of the hard palate to the spheno-basiocciput synchondrosis.
The main radiological method is a lateral plain radiograph of the post-nasal space (PRPNS). The question we wanted to answer was to the presence of any significant difference in the measurement of adenoidal size dependent upon the position of the patient.
2. Material and methods/patients Eighteen patients were referred for a PRPNS over the course of a year. They were aged 5– 9 years of age (mean 7 years). The PRPNS were taken in the supine and sitting position. The degree of adenoidal hypertrophy was compared in the two positions. The method of assessment was the FUJIOKA method (Fig. 1) [2]. The adenoid (A) to nasal (N) ratios were documented in both positions and comparison made. Table 1 A and N values in centimeters, with A/N ratios in both positions Patient
N (cm)
A erect
A supine
A/N erect
A/N supine
1 2 3 4 5 6 7 8 9 10 11 Mean
3.5 3.5 2.5 3.5 3.0 3.5 3.5 3.1 3.4 3.0 2.8 3.2
2.3 2.0 1.2 2.0 2.2 1.8 3.0 2.2 1.5 2.0 2.0 2.0
3.1 2.5 1.4 2.5 2.5 2.0 3.0 2.4 1.7 1.7 2.0 2.6
0.66 0.57 0.48 0.57 0.73 0.51 0.86 0.71 0.44 0.67 0.71 0.62
0.89 0.71 0.56 0.71 0.83 0.57 0.86 0.77 0.50 0.57 0.71 0.69
K.S. Mangat et al. / International Congress Series 1240 (2003) 1433–1435
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3. Results 18 patients radiographed, 7 excluded due to technical inadequacy, remaining 11 patients’ radiographs analyzed: mean age, 7 years. N and A values quoted in centimeters, and A/N ratios for both erect and supine positions are presented in Table 1. N value remained constant for individual patients on both supine and erect views. A value
A/N mean
supine > erect 8 (73%) supine = erect 2 (18%) erect > supine 1 (9%) Supine 0.69 Erect 0.62
4. Discussion In 73% of patients in this study the adenoidal size would be underestimated if erect views were obtained. Only in one patient of eleven the adenoidal size was found to be greater in the erect position. Patients with symptoms from adenoidal hypertrophy mainly have symptoms whilst supine in bed. Thus in our opinion a PRPNS should be taken in the supine position as this is more likely to reflect an accurate situation as opposed to the erect position which is likely to significantly underestimate the degree of adenoidal hypertrophy.
References [1] J. Paradise, B. Bernard, K. Colborn, J. Janosky, Assessment of adenoidal obstruction: clinical signs versus roentgenographic findings, Paediatrics 101 (6) (1998) 979 – 986. [2] M. Fujioka, L. Young, B. Girdany, Radiographic evaluation of adenoidal size in children: adenoidal-nasopharyngeal ratio, American Journal of Radiology 133 (1979) 401 – 404.
Adenoidal imaging sitting or supine? K.S. Mangat a, S.V. Chavda a,*, A.L. Pahor b b
a Department of Radiology, City Hospital, Dudley Road, Birmingham, UK Department of Otorhinolaryngology, City Hospital, Dudley Road, Birmingham, UK
Abstract Assessment of adenoidal size pre-operatively remains controversial but includes clinical examination, endoscopic and radiological assessment. The radiology utilized is a lateral soft tissue plain radiograph of the postnasal space (PRPNS). The guidelines used to obtain these have been documented in most radiology textbooks. There is however no definitive protocol as to whether the patient should be standing, sitting or supine. The aim of the present study was to assess any significant change in the size of adenoids with change in position, which may alter the measurement of adenoidal hypertrophy, and hence affect the decision for operative intervention. After appropriate consent PRPNS were obtained in supine and sitting position in patients referred to the radiology department for assessment of adenoidal hypertrophy. Over a year this study prospectively studied a total of 18 children aged 5 – 9 years. Our findings confirm the disparity between supine and sitting measurements of adenoidal encroachment on the postnasal space, with the latter underestimating such encroachment. We recommend that assessment of symptomatic adenoidal hypertrophy with plain X-rays be undertaken in the supine position, as this gives a more accurate reflection of the presenting pathophysiology. D 2003 International Federation of Otorhinolaryngological Societies (IFOS). All rights reserved. Keywords: Adenoids; Radiograph; Postnasal space
1. Introduction Assessment of the degree of adenoidal hypertrophy is difficult. Methods include clinical assessment of mouth breathing and hypo nasality [1], endoscopic and radiological. Abbreviations: Plain Radiograph of the Postnasal space, PRPNS. * Corresponding author. Tel.: +44-121-554-3801x5707; fax: +44-121-523-5041. E-mail address: [email protected] (S.V. Chavda). 0531-5131/ D 2003 International Federation of Otorhinolaryngological Societies (IFOS). All rights reserved. doi:10.1016/S0531-5131(03)00799-4
1434
K.S. Mangat et al. / International Congress Series 1240 (2003) 1433–1435
Fig. 1. Fujioka method of A/N ratio measurement. Line b running along the anterior surface of the basiocciput. Line A runs perpendicularly from a point on line b to the point of maximum adenoid convexity. Line N runs from the posterior aspect of the hard palate to the spheno-basiocciput synchondrosis.
The main radiological method is a lateral plain radiograph of the post-nasal space (PRPNS). The question we wanted to answer was to the presence of any significant difference in the measurement of adenoidal size dependent upon the position of the patient.
2. Material and methods/patients Eighteen patients were referred for a PRPNS over the course of a year. They were aged 5– 9 years of age (mean 7 years). The PRPNS were taken in the supine and sitting position. The degree of adenoidal hypertrophy was compared in the two positions. The method of assessment was the FUJIOKA method (Fig. 1) [2]. The adenoid (A) to nasal (N) ratios were documented in both positions and comparison made. Table 1 A and N values in centimeters, with A/N ratios in both positions Patient
N (cm)
A erect
A supine
A/N erect
A/N supine
1 2 3 4 5 6 7 8 9 10 11 Mean
3.5 3.5 2.5 3.5 3.0 3.5 3.5 3.1 3.4 3.0 2.8 3.2
2.3 2.0 1.2 2.0 2.2 1.8 3.0 2.2 1.5 2.0 2.0 2.0
3.1 2.5 1.4 2.5 2.5 2.0 3.0 2.4 1.7 1.7 2.0 2.6
0.66 0.57 0.48 0.57 0.73 0.51 0.86 0.71 0.44 0.67 0.71 0.62
0.89 0.71 0.56 0.71 0.83 0.57 0.86 0.77 0.50 0.57 0.71 0.69
K.S. Mangat et al. / International Congress Series 1240 (2003) 1433–1435
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3. Results 18 patients radiographed, 7 excluded due to technical inadequacy, remaining 11 patients’ radiographs analyzed: mean age, 7 years. N and A values quoted in centimeters, and A/N ratios for both erect and supine positions are presented in Table 1. N value remained constant for individual patients on both supine and erect views. A value
A/N mean
supine > erect 8 (73%) supine = erect 2 (18%) erect > supine 1 (9%) Supine 0.69 Erect 0.62
4. Discussion In 73% of patients in this study the adenoidal size would be underestimated if erect views were obtained. Only in one patient of eleven the adenoidal size was found to be greater in the erect position. Patients with symptoms from adenoidal hypertrophy mainly have symptoms whilst supine in bed. Thus in our opinion a PRPNS should be taken in the supine position as this is more likely to reflect an accurate situation as opposed to the erect position which is likely to significantly underestimate the degree of adenoidal hypertrophy.
References [1] J. Paradise, B. Bernard, K. Colborn, J. Janosky, Assessment of adenoidal obstruction: clinical signs versus roentgenographic findings, Paediatrics 101 (6) (1998) 979 – 986. [2] M. Fujioka, L. Young, B. Girdany, Radiographic evaluation of adenoidal size in children: adenoidal-nasopharyngeal ratio, American Journal of Radiology 133 (1979) 401 – 404.