Adenoids assessment using nasopharyngolaryngoscopy: A method validation

Abstract

Introduction. Adenoid hyperplasia is a frequent pediatric pathology that accounts for a large percentage of surgical ORL procedures. However, the methods for adenoid evaluation and surgical indication in cases of adenoid hyperplasia available today are subjective and greatly variable across examiners. Recently, a new, partially validated classification has been proposed abroad, but a local evaluation is lacking. Aim. To validate a classification system for adenoid hyperplasia by a trans-nasal flexible endoscopic study. Material and Method. Nasopharyngolaryngoscopy recordings of 50 patients were analyzed by a group of 10 examiners (5 training residents and 5 otorhinolaryngologists), who classified the images according to the proposed methodology. The degree of agreement among examiners was analyzed by intra-class correlation. Results. The proposed method would be completely reliable and valid if implemented by otorhinolaryngologists with at least 5 years of experience (intra-class correlation coefficient interval between 0.61 and 0.80; 95% confidence level, representing a significant agreement among examiners). It has only moderate validity when implemented by training residents, and the results of such an evaluation are not recommended as the sole parameter when deciding a surgical treatment. Conclusion. The proposed adenoid hyperplasia scale seems to be valid and objective only in the hands of experimented operators. Its results are yet to be correlated with upper airway respiratory pathology and surgical indication, and with the usefulness of implementing a directed training program in order to improve its results as a diagnostic tool.