ASSESSMENT OF ADENOIDAL OBSTRUCTION IN CHILDREN - CLINICAL SIGNS VERSUS ROENTGENOGRAPHIC FINDINGS

Objective. As part of a comprehensive study of indications for tonsill ectomy and adenoidectomy, we investigated the reliability of standardi zed clinical assessments and standardized roentgenographic assessments of adenoidal obstruction of the nasopharynx, and the degree of correl ation between clinical assessments and roentgenographic assessments. M ethods. We rated the degree of patients' mouth breathing and patients' speech hyponasality on a 4-point scale (none = 1; mild = 2; moderate = 3; marked = 4), we averaged the ratings for each child to obtain a N asal. Obstruction Index, and we determined levels of interobserver agr eement concerning the ratings. We classified lateral soft-tissue roent genograms of the nasopharynx, based on assessments of adenoid size and of nasopharyngeal airway patency, as showing either no obstruction, b orderline obstruction, or obstruction, and we determined levels of int er-and intraobserver agreement concerning the classifications. Finally , we determined correlations in individual patients between clinical r atings and roentgenographic ratings of nasal/nasopharyngeal obstructio n, and calculated the predictive values of clinical ratings based on r oentgenographic ratings as the gold standard. Results. In sets of pair ed examinations, weighted kappa values for interobserver agreement con cerning mouth breathing (total, 235 children) and speech hyponasality (total, 648 children) ranged from 0.84 to 0.91. The value for interobs erver agreement concerning roentgenographic assessment of nasopharynge al airway status (207 children) was 0.92, and for intraobserver agreem ent (191 children) 0.88. The Kendall's tau b value for concordance bet ween Nasal Obstruction Index values and roentgenographic ratings (1033 children) was 0.51. Nasal Obstruction Index values at the lower and u pper extremes-ie, 1.0 and greater than or equal to 3.5, respectively-w ere highly predictive of concordant roentgenographic ratings. Conclusi ons. We conclude that standardized clinical ratings of the degree of c hildren's 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 a re particularly valid at the extremes of either marked obstruction or no obstruction. Clinical assessment alone may be insufficient to estab lish the presence of adenoidal, obstruction, but clinical assessment a lone when findings are unequivocally negative can suffice to rule out adenoidal obstruction with a high degree of confidence.