Validation of a new grading system for endoscopic examination of adenoid hypertrophy.

OBJECTIVE To propose and validate a new subjective grading system of adenoid size with flexible fiberoptic evaluation. STUDY DESIGN AND SETTING Digital video clips of 24 flexible fiberoptic nasopharyngeal exams were presented to 24 examiners (otolaryngology resident and consultant physicians) at a tertiary care institution. Examiners were asked to use the proposed grading system to rate adenoid hypertrophy. Kappa statistical analysis was used to evaluate the degree of intergrader agreement or disagreement. RESULTS Statistical analysis of intergrader agreement demonstrated an overall Kappa score of 0.71 suggesting a "substantial" strength of agreement. The Kappa strength of agreement was found to be 0.83 (almost perfect) among consultant physicians and 0.62 (substantial) among resident physicians. CONCLUSIONS The proposed adenoid staging system is a reliable and consistent method of staging adenoid tissue size. SIGNIFICANCE This new validated grading system may be a useful standard for reporting adenoid size in future clinical outcome studies.