Assessing adenoid hypertrophy in children: X-ray or nasal endoscopy?

BACKGROUND Upper airway obstruction is a common complaint in children presenting to otolaryngology clinics. In such children, adenoid hypertrophy is often suspected. There are numerous ways to determine adenoid size, including palpation, mirror examination, endoscopic examination, lateral neck roentgenogram (X-ray), magnetic resonance imaging (MRI), and acoustic rhinometry. Pediatric patient cooperation limits the utilization of palpation and mirror examination, while acoustic rhinometry and MRI are not practical in the clinical setting. Thus, flexible fiberoptic nasal endoscopy (FNE) and lateral neck X-ray are the two most common diagnostic tools used to assess for adenoid hypertrophy. Cost-effective, age-specific guidelines on how best to evaluate adenoid size are lacking. The aim of this review is to determine whether X-ray or endoscopy is superior in assessing adenoid hypertrophy in pediatric patients presenting with upper airway obstruction.