Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective

Our study showed significantly higher AHI in children who had recurrent/residual adenoid tissue hypertrophy with moderate to severe nasopharyngeal obliteration on STN-XR. There are a very limited number of studies that examined the association between OSA and the degree of adenoidal enlargement by neck radiography. Of these, Brooks et al in 1998 studied the extent that adenotonsillar hypertrophy contributes to the severity of OSA in children. Although they found that adenoid-nasopharyngeal ratio and tonsillar size did not predict the number of apneas, a significant relation was noted between adenoid-nasopharyngeal ratio and duration of obstructive apneas. Similarly, a study conducted by Jain and Sahni in 2002 showed that relative adenoidal size on X-ray, expressed as a ratio between the distance from the point of maximum thickness of adenoids along a line drawn along a straight part of the basiocciput and distance from the posterior nasal spine to the antero-inferior edge of the sphenobasioccipital synchondrosis, had a significant correlation with the grade of OSA. In that study, all patients with a measured ratio > 0.64 were found to have OSA. None of these previous studies evaluated the role of STN-XR in assessing recurrent/residual adenoid hypertrophy.

https://jcsm.aasm.org/doi/full/10.5664/jcsm.10468