Methods
upper airway infection, rhinopharyngeal obstruction, nasosinusal complaints, OSA, palate, congenital diseases, craniofacial malformations
OBSTRUCTIVE SLEEP APNEA, DOWN SYNDROME, IMMUNODEFICIENCIES, TONSILLAR HYPERTROPHY, NEUROMUSCULAR DISEASES, CONGENITAL DISEASES
Cross-sectional observational study that analyzes the reliability of adenoid evaluation by nasofibroscopy and correlates the degree of rhinopharyngeal obstruction with clinical symptoms.The study was approved by the Ethics and Research Committee (CAAE 29266820.1.0000.5479). Data were stored on the RedCap platform.The patients were screened at the various outpatient clinics of the Department of Otorhinolaryngology at Santa Casa of São Paulo over the years 2020 and 2021.Patients of both sexes, between 4 and 14 years old, with nasosinusal complaints and/or nocturnal snoring, who would undergo nasofibroscopy for clinical investigation, were selected. Patients who presented craniofacial malformations, Down Syndrome, congenital diseases, neuromuscular diseases, immunodeficiencies, current symptoms of upper airway infection, obstructive nasal septum deviation, and patients with Grade III or IV tonsillar hypertrophy were excluded. Patients who did not tolerate the examination or who presented poor quality videos that made it impossible to visualize the adenoid were also excluded.After being instructed about the risks and benefits of participating in the study and agreeing to participate, patients and family members signed the informed consent and assent and answered a clinical and demographic questionnaire (Annex 1). To determine the clinical outcome, they answered the OSA 18 (Obstructive Sleep Apnea) questionnaire (Annex 2),All patients underwent nasofibroscopy, in a sitting position, with a flexible fiberoptic nasofibroscope (OlympusTM ENFP4, 3.5 mm), with 250-watt halogen light, under topical anesthesia in both nasal cavities (4% lidocaine gel). Parents were informed how the exam would be performed and decided whether the children would be sitted alone or on their laps. No other immobilization method was used, and the examination was interrupted at any sign of discomfort. All videos ensured that the choana region was filmed during inspiration, with the palatal musculature relaxed, the moment for better assessment of rhinopharyngeal obstruction by the adenoid. The exam was recorded and edited in order to preserve the patient's identification.The group of evaluators was composed of four independent otorhinolaryngologists, with a minimum of five years of clinical experience, who are not study authors and did not have access to research protocol data. All were instructed to choose the moment for the best evaluation of the choana, soft palate relaxed during inspiration and the fiber being located in the distal position of the inferior turbinate. The video clips were sent to the evaluators, numbered by codes and without identification, in two different moments (T1 and T2) with an interval of at least one month between them. In the second evaluation, the order of the videos was randomized to avoid the influence of the first evaluation. The examiners did not have access to the grading attributed by themselves in the first evaluation, nor the grading attributed by the other evaluators. In each analysis, examiners were instructed to subjectively estimate a percentage of rhinopharyngeal obstruction by adenoid tissue.In addition to the subjective classifications, the videos were also digitally evaluated using the Pro Image J Software, which estimates the degree of rhinopharyngeal obstruction by the adenoid. In this software, a fifth evaluator delimited the area occupied by the adenoid and the choana area, as shown in Nasal endoscopy to evaluate the rhinopharynx using the Pro Image J Software. (A) Area of the choana estimated by Software Pro Image J. (B) Area of adenoid tissue estimated by Software Pro Image J.