Adenoid hypertrophy grading

Endoscopic Powered Adenoidectomy

Proposed definitive grading system tool for the assessment

This grading system is simple, reliable, and easily used. It offers standardization for clinicians and researchers in facilitating communications, and allowing interpretation of adenoid tissue observed with its relationship to and effect on adjacent anatomic structures. This will allow more detailed Validation of a new grading system for endoscopic examination of adenoid hypertrophy This new validated grading system may be a useful standard for reporting adenoid size in future clinical outcome studies. This new validated grading system may be a useful standard for reporting adenoid size in future clinical outcome studies Conclusion: Clinical grading was found to be a reliable parameter for assessment of the severity of adenoid hypertrophy. Though x-ray is a convenient procedure for diagnosing adenoid hypertrophy, it was found to be less accurate in assessing the clinical implications when compared to endoscopy

[PDF] Validation of a new grading system for endoscopic

grading system for adenoid hypertrophy was createdbased on the anatomical relationships between the adenoidtissue and the following structures: vomer, soft palate, andtorus tubaris (Table 1). The grading is based on the rela-tionship of the adenoids to adjacent structures when thepatient is at rest (ie, when the soft palate is not elevated). Aprospective protocol for validation of this grading systemwas proposed and then Institutional Review Board approvalfor the study was obtained Adenoid hypertrophy is an obstructive condition related to an increased size of the adenoids. The condition can occur with or without an acute or chronic infection of the adenoids. The adenoids are a collection of lymphoepithelial tissue in the superior aspect of the nasopharynx medial to the Eustachian tube orifices. In conjunction with the faucial and lingual tonsils, the adenoids make up. Adenoidal hypertrophy (children) Dr B Gulhane and Dr Mohammed Wahba et al. Adenoidal hypertrophy or enlargement in children is common and due to an increase in the size of the adenoids. For adenoidal enlargement in adults, which is much rarer and usually pathological, please see the separate article, adenoidal hypertrophy (adults) adenoidal obstruction (assessed radiologically) is presented in Table 2. Table 3 shows radiological grading of adenoidal obstruction according to symptomatology score. Table 1: Symptomatology score by patient age (in year) Age(yrs) Mild Moderate Severe Total 1-3 0 20 0 20 4 -6 10 15 30 55 7 -9 0 20 35 5

But the adenoids of the 5th degree in the child - this is more a phenomenon from the realm of fantasy. Such a diagnosis would be clearly incorrect. The final diagnosis of whether the child has hypertrophy of adenoids and what it has reached a degree is made by an otolaryngologist (or in the traditional ENT) ,'gestalt' ' grading. Patients withaverage-size orsmall ade-noids allhadample airpassages. Insome instances, chil-drenwithlarge butnotabnormally enlarged adenoids were thought tohavenarrowed airspaces. Discussion Simple, accurate, and objective measurements forthe radiographic assessment ofadenoidal size inchildren ma

In 2006, Parikh et al. [ 14] proposed a new grading system for endoscopic examination of adenoid hypertrophy, in which the adenoid size was graded of 1, 2, 3, or 4 according to the anatomical relationships between the adenoid and the three adjacent structures vomer, soft palate, and torus tubaris based on the endoscopic nasopharyngeal image A grading system for adenoid hypertrophy was created based on the anatomical relationships between the adenoid tissue and the following structures: vomer, soft palate, and torus tubaris (Table 1)

radiographic grading systems presented low sensitivity for the identification of patients with two-thirds choanal space obstruction. However, some of these parameters presented relatively high specificity rates when three-quarters adenoid obstruction was the threshold of interest DOI: 10.1016/j.otohns.2006.05.003 Corpus ID: 36893868. Validation of a new grading system for endoscopic examination of adenoid hypertrophy @article{Parikh2006ValidationOA, title={Validation of a new grading system for endoscopic examination of adenoid hypertrophy}, author={S. Parikh and Mark J. Coronel and J. Lee and S. Brown}, journal={Otolaryngology-Head and Neck Surgery}, year={2006. The LC grading was significantly correlated with the number of mucin-producing cells and lymphoid follicles (P <.001). Conclusions: In NBI endoscopy, observation of an LC on the epithelial surface of the nasopharyngeal mucosa is a highly accurate predictor of the presence of adenoid hypertrophy

Community level evaluation of adenoid hypertrophy on the

Correlation between clinical grading of adenoid or tonsil hypertrophy and adenoid or tonsil volume post adenotonsillectomy: a prospective cohort study Daniel D. Kokong1*, Adeyi A. Adoga 1, Ishaku Turaki1, Nuhu D. Maan 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. Standardized tonsillar hypertrophy grading scale. (0) or a nasopharyngoscopic examination to evaluate the size of the adenoidal tissue and the site of airway collapse. Detection of tonsillar.

Validation of a new grading system for endoscopic

Adenoid enlargement may cause partial or complete obstruction of the nasopharynx. It can result in obstructive symptoms such as obstructive sleep apnea and generalized lethargy Lateral neck radiography is the main imaging modality for adenoid hypertrophy assesment. Airway to soft palate ratio method can be used assessing and grading adenoid enlargement on this view Adenoid hypertrophy is common in children. Size of the adenoid increases up to the age of 6 years, then slowly atrophies and completely disappears at the age of 16 years. Adenoid hypertrophy in adults is rare. Present study shows that adenoid hypertrophy is now increasing in adults because of various causes keywords = ACE grading, Adenoid hypertrophy, Choana, Endoscopic adenoid grading, Eustachian tube, Nasopharyngeal airway, author = Varghese, {Ajoy Mathew} and P. Naina and Cheng, {Alan T.} and Asif, {Syed Kamran} and Mary Kurien

Adenoid hypertrophy (enlarged adenoids) is the unusual growth (hypertrophy) of the adenoid (pharyngeal tonsil) first described in 1868 by the Danish physician Wilhelm Meyer (1824-1895) in Copenhagen.He described a long term adenoid hypertrophy that will cause an obstruction of the nasal airways. These will lead to a dentofacial growth anomaly that was defined as adenoid facies (see long. adenoid hypertrophy than the lateral neck X-ray.7,8,10 Although nasal endoscopy is a reliable and safe diagnostic method, it also has a number of disadvantages. choanae was estimated using the grading system proposed by Clemens and McMurray. • Grade I: Adenoid tissue filling one-third of the vertical portion of the choanae.. Mere presence of adenoid enlargement cannot explain the severity of symptoms. In order to categories adenoid hypertrophy one grading system proposed by Parikh et at. was used, which classify adenoid hypertrophy into grade 1 to 4 on basis of structures in contact with the adenoid tissue. Severity of symptoms and clinical findings were consistent. The diagnosis of adenoid hypertrophy was made on the basis of the medical history, X-ray nasopharynx soft tissue lateral view, and endoscopy was obtained in an erect position with neck extended to visualize the shadow of the adenoid.Radiological assessment and grading of the size of adenoid was done accordingly [6 adenoid hypertrophy was made on the basis of the medical history, X-ray nasopharynx soft tissue lateral view, and endoscopy was obtained in an erect position with neck extended to visualize the shadow of the adenoid.Radiological assessment and grading of the size of adenoid was done accordingly [6

  1. structures; grade 2 for adenoid tissue in contact with torus tubarius, grade 3 for adenoid tissue in contact with vomer, and grade 4 for adenoid tissue in contact with soft palate (at rest) [12]. However, other methods to perform a grading system of adenoid hypertrophy have been reported in literature [11,13]
  2. ation of adenoid hypertrophy . Otolaryngol Head Neck Surg. 2006; 135(5):684-7
  3. The three types of tonsil grading are the Brodsky scale, Freidman scale, and a modified three grading scale. Grading scales have been established for tonsil size, adenoid hypertrophy, palate position, and tongue base obstruction
  4. Adenoid grading scores were assigned to 150 pediatric patients, 74 males and 76 females, who underwent surgery for adenoidectomy with or without tonsillectomy and/or myringotomy and tube placement. Seven patients were found to have no adenoid tissue in the nasopharynx as they had previous adenoidectomy and received a grade of 0A−
  5. Adenoid hypertrophy/ airway obstruction Moderate to severe nasal obstruction/ including sleep apneas Chronic mouth breathing/hyponasal speech/impaired olfaction (quality of life) Obstruction is based on their size alone Must be distinguished from allergy, sinusitis, structural nasal disorders Adenoidectomy > spontaneous improvement.
  6. Table 4.2: Adenoid Hypertrophy Grading.. 21 Table 5.1: Means and standard deviations for airway volume, cross-sectional area, depth and adenoid hypertrophy grade for pre-surgical, post-surgical and control groups... 40 Table 5.2: Mean and standard deviations for pre-surgical and post-surgical patient measurements and amount of change.

Adenoid was examined and graded I-IV in relation to posterior choana bilaterally by flexible nasopharyngoscopy. The adenoid grade was compared with the other side in each child. Results The findings from endoscopy were analyzed: there was a high degree of agreement in grading both sides, that was 92% with kappa=0.868 Details of the literature grading system are available in the accompanying technical report published online. failure to thrive, and cor pulmonale, particularly in severe cases. Risk factors include adenotonsillar hypertrophy, obesity, craniofacial anomalies, and neuromuscular disorders. which is the age when the tonsils and adenoids. Adenoid hypertrophy is an obstructive condition, with its symptomatology depending on the obstructed structure. Nasal obstruction by hypertrophic adenoid tissue can cause the patient to complain of rhinorrhea, difficulty breathing through the nose, chronic cough, post-nasal drip, snoring, and/or sleep-disordered breathing in children The grading of the symptoms reflected a progressive increase in the clinical severity of adenoidal obstruction. For instance, when considering snoring, adenoidal obstruction that caused patients to breathe noisily both during the daytime and during sleep was considered more severe than obstruction that caused noisy breathing only during sleep adenoid face (open-mouthed face) and potential alterations in dental arches, facial bones, and muscle function with The current tonsil grading systems evaluate tonsil size, but the correlation with In this respect, hypertrophy of the palatine tonsils and adenoids might follow a similar course of natural history

Adenoid Hypertrophy : X-ray - Sumer&#39;s Radiology Blog

Adenoid Hypertrophy - StatPearls - NCBI Bookshel

Adenoid hypertrophy (AH): Impaired mucociliary clearance has been implicated as playing a role in adenoid hypertrophy, a condition typically seen in children. An enlarged adenoid may block breathing and be a cause of snoring or obstructive sleep apnea. Adenoid hypertrophy can also lead to comorbid conditions such as serous otitis and sinusitis BACKGROUND AND OBJECTIVES: To assess the possibility of adenoid size asymmetry in both nasal sides by nasopharyngoscopy. DESIGN AND SETTINGS: This is a prospective study involving 100 children, wit..

Adenoidal hypertrophy (children) Radiology Reference

The size of the adenoid can be graded using Clemens grading. X-ray neck lateral view of the soft tissues will usually reveal the degree of adenoid hypertrophy. X-ray cervical spine in Down's syndrome to check C 1 C 2 subluxation. Following investigations are done and the patien ADENOID HYPERTROPHY AND ADENOTONSILLECTOMY The term adenotonsillar hypertrophy refers to the unusual growth of the adenoids and palatine tonsils (3) . It was first described by Danish physician Wilhelm Meyer in Copenhagen in 1868 (4). He explained that chronic adenoid hypertrophy results in nasal airway obstruction, and tha

Adenoid Hypertrophy in Adults- A Prospective Study

Video: Degrees of adenoids in children - 1, 2, 3: treatment

Adenoid and tonsil hypertrophy in infants and children is a relatively common occurrence. The precise cause is unknown although it is often thought to run in the family. The adenoids are located at the back of nose and when enlarged, may cause nasal obstruction, recurrent sinusitis, post nasal drip, sleep apnea , chronic runny nose. What is adenoid hypertrophy or adenoiditis? In children, sometimes adenoid enlarges and becomes symptomatic. The reason may be repeated nasal allergy, rhinitis, sinusitis or tonsillitis. A simple endoscopy of the nose and nasopharynx will help in visualizing and grading the size of adenoid, which further helps in reviewing the improvements.

Radiographic evaluation of adenoidal size in children

The ACE endoscopic adenoid grading system is consistent and reliable in evaluation of adenoids. AB - To establish an association between adenoid hypertrophy and hearing loss and its impact on speech and language in pediatric age group. A prospective case control study done in a tertiary hospital in South India Adenoid hypertrophy can also lead to comorbid conditions such as serous otitis and sinusitis. Assessing adenoid size can be achieved through flexible nasal endoscopy, where adenoid size grading is on a scale of I to IV. This scale represents the percentage of the posterior choana blocked by the adenoid tissue, with grade IV representing the. RESULTS: In the study group 13 out of 32 had grade 4 adenoid hypertrophy. This grade 4 adenoid hypertrophy was found to be statistically significant in children with otitis media with effusion (P < 0.0002). In control group 15 out of 28 had grade 1 adenoid hypertrophy which was significant in the same group (P < 0.002)

adenoids hypertrophy < 50% of posterior choanae recurrent epistaxis or immunodeficiency, severe septal deviation, kissing tonsils, choanal atresia, large masses, known allergy to nasonex (mometasone furoate nasal spray), chronic otitis media, cystic fibrosis, acute infection Adenoid hypertrophy (AH) is one of the most important respiratory disease in preschool children. In normal conditions adenoid tissue enlarges up to 5 years and become smaller afterwards. But in some children who have recurrent upper respiratory tract infections (URTI)s, it keeps growing and this can be associated with complications Introduction: Adenoid is thought to be one of the causes of otitis media with effusion, though it is controversial. Grading the adenoid by rigid nasal endoscope in patients with Otitis Media with effusion may justify adenoidectomy in Otitis media with effusion in the future. Methods: A Prospective study was carried out at GMS Memorial Academy of ENT and Head Neck studies from 15th December.. The grading of adenoids was correlated clinically with the severity of symptoms attributed to chronic adenoiditis. Materials and methods: Our study was an observational prospective study of 80 children with a diagnosis of chronic adenoiditis conducted adenoid hypertrophy than X-ray nasopharynx.7-9 It is a reliable technique, reproducible. Enlarged Tonsils and Adenoids. Lymphoid tissue on the posterior wall of the nasopharynx and part of Waldeyer's ring, which consists primarily off the adenoids, palatine tonsils and lingual tonsils. The size of the adenoids is less of a consideration than the degree to which they do or do not impinge on the nasopharyngeal airway

Modified adenoid grading system for evaluating adenoid

Upper respiratory obstruction is a common sequela in children with Zika-related microcephaly (ZRM). As a cross-sectional analysis nested in a cohort study, this study aims to investigate the prevalence of adenoid hypertrophy (AH) in children with ZRM and symptoms of respiratory obstruction. The data were collected in the first three years of life from children with ZRM who were followed in two. position was done to confirm adenoid hypertrophy.12 Endoscopic grading was done during surgery in these children.11 Endoscopic picture of adenoid The following images (from Figures 1 to 4) shows various grades of adenoid hypertrophy. Figure 1: Grade I adenoid hypertrophy. Figure 2: Grade II adenoid hypertrophy 3. Predominant adenoid hypertrophy Cliniciai. diagnosed and radiologically confirmed adenoid hypertrophy with tonsil grade 0-2 on Brodsky classification as illustrated in Figure 3.4 4. Predominant adenotonsillar hypertrophy Clinician diagnosed and radiologically confirmed adenoid hypertrophy with tonsil grade 3-4 on Brodsky classification as. In this series, six cases of adenoid hypertrophy showing varying clinical presentations in relation to its clinical course were surgically treated using a PEAK PlasmaBlade. Before and after surgery, all patients underwent nasal endoscopy to define the grading of hypertrophic adenoids and postoperative outcome

Adenoid hypertrophy grading system proposed by Parikh et

Radiographic adenoid evaluation - suggestion of referral

ment in pertinent imaging [3]. The antrum-adenoidal space, the ratio between adenoid, the nasopharyngeal space, and the measured choanal obstruction space are examples of objective measurements. Adenoid grading methods also vary from simply categorical normal or enlarged [4, 5], small, moderate and large [6]toordina More than half declared that they graded adenoidal hypertrophy on the basis of the percentage of adenoid-induced choanal obstruction and the patency of the Eustachian tube, and fewer than 50 % that they used a standardised grading system (mainly Cassano's [], which was chosen by 36 % of the respondents).Table 4 shows the significant associations between the otolaryngologists' attitude. Parikh SR, Coronel M, Lee JJ (2006) Validation of a new grading system for endoscopic examination of adenoid hypertrophy. Otolaryngol Head Neck Surg135: 684-687. Berlucchi M, Valetti L, Parrinello G (2008) Long-term follow-up of children undergoing topical intranasal steroid therapy for adenoidal hypertrophy ADENOIDS, which are nasopharyngeal lymphoid tissue forming part of the Waldeyer ring, were initially described in 1868 by Meyer. 1 Present from early gestation, adenoid growth continues until about 6 years of age, after which atrophy occurs. Adenoidal hypertrophy during childhood may both fill the nasopharynx and extend through the posterior choanae into the nose, resulting in nasal airway.

Effect of Adenoid Hypertrophy on Otitis Media with

[PDF] Validation of a new grading system for endoscopic

Narrow‐band imaging for diagnosing adenoid hypertrophy in

Correlation between clinical grading of adenoid or tonsil

Tonsillar hypertrophy is graded from Grade 1 to Grade 4. The space that has to be visualized for grading is from the anterior tonsillar pillar to midline. Grade 1: Tonsils are covering 0 to 25% area from the anterior tonsillar pillar to midline. Grade 2: Tonsils are covering 25 to 50% area from the anterior tonsillar pillar to midline OBJECTIVE: To assess the reliability of endoscopic ACE grading system of adenoids. METHODS: This observational prospective study was conducted over 1 year. Patients between 3 and 16 years for adenoidectomy underwent rigid nasal endoscopy and grading was done at OPD. Intra-operative endoscopic grading of adenoids was repeated (theatre or standard grade) and still images were captured Pediatric OSDB. OSDB occurs in 1.2% to 5.7% of children. 2 Associated sequelae include cardiopulmonary disease and growth impairment. 17 Memory problems, poor school performance, as well as behavioral issues such as aggression, attention deficit, hyperactivity, and aggression have been associated with this condition. 2,18 Hypertrophy of the adenoid, and particularly, the tonsils are the most. Grading Scale. Tonsil 0: Tonsil s fit within Tonsil lar fossa. Tonsil 1+: Tonsil s <25% of space between pillars. Tonsil 2+: Tonsil s <50% of space between pillars. Tonsil 3+: Tonsil s <75% of space between pillars. Tonsil 4+: Tonsil s >75% of space between pillars

Obstructive Sleep Apnea in Children - American Family

What is Tonsil Grading? The tonsil grading is a scale that ENT doctors rely upon to check the change in the tonsil size. It is used to determine the size of the tonsils as well as grade the tonsils and monitor the sizes regularly to document any changes Parikh et al. have proposed a grading system for endoscopic examination of adenoid hypertrophy that is validated and user-friendly. Other methods such as video fluoroscopy have been shown to be effective at assessing adenoid size but are less commonly used and carry unnecessary radiation exposure ( 36 )

2. Hypertrophy causing upper airway obstruction (sleep apnea) View Abstract View Abstract, severe dysphagia (trouble swallowing), sleep disorders, or cardiopulmonary complications. Usually, removal of both the tonsils and adenoids are indicated. 3. Peritonsillar abscess unresponsive to medical management and drainage documented by surgeon, unless surgery performed during acute stage A Clinical Approach to Tonsillitis, Tonsillar Hypertrophy, and Peritonsillar and Retropharyngeal Abscesses Risa E. Bochner , Mona Gangar , Peter F. Belamarich Pediatrics in Review Feb 2017, 38 (2) 81-92; DOI: 10.1542/pir.2016-007 One of the studies has shown that that correlate more closely with the severity of the the growth of the adenoid outstrips that of the adenoid hypertrophy than the lateral neck X-ray.7,8,10 nasopharynx in children between 3 to 5 years of age with Although nasal endoscopy is a reliable and safe resultant reduction in the nasopharyngeal airway A recently proposed grading system by Parikh et al grades the adenoids as seen in outpatients with an endoscope and may be useful as a standard for reporting clinical outcome studies 17: Grade 1: adenoid tissue not in contact with surrounding structures. Grade 2: adenoid tissue in contact with Eustachian tube cushions

Adenoid enlargement Radiology Case Radiopaedia

Adenoids are small tissues located at the back of the throat. They are similar to the tonsils, and located right above them. Both adenoids and tonsils are part of the immune system. Adenoids are. Adenoid tissue and tonsils continue to grow until a child is about eight years old. In most individuals, the adenoids will regress in size during puberty and may be nearly absent by adulthood. For this reason, adenoiditis is commonly a problem of childhood and adolescence 7). Adenoid size grading is on a scale of zero to four: Grade 0 = Absen The evaluation of adenoid hypertrophy and obstruction grading based on rhinomanometry after nasal decongestant test in children ; An overview on upper respiratory tract infections and bacteriotherapy as innovative therapeutic strateg Grading of adenoidal hypertrophy was performed as described by Cassano et al. According to this classification, patients with 50%-75% obstruction of adenoid tissue in the endoscopic view are grade 3 and total choanal obstruction with adenoid tissue is grade 4. We excluded the <25 Beyond all other diagnostic methods, nasoendoscopy using a standardized grading system is the gold standard for diagnosis of adenoid hypertrophy. 55-57 Nasoendoscopy is minimally invasive, highly reliable, and easy for an otolaryngologist to perform. However, performing nasoendoscopy is outside the scope of practice for other health-care.

1 Introduction. Adenoid hypertrophy is one of the most common causes of pediatric upper airway infection, nasal obstruction, otitis media with effusion, and obstructive sleep apnea (OSA) syndrome, with adenoidectomy continuing as one of the commonest surgical procedures in clinical. Adenoid hypertrophy is believed a multifactorial process, recurrent acute viral, chronic bacterial infection. Adenoidal hypertrophy is considered one of the most common diseases in otolaryngology. It is usually associated with nasal obstruction symptoms like snoring and hyponasality. If not treated well, children will encounter many complications like otitis media with effusion and craniofacial abnormalities. Adenoidectomy is the main line of treatment for many otolaryngologists, but recently medical. Tonsillar hypertrophy, or enlarged tonsils, can be caused by an ongoing (chronic) condition or be a temporary effect of an infection. Tonsils are small glands on either side of the back part of the throat. Their main job is to help stop bacteria from getting farther down the throat. Enlarged tonsils.

Adenoid hypertrophy Radiology Case Radiopaedia

Residual or recurrent adenoid tissue is evaluated 3 months after operation and it described as more than grade 1 of Clemens clinical grading system . We examine the patient after 3, 12, 24, 48 hours after operation and the monthly for 1 year and any complication was recorded in Table 2 Adenoid tissue rhinopharyngeal obstruction grading based on fiberendoscopic findings: a novel approach to therapeutic management. Int J Pediatr Otorhinolaryngologol 67(12): 1303-1309. 6. Rout MR, Mohanty D, Vijaylaxmi Y, Bobba K, Metta C (2013) Adenoid Hypertrophy in Adults: A case Series. Ind J Otolaryngol Head Neck Surg (July-Sept) 65(3): 269.


viruses Article The Prevalence of Adenoid Hypertrophy among Children with Zika Related Microcephaly Mariana C. Leal 1,2,*, Danielle Seabra Ramos 1,3, Thiago Pinto Bezerra 1, Ana Elizabeth S. C. Vilela 2, Rebeka Jacques de F. Maciel 1, Mirella Rodrigues 1, Mariana Lira 4, Karen Pena de Souza Cavalcanti 4,5, Vanessa Van der Linden 6, Marli T. Cordeiro 6, Demócrito Miranda-Filho 7, Ricardo. The adenoid size was measured by using adenoidal/nasopharyngeal ratio. Results: Of 71 children (142 ears), 20 children (40 ears) had gross adenoid enlargement, of which tympanometry was found to be normal in 75% and abnormal in 25%. In 28 children (56 ears) with moderate adenoid enlargement, tympanometry was normal in 78.6% and abnormal in 21.4% Adenoid Hypertrophy : X-ray. Tuesday, October 04, 2016 head and neck radiology. The size of the adenoids is less of a consideration than the degree to which they do or do not impinge on the nasopharyngeal airway. If the nasopharyngeal stripe of air is half the size of the soft palate, significant obstruction occurs In this study, a validated endoscopic grading system (ranging from 1 to 4) of adenoid size for fiberoptic nasoendoscopy was used [10]. The endoscopic grading system used for assessing adenoid size has been based on the relationship of the adenoids to adjacent structures (torus tubaris-Eustachian tube orifice Our group uses an adenoid size grading approach similar to that used in a 2011 study comparing endoscopic versus soft tissue lateral X-ray adenoid size. They used a 4-category endoscopic adenoid size grading scale based on percent of choanal obstruction [22]