Radiographic findings of adenoid hypertrophy and associated risk factors among children attending Muhimbili National Hospital.

Abstract

Background: Adenoid is a mass of lymphoid tissue in the nasopharynx that produces antibodies. Adenoid hypertrophy is the most common cause of nasal airway obstruction in children. PNS, STL radiographs are used widely to diagnose adenoid hypertrophy. The aim of this research is to find common radiographic findings and associated risk factors of adenoid hypertrophy among children refered for PNS, STL radiography at Muhimbili National hospital. Less is known on radiographic patterns of adenoid hypertrophy at our setup. Broad objective: To determine radiographic findings of adenoid hypertrophy and associated risk factors among children attending Muhimbili National Hospital. Methodology: This was a descriptive cross sectional study which was conducted at Radiology department, Muhimbili National Hospital from June to December 2015. Children referred for PNS, STL radiography for assessment of nasopharynx were included in the research. Consenting patients were consecutively included in the research. Structured questionnaires were used for recording patients' demographics, clinical information and imaging findings obtained from PNS, STL radiographs. Data analysis was done using the Statistical Package for Social Sciences (SPSS) version 20. Statistical associations were done by using cross tabulations and Chi-square test was used to compare proportions. P value of < 0.05 was considered statistically significant. Results The research included 114 children who where refered to the Radiology department due to features suggestive of nasal obstruction. Moderate degree of obstruction on radiography was present in majority of cases. Most of the patients were in 1-3 years old age group (57.9%). The median age was 3 years. Males were 57% and females are 43%(1.3:1). The highest mean nasopharyngeal depth was 36.63mm in the age group 10 to 12 years and the lowest mean is in the youngest age group which is 25.95. The research showed significant correlation between presenting symptoms and degree of obstruction assessed by adenoid to nasopharyngeal ratio (Fujioka et al method), Pearson correlation of 0.612 (p value= 0.000). Among these children 56.1% had history of allergic rhinitis, 23.7% had history of recurrent infection, 10.5% had history of both and 9.6% had none. Those with both risk factors had higher proportion of cases with severe degree of obstruction compared to others. Only 4 (3.5%) children had associated tonsillar hypertrophy diagnosed on lateral radiography.. Conclusion There are 114 children with symptoms suggestive of adenoid hypertrophy, males were more than females. Most of the children showed moderate degree of obstruction on radiography. The mean nasopharyngeal depth was lowest in the 1-3 year old age group while was highest in the 9-12 year old age group. There was no significant statistical difference between males and females mean nasopharyngeal depth. There was a statistical significant relationship between risk factors and symptoms with degree of obstruction. Also there was a statistical significant relationship between age and degree of obstruction. There were more cases with severe degree of obstruction in the younger age group and less in the higher age groups. Recommendation: 1. Adopt quantitative analysis in assessing patients with adenoid hypertrophy in routine reporting. Fujioka et al method should be adopted in our settings 2. More researches should be done on imaging methods for assessment of adenoid hypertrophy.