Correlation between radiological and tympanometry findings among pediatric patients with adenoid hypertrophy attending otorhinolaryngology clinic at Muhimbili National Hospital

Abstract

ABSTRACT Background: The most prevalent cause of nasal obstruction in pediatric patients is adenoid hypertrophy (AH), often leading to symptoms such as snoring, sleep apnea, difficulty breathing, or mouth breathing. Adenoid hypertrophy significantly contributes to the development of otitis media with effusion (OME) in children, with a higher incidence observed as adenoid size increases. The most dependable and cost-effective evaluation method for enlarged adenoids and the determination of the adenoid-nasopharyngeal ratio (ANR) was lateral nasopharynx Xray. Tympanometry test is not a routine test carried out for patients with adenoid hypertrophy at our facility. In this study it was effectively used to detect the middle ear complications associated with adenoid hypertrophy such as otitis media with effusion. Objective: The main aim of the study was to determine correlation between radiological and tympanometry findings among pediatric patients with adenoid hypertrophy attending the otorhinolaryngology clinic at Muhimbili National Hospital. Materials and methods: This was a hospital based cross-sectional study design, conducted at otorhinolaryngology departmental clinic at Muhimbili National Hospital from July 2023 to January 2024 among patients aged below 18 years who were diagnosed with AH using lateral nasopharyngeal X-rays. Adenoid nasopharyngeal ratio was used to determine the grade of AH. The patients were sent for a tympanometry test. A designed structured data collecting tool was used for recording patients' demographic data, radiological findings obtained from the lateral nasopharyngeal x-ray radiography as well as tympanometric findings. Data were analyzed by using statistical package for the social science (SPSS) version 24 and presented in cross tabulations and figures. Correlation coefficient and the Chi-square test were used for statistical associations and compare proportions. P value <0.05 was considered statistically significant. Results: Majority of patients (53%) were aged 5-8 years, with males’ predominance (61.6%). Common symptoms were snoring (32.2%) and mouth breathing (27.6%), while hypo nasal speech was rare (1.5%).Grade III AH was most common (50.4%), followed by grade IV (26.3%), and grade I was least common (1.3%). Tympanometry types varied, with type B most prevalent, right 56.0% and left 57.8%, followed by type A right 33.6% and left 31.0%, and type vi Ad least common (0.4%). The study observed a strong correlation between radiological and tympanometry findings with bilateral decrease in the proportion of type A and increase in proportion of type B with increase in radiological grades. (r = 0.597 for right ear, r = 0.643 for left ear, p < 0.001). Conclusion and recommendations: Adenoid hypertrophy grades III and IV were majority observed in 1 to 4 years. Males predominantly presented with grade I,II and IV, and female with grade III. Tympanometry type B was most commonly observed followed by type A, and least was type Ad bilaterally. The study found a strong correlation between radiological and tympanometry findings, noting a bilateral decrease in the proportion of type A and increase in proportion of type B as radiological grades increases. Implement regular screening for adenoid hypertrophy in pediatric patients aged 1 to 4 years, focusing on those presenting with symptoms snoring, mouth breathing, and hypo-nasal speech. Patients presented with severe adenoid hypertrophy (grades III and IV) accompanied by type B tympanograms, to consider performing adenoidectomy and grommet tube insertion together in a single setting. Standardized clinical guidelines integrating radiological imaging and tympanometry are recommended, with further research needed on longitudinal correlations and adenoidectomy outcomes