Adenoid size assessment: a comparison of palpation, nasendoscopy and mirror examination.

OBJECTIVES To compare the digital, mirror and nasendoscopic assessment of adenoid size and posterior choanal obstruction in patients undergoing adenoidectomy. DESIGN Prospective, blinded study. SETTING Otorhinolaryngology department at a London teaching hospital. PARTICIPANTS Twenty-eight consecutive patients undergoing adenoidectomy in conjunction with tonsillectomy or myringotomy under general anaesthesia, aged 17 months to 16 years. MAIN OUTCOME MEASURES Adenoid size and postnasal space obstruction as assessed by digital examination, nasendoscopy and trans-oral mirror visualization. These examination methods were each compared with each other. RESULTS Nasendoscopy and mirror examination correlated well (Spearman's R(S) = 0.71, P < 0.0001) but Passing and Bablock regression analysis demonstrated that mirror examination consistently underestimated the degree of choanal obstruction in comparison with nasendoscopy. There was no significant correlation between nasendoscopy and palpation (R(S) = 0.26, P = 0.17) and only a moderate correlation between mirror examination and palpation (R(S) = 0.46, P = 0.014). CONCLUSION If nasendoscopy is considered the gold standard, then palpation is a poor measure of adenoid hypertrophy and mirror examination consistently underestimates choanal occlusion.