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Vol. 90. Núm. 3.
Páginas 279-285 (Maio - Junho 2014)
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Vol. 90. Núm. 3.
Páginas 279-285 (Maio - Junho 2014)
ARTIGO ORIGINAL
DOI: 10.1016/j.jpedp.2013.09.005
Open Access
Radiographic adenoid evaluation – suggestion of referral parameters
Avaliação radiográfica da adenoide − sugestão de parâmetros de referência
Visitas
...
Murilo F.N. Feresa,
Autor para correspondência
, Juliana S. Hermannb, Ana C. Sallumb, Shirley S.N. Pignatarib
a Faculdade de Odontologia, Universidade São Francisco (USF), Bragança Paulista, SP, Brasil
b Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
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Abstract
Objective

this study aimed to evaluate the usefulness of current radiographic measurements, which were originally conceived to evaluate adenoid hypertrophy, as potential referral parameters.

Methods

children aged from 4 to 14 years, of both genders, who presented nasal obstruction complaints, were subjected to cavum radiography. Radiographic examinations (n = 120) were evaluated according to categorical and quantitative parameters, and data were compared to gold-standard video nasopharyngoscopic examination, regarding accuracy (sensitivity, negative predictive value, specificity, and positive predictive value).

Results

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. Amongst the quantitative variables, a mathematical model was found to be more suitable for identifying patients with more than two-thirds obstruction.

Conclusion

this model was shown to be potentially useful as a screening tool to include patients with, at least, two-thirds adenoid obstruction. Moreover, one of the categorical parameters was demonstrated to be relatively more useful, as well as a potentially safer assessment tool to exclude patients with less than three-quarters obstruction, to be indicated for adenoidectomy.

Keywords:
Mouth breathing
Diagnosis
Adenoidectomy
Resumo
Objetivo

o objetivo deste estudo foi de investigar a utilidade de medidas radiográficas destinadas à avaliação da tonsila faríngea a serem utilizadas como potenciais parâmetros de encaminhamento.

Métodos

crianças de quatro a 14 anos, de ambos os gêneros, que apresentavam queixas referentes à obstrução nasal foram submetidas à radiografia do cavum. Os registros radiográficos (n = 120) foram avaliados de acordo com parâmetros categóricos e quanti- tativos, e dados resultantes foram comparados ao exame padrão-ouro de videonasofarin- goscopia, em relação às suas taxas de acurácia (sensibilidade, valor preditivo negativo, especificidade e valor preditivo positivo).

Resultados

os parâmetros radiográficos categóricos apresentaram baixa sensibilidade para a identificação de pacientes portadores de 2/3 de obstrução do espaço coanal. No entanto, alguns destes parâmetros apresentaram especificidades relativamente altas quando 3/4 de obstrução coanal era o ponto de corte de interesse. Dentre as variáveis quantitativas, um modelo matemático se mostrou mais adequado para identificar pacien- tes com mais de 2/3 de obstrução coanal.

Conclusão

este modelo demonstrou, assim, ser potencialmente útil como método de rastreamento para identificação de pacientes com pelo menos 2/3 de obstrução adenoi- diana. Além disso, um dos parâmetros categóricos analisados demonstrou ser relativa- mente mais útil e potencialmente seguro para eliminar pacientes queixosos com menos de 3/4 de obstrução a serem indicados à adenoidectomia.

Palavras-chave:
Respiração bucal
Diagnóstico
Adenoidectomia
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Como citar este artigo: Feres MF, Hermann JS, Sallum AC, Pignatari SS. Radiographic adenoid evaluation − suggestion of referral parameters. J Pediatr (Rio J). 2014;90:279-85.

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