Inter-observer variability in the clinical and radiological assessment of adenoid size, and the correlation with adenoid volume

Abstract

Children (46) were independently assessed with respect to size of adenoids and other clinical features by 3 observers of differing experience. Similar assessment was made of adenoid area and postnasal space airway from lateral cephalometric X-rays. The interobserver agreement for these findings was calculated. Absolute agreement between observers for the assessments was poor and in some instances this was related to clinical experience. In relative terms the agreement was more satisfactory. A nasal obstruction score due to adenoid enlargement was derived from assessment of mouth breathing and speech hyponasality and this correlated with the nasopharyngeal radiology score derived from visual assessment of the radiological adenoid area and postnasal space airway. The radiology score correlated well with measurement of the nasopharyngeal area made by planimetry. Both the radiology score and the nasal obstruction score correlated with the volume of adenoid tissue removed at adenoidectomy. The basis for a scoring system for the clinical and radiological assessment of adenoids in order to detect preoperatively those children most likely to benefit from adenoidectomy was provided.