Michael P Major1, Humam Saltaji, Hamdy El-Hakim, Manisha Witmans, Paul Major, Carlos Flores-Mir. 1. Dr. Michael P. Major is an assistant clinical professor and the director, Inter-disciplinary Airway Research Clinic, Division of Orthodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, 5-476 Edmonton Clinic Health Academy, 11405-87 Ave., Edmonton, Alberta, Canada T6G 1C9, mpmajor@ualberta.ca.
Abstract
BACKGROUND: Adenoid hypertrophy may cause sleep-disordered breathing and altered craniofacial growth. The authors conducted a study to gauge the accuracy of alternative tests compared with nasoendoscopy (reference standard) for screening adenoid hypertrophy. METHODS: The authors conducted a systematic review that included searches of electronic databases, hand searches of bibliographies of relevant articles and gray literature searches. They included all articles in which an alternative test was compared with nasoendoscopy in children with suspected nasal or nasopharyngeal airway obstruction. RESULTS: The authors identified seven articles that were of poor to good quality. They identified the following alternative tests: multirow detector computed tomography (sensitivity, 92 percent; specificity, 97 percent), videofluoroscopy (sensitivity, 100 percent; specificity, 90 percent), rhinomanometry with decongestant (sensitivity, 83 percent; specificity, 83 percent) and clinical examination (sensitivity, 22 percent; specificity, 88 percent). Lateral cephalograms tended to have good to fair sensitivity (typically 61-75 percent) and poor specificity (41-55 percent) when adenoid size was evaluated but excellent to good specificity when airway patency was evaluated (68-96 percent). CONCLUSIONS: No ideal tool exists for dentists to screen adenoid hypertrophy, owing to access constraints, radiation concerns and suboptimal diagnostic accuracy. Research is needed to identify a low-risk, easily acceptable, highly valid diagnostic screening tool. PRACTICAL IMPLICATIONS: Although lateral cephalograms (which have good to fair sensitivity) and a thorough medical history (which has good specificity) are imperfect individually, when they are used together, they can compensate for each others weaknesses. This combined approach is the best tool available to dentists for screening adenoid hypertrophy.
BACKGROUND:Adenoid hypertrophy may cause sleep-disordered breathing and altered craniofacial growth. The authors conducted a study to gauge the accuracy of alternative tests compared with nasoendoscopy (reference standard) for screening adenoid hypertrophy. METHODS: The authors conducted a systematic review that included searches of electronic databases, hand searches of bibliographies of relevant articles and gray literature searches. They included all articles in which an alternative test was compared with nasoendoscopy in children with suspected nasal or nasopharyngeal airway obstruction. RESULTS: The authors identified seven articles that were of poor to good quality. They identified the following alternative tests: multirow detector computed tomography (sensitivity, 92 percent; specificity, 97 percent), videofluoroscopy (sensitivity, 100 percent; specificity, 90 percent), rhinomanometry with decongestant (sensitivity, 83 percent; specificity, 83 percent) and clinical examination (sensitivity, 22 percent; specificity, 88 percent). Lateral cephalograms tended to have good to fair sensitivity (typically 61-75 percent) and poor specificity (41-55 percent) when adenoid size was evaluated but excellent to good specificity when airway patency was evaluated (68-96 percent). CONCLUSIONS: No ideal tool exists for dentists to screen adenoid hypertrophy, owing to access constraints, radiation concerns and suboptimal diagnostic accuracy. Research is needed to identify a low-risk, easily acceptable, highly valid diagnostic screening tool. PRACTICAL IMPLICATIONS: Although lateral cephalograms (which have good to fair sensitivity) and a thorough medical history (which has good specificity) are imperfect individually, when they are used together, they can compensate for each others weaknesses. This combined approach is the best tool available to dentists for screening adenoid hypertrophy.
Authors: K Bhagya Lakshmi; Sri Harsha Yelchuru; V Chandrika; O G Lakshmikar; V Lakshmi Sagar; G Vivek Reddy Journal: J Int Soc Prev Community Dent Date: 2018-05-17
Authors: Claudine Thereza-Bussolaro; Manuel Lagravère; Camila Pacheco-Pereira; Carlos Flores-Mir Journal: Head Face Med Date: 2020-03-09 Impact factor: 2.151