The aim of the study is to compare intra-operative mirror and nasendoscopic assessment of the degree of posterior choanal obstruction caused by adenoidal hypertrophy in children undergoing adenoidectomy.
This is a prospective blinded study of 26 children undergoing adenoidectomy under general anaesthesia, aged between 2 to 13 years. A total of 52 Intra-operative nasendoscopic views and 26 mirror views of the posterior choanae were photographed. Two independent ENT specialists (a registrar and a consultant), who were blinded to the clinical history and identity of the patients, assessed these 78 photographs. Assessors scored the degree of choanal obstruction out of 100%. The scores were analysed using the Two-Sample equal variance T-test function on Microsoft Excel 2013.
The nasendoscopic views consistently showed a significantly higher degree of posterior choanal obstruction compared to mirror examination views (P-value <0.001). There was no significant difference between the scores of both assessors (P-value > 0.05). In 8 of the 26 patients (30.7%), the registrar’s decision not to proceed with surgery after reviewing the mirror view was changed to proceeding with surgery having reviewed the nasoendoscopic view. This was the case for 6 of the 26 patients (reviewed by the consultant. There were three patients in common in which the registrar and consultant reached the above conclusion.
Intra-operative nasendoscopy is more accurate in assessing the degree of posterior choanal obstruction due to adenoidal hypertrophy than mirror examination. It is important to consider nasendoscopy in patients with nasal symptoms where mirror examination of the posterior choanae is negative.