What question did this study set out to answer?

To identify endoscopic adenoid-to-choanae ratio thresholds that differentiate symptomatic from asymptomatic preschool children.

March 21, 2026Open Access

From Physiology to Intervention: Endoscopic Adenoid-to-Choanae Ratio Thresholds for Symptomatic Adenoid Hypertrophy in Preschool Children

Key Points

To identify endoscopic adenoid-to-choanae ratio thresholds that differentiate symptomatic from asymptomatic preschool children.
Retrospective analysis of 225 preschool children (ages 3-7)
Flexible nasopharyngoscopy performed to assess adenoid size
Standardized history-taking and MASNA scoring used for symptom evaluation
Receiver operating characteristic (ROC) analysis to identify optimal A/C thresholds
Median A/C ratio was higher in symptomatic children than in asymptomatic children
Symptomatic children presented with increased MASNA mucus scores and rhinorrhea frequency
ROC analysis identified an A/C ratio of 60% as optimal for distinguishing symptomatic status
An A/C ratio >60% was the only independent predictor of symptomatic status

Abstract

ImportanceAdenoid enlargement in preschool children is commonly cited as a cause of nasal obstruction and sleep-disordered breathing, yet age-related lymphoid development complicates differentiation between physiological growth and clinically significant hypertrophy. Existing endoscopic grading schemes lack consensus on age-specific normative limits and clear management thresholds.ObjectiveThis study aimed to determine endoscopic adenoid-to-choanae (A/C) ratio cut-offs that discriminate symptomatic from asymptomatic preschool children and to propose a practical, management-oriented grading scale.DesignSTROBE.ParticipantsWe performed a retrospective analysis of 225 preschool children (age 3-7). Standardized history-taking, flexible nasopharyngoscopy, MASNA (Mucus on Adenoid Scale by Nasopharyngoscopy Assessment) mucus scoring, and tympanometry were performed.InterventionChildren were classified as symptomatic (≥2 "yes" responses to core symptom items) or asymptomatic (no more than one "occasionally" response). Adenoid size was quantified from blinded video review as the A/C ratio.Main Outcome MeasuresReceiver operating characteristic (ROC) analysis identified an optimal A/C threshold for symptomatic status; multivariable logistic regression evaluated independent predictors.ResultsMedian A/C ratio was greater in symptomatic versus asymptomatic children. Symptomatic children also had higher MASNA mucus scores, greater reported rhinorrhea frequency, and less favorable tympanometric profiles. ROC analysis identified an A/C ratio of 60% as the optimal cut-off to discriminate symptomatic from asymptomatic children. An A/C ratio >60% emerged as the sole independent predictor of symptomatic status.ConclusionIn this cohort, the endoscopic A/C ratio strongly discriminated symptomatic from asymptomatic presentations. An A/C threshold of 60% reliably separated predominantly asymptomatic from symptomatic children.RelevanceThese findings, in conjunction with clinical experience and results from our previous studies, form the basis for a proposed three-tier, management-oriented endoscopic scale for preschool patients: Degree I (A/C ≤60%)-within age-appropriate norm; Degree II (A/C 65%-75%)-hypertrophy amenable to conservative management/observation; Degree III (A/C ≥80%)-hypertrophy for which we suggest that surgical intervention ought to be considered.

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Cite This Study

Zwierz et al. (Sun,) studied this question.

synapsesocial.com/papers/69be38ee6e48c4981c679a13 https://doi.org/https://doi.org/10.1177/19160216261421112

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