title: Clinical assessment of adenoidal obstruction based on the nasal obstruction index is no longer useful in children.
abstract: OBJECTIVE
  To evaluate the accuracy of clinical assessment of adenoidal obstruction based on a standardized score of the degree of mouth breathing and speech hyponasality (nasal obstruction index [NOI]) in comparison to nasal fiberoptic endoscopy.
  
  
  METHODS
  Cross-sectional study with planned data collection.
  
  
  METHODS
  Outpatient clinics of the Departments of Maternal and Pediatric Sciences and Specialized Surgical Sciences, University of Milan, Italy.
  
  
  METHODS
  Children aged three to 12 years with adenoidal obstruction suspected on the grounds of persistent/recurrent otitis media or perceived obstructive nasal breathing were eligible. Ear, nose, and throat examination, allergy testing, NOI measurement, and nasal fiberoptic endoscopy to assess the degree of adenoidal hypertrophy were performed. Agreement between the NOI and adenoidal hypertrophy grade was assessed in the patients as a whole and by clinical subgroups.
  
  
  RESULTS
  A total of 202 children were enrolled: 54.9 percent had otological diseases and 45.1 percent had perceived obstructive nasal breathing. Most of the children (79.2%) showed mild or moderate clinical nasal obstruction. Adenoidal hypertrophy ranged from no obstruction (18%) to severe obstruction (38%). There was no substantial agreement between the NOI and the degree of adenoidal obstruction in the population as a whole and in all the clinical subgroups. False positive findings were significantly more frequent among allergic children (50%) than non-allergic children (22.4%, P = 0.009).
  
  
  CONCLUSIONS
  Clinical assessment based on the NOI is incapable of accurately predicting the degree of adenoidal obstruction. In children with clinical nasal obstruction not explainable by adenoidal size, the clinician should consider, among causes of more anterior obstruction, nasal allergy.
authors.affiliation: Department of Maternal and Pediatric Sciences, University of Milan, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Marchisio
authors.forename: Sara
authors.initials: S
authors.lastname: Torretta
authors.forename: Pasquale
authors.initials: P
authors.lastname: Capaccio
authors.forename: Susanna
authors.initials: S
authors.lastname: Esposito
authors.forename: Elisa
authors.initials: E
authors.lastname: Dusi
authors.forename: Erica
authors.initials: E
authors.lastname: Nazzari
authors.forename: Anna
authors.initials: A
authors.lastname: Bossi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Pignataro
authors.forename: Nicola
authors.initials: N
authors.lastname: Principi
mesh_terms: D000234:Adenoids / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000150:complications; D007828:Laryngoscopy; D008297:Male; D009058:Mouth Breathing / Q000209:etiology; D015508:Nasal Obstruction / Q000175:diagnosis* / Q000209:etiology; D010031:Otitis / Q000209:etiology; D018570:Risk Assessment; D012720:Severity of Illness Index; D014832:Voice Disorders / Q000209:etiology