title: Reliability of subjective, linear, ratio and area cephalometric measurements in assessing adenoid hypertrophy among different age groups.
abstract: OBJECTIVE
  To test the validity of four different types of lateral cephalometric radiograph (LCR) measurements as a diagnostic test of adenoid hypertrophy in different age groups of mouth-breathing children.
  
  
  METHODS
  Eighty-six mouth-breathing children (male 54.65%, mean age 7.0 ± 2.2 years) were randomly selected from a hospital population. Adenoid obstruction of the nasopharynx was evaluated by subjective, linear, ratio, and area LCR measurements. Each measurement was compared with flexible fiberoptic endoscopy diagnosis.
  
  
  RESULTS
  Kendall correlation coefficients for agreement between tests were ≥ 0.67 and kappa scores were substantial (≥ 0.64). Higher correlation coefficients and agreement values were found in older age groups. When the sample was stratified by age, the 3- to 5-year-old age group showed lower correlation coefficients and agreement strength for subjective, linear, and ratio measurements. The sensitivity of LCR varied from 71% (ratio) to 84% (linear). The specificity varied from 83% (linear) to 97% (ratio). The positive predictive value varied from 88% (linear) to 97% (ratio). The negative predictive value varied from 70% (ratio) to 78% (linear). The validity of each measure was different among the age groups.
  
  
  CONCLUSIONS
  LCR is a valid method for measuring adenoid hypertrophy in children from 6 to 12 years old. The diagnosis of adenoid hypertrophy, based on LCR measurements, in children with primary dentition (3-5 years old) should be made with caution. The combination of linear and ratio LCR measurements is a reliable screening tool to determine the need for an ear, nose, and throat evaluation.
authors.affiliation: Undergraduate Program in Speech Pathology, Izabela Hendrix Methodist University, Belo Horizonte, Brazil.
authors.forename: Marcelo Quiroga
authors.initials: MQ
authors.lastname: Souki
authors.forename: Bernardo Quiroga
authors.initials: BQ
authors.lastname: Souki
authors.forename: Letícia Paiva
authors.initials: LP
authors.lastname: Franco
authors.forename: Helena Maria Gonçalves
authors.initials: HM
authors.lastname: Becker
authors.forename: Eustáquio Afonso
authors.initials: EA
authors.lastname: Araújo
mesh_terms: D000234:Adenoids / Q000000981:diagnostic imaging / Q000473:pathology*; D000367:Age Factors; D000402:Airway Obstruction / Q000150:complications* / Q000000981:diagnostic imaging; D019540:Area Under Curve; D002508:Cephalometry / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000175:diagnosis; D008297:Male; D009058:Mouth Breathing / Q000209:etiology*; D009305:Nasopharynx / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011859:Radiography; D015203:Reproducibility of Results