title: ACE grading-A proposed endoscopic grading system for adenoids and its clinical correlation.
abstract: OBJECTIVE
  To propose a novel endoscopic adenoid grading system using a rigid nasal endoscope and to study its correlation with the clinical diagnosis.
  
  
  METHODS
  Prerecorded video clips of rigid nasal endoscopy taken during endoscopic adenoidectomy were retrieved. Otolaryngology consultants blinded to the clinical diagnosis of the child were presented these videos and asked to grade the adenoid hypertrophy as per the proposed endoscopic ACE (Airway/Choana/Eustachian tube) grading system. The clinical diagnosis was correlated with the different aspects of the descriptive endoscopic grading system.
  
  
  RESULTS
  152 video clips were presented to the otolaryngology consultants for grading. The average age was 8.6 years (SD-3.48), while the male female ratio was 3:2. The A subcomponent of the ACE grading showed significant correlation with the diagnosis of sleep disordered breathing and chronic adenotonsillitis, C subcomponent with sleep disordered breathing and the E subcomponent with the diagnosis of otitis media.
  
  
  CONCLUSIONS
  The proposed endoscopic grading is easily applicable and at the same time clearly describes the relation of the adenoids to the nasopharynx, choana and Eustachian tube. Different aspects of the grading system correlated differently with the clinical diagnosis emphasizing that a descriptive scoring rather than a comprehensive scoring is a more relevant clinical tool.
authors.affiliation: Department of ENT, Christian Medical College, Vellore 632004, India. Electronic address: ajoymathew@gmail.com.
authors.forename: Ajoy Mathew
authors.initials: AM
authors.lastname: Varghese
authors.affiliation: Department of ENT, Christian Medical College, Vellore 632004, India. Electronic address: drp.naina@hotmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Naina
authors.affiliation: Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia; Department of Paediatric Otolaryngology, The Children's Hospital at Westmead, Sydney, Australia. Electronic address: atlcheng@bigpond.com.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Cheng
authors.affiliation: Department of ENT, Christian Medical College, Vellore 632004, India. Electronic address: skamrann@gmail.com.
authors.forename: Syed Kamran
authors.initials: SK
authors.lastname: Asif
authors.affiliation: Department of ENT, Christian Medical College, Vellore 632004, India. Electronic address: kurien_mary@hotmail.com.
authors.forename: Mary
authors.initials: M
authors.lastname: Kurien
mesh_terms: D000233:Adenoidectomy / Q000379:methods*; D000234:Adenoids / Q000473:pathology* / Q000601:surgery; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000379:methods*; D005064:Eustachian Tube / Q000473:pathology; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000601:surgery; D008297:Male; D008866:Microsurgery; D009305:Nasopharynx / Q000473:pathology; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000175:diagnosis*
keywords: ACE grading; Adenoid hypertrophy; Choana; Endoscopic adenoid grading; Eustachian tube; Nasopharyngeal airway