The adenoids must be checked with an angled mirror since they lie between the back of the nose and the throat. Swollen tonsils are easier to see, forming a reddish, oval mass. Occasionally they are large enough to actually touch in the middle. The severity and frequency of tonsillitis must be taken into account when considering a tonsillectomy. Massively enlarged tonsils and adenoids may obstruct the airway and cause sleep apnea and breathing difficulty during the daytime.
Fortunately, the size of the tonsils and adenoids generally begins to decrease after age 9 and shrinks rapidly during the teen years.
Also, the incidence of tonsillitis peaks between ages 4 and 7, then begins to decrease; tonsillitis becomes relatively uncommon after age The modifications involved conversion to 3-grade and 5-grade scales by varying the cutoff values. This study is a part of an ongoing epidemiologic study of sleep-related breathing disorder in children in Hong Kong that was approved by the ethics committee of The Chinese University of Hong Kong.
On examination of the tonsils, the tongue was in the neutral natural position in the mouth and was gently pressed onto the floor of the mouth. The appearance of the tonsils was video recorded using the flexible endoscope, which was placed inside the oral cavity. A random sample of 60 such video recordings was obtained for this study. This study recruited 12 independent observers, including 2 otorhinolaryngology specialists, 2 otorhinolaryngology residents, 2 pediatric specialists, 2 pediatric residents, 2 family physicians, and 2 interns.
They reviewed the video recordings separately and visually assessed the size of the tonsils, as gauged by their medial extension compared with the width of the oropharyngeal airway defined as the linear distance between the anterior tonsillar pillars at the midtonsillar level.
To aid in visual judgment and to account for some cases of asymmetric tonsils, the independent observers were asked to assess the tonsillar size in the following manner. The medial extension of the tonsil on one side was estimated first. The result was recorded. This was repeated for the contralateral tonsil. Then, the size of both tonsils represented by the horizontal distance of the medial extension as a percentage of the whole oropharynx represented by the distance between the anterior tonsillar pillar at the midtonsillar pole was derived by taking the mean of these 2 values.
Having the estimated percentage in mind, the independent observers then decided on the tonsillar grade using the different grading scales, which were recorded on a data sheet. After the first round of observations, the video recordings were shuffled, and the independent observers reviewed the video recordings the next day.
The same estimation procedures were repeated. Therefore, each observer had 2 sets of observations for the same collection of video recordings. The intraobserver and interobserver reproducibility of the different grading scales for tonsillar size was determined. In this study, 3 grading scales were used. These include the Brodsky grading scale and the modified 3-grade and 5-grade scales.
The intraobserver and interobserver reproducibility for the different grading scales was determined using the statistical method of intraclass correlation. An ICC of 0 indicates complete lack of agreement beyond chance, and an ICC of 1 indicates perfect agreement between the sets of observations. An ICC exceeding 0. The intraobserver reproducibility of the tonsillar size estimation for the 12 independent observers is given in Table 1. The intraobserver ICC exceeded 0.
This observer's ICC was below 0. The mean intraobserver ICCs for the Brodsky grading scale, modified 3-grade scale, and modified 5-grade scale were 0. The interobserver reproducibility of the tonsillar size estimation for the 12 independent observers is given in Table 2. Because each observer had 2 sets of observations, the interobserver ICC was calculated for both sets of data. The mean interobserver ICCs for the 2 sets of observations using the Brodsky grading scale, modified 3-grade scale, and modified 5-grade scale were 0.
A prerequisite for a useful clinical grading system is good reproducibility of the results, including observations made at different times by the same rater or observations made by different observers. In addition, physicians with various backgrounds should be able to successfully use it.
Results: In total, patients age range, 1 month years were enrolled in the study. Mean measurements for the sums of both tonsils for the transverse diameter, anteroposterior diameter, and length were 1. Tonsillar size and volume increased according to age. PubMed Google Scholar.
Usefulness of adenotonsillar size for prediction of severity of obstructive sleep apnea and flow limitation. Otolaryngol Head Neck Surg. Diagnosis and management of childhood obstructive sleep apnea syndrome. Reproducibility of clinical grading of tonsillar size.
Arch Otolaryngol Head Neck Surg. Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clin North Am. Clinical predictors of obstructive sleep apnea. Variation in tonsil size in 4- to year-old schoolchildren. J Otolaryngol. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. Nolan J, Brietzke SE. Systematic review of pediatric tonsil size and polysomnogram-measured obstructive sleep apnea severity.
Does subjective tonsillar grading reflect the real volume of palatine tonsils? Int J Pediatr Otorhinolaryngol. Brietzke SE, Gallagher D. A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med. Obstructive sleep apnea syndrome due to adenotonsillar hypertrophy in infants.
Digital oral photography for pediatric tonsillar hypertrophy grading. Reliability of radiographic parameters in adenoid evaluation. Braz J Otorhinolaryngol. Brodsky and Friedman Grading Scales. Save Preferences. Privacy Policy Terms of Use. This Issue. Views 16, Citations View Metrics. Twitter Facebook More LinkedIn. Original Investigation.
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