Correlation of adenoid hypertrophy with impedance audiometry findings in children under twelve

Abstract

Background: Adenoid hypertrophy is a common cause of nasal obstruction, hearing impairment, and otitis media with effusion (OME) in children. Accurate evaluation of adenoid size and its relationship with middle ear status is essential for appropriate management.

Methods: This cross-sectional observational study included 80 children aged 2–12 years presenting with symptomatic adenoid hypertrophy. Adenoid size was assessed using radiological methods and nasal endoscopy. Endoscopic evaluation was performed using the Adenoid-Choanal-Eustachian (ACE) grading system. Middle ear status was evaluated using impedance audiometry, and tympanogram patterns were correlated with adenoid size and endoscopic findings.

Results: A significant correlation was observed between increasing grades of adenoid hypertrophy and the incidence of OME. Among patients with Grade 2 hypertrophy, 75% had OME, while 90% of those with Grade 3 hypertrophy were affected. Bilateral type B tympanograms, indicative of middle ear effusion, were seen in 33.33% of Grade 2 cases and 55.56% of Grade 3 cases. Nasal endoscopy using the ACE grading system demonstrated a 100% correlation with Type B tympanograms in cases where adenoid tissue abutted the Eustachian tube.

Conclusions: Higher grades of adenoid hypertrophy are strongly associated with OME. The ACE grading system is a reliable tool for predicting Eustachian tube involvement. A combined approach using nasal endoscopy and impedance audiometry improves diagnostic accuracy and supports standardized management in pediatric patients.