Sensitivity and specificity of nasal flexible fiberoptic endoscopy in the diagnosis of adenoid hypertrophy in children

OBJECTIVE: To evaluate nasal flexible fiberoptic endoscopy as a diagnostic test of adenoid hypertrophy in children with nasal obstruction. METHODS: One hundred and thirty consecutive children aged 2-12 years were examined from May to October 2005. A questionnaire answered by parents or guardians was used to obtain a symptom score. Adenoid size was measured on radiographs of the nasal cavity using the Cohen and Konak method, and by nasal flexible fiberoptic endoscopy using the Wornald and Prescott classification. The criterion standard was the adenoid size demonstrated on radiograph. RESULTS: The sensitivity of nasal flexible fiberoptic endoscopy was 92% (95% CI, 0.90-0.93), and specificity, 71% (95% CI, 0.70-0.72). The area under the ROC curve was 0.83 (95% CI, 0.76-0.90) at a p<0.001 level of significance. Kappa values were 0.94 (p<0.001) for interobserver agreement, 0.95 (p<0.001) for intraobserver agreement, and 0.54 (p<0.001) for agreement between tests. CONCLUSIONS: Results suggest that nasal flexible fiberoptic endoscopy is a highly accurate diagnostic method. This examination can be performed easily in cooperative children; it is safe, objective and dynamic, and helps to establish diagnoses in difficult cases.