Investigation of factors associated with choanal featuresin pediatric patients with sleep-disordered breathing

Abstract

　Objective: The aim of the present study was to investigate the degree of choanal coverage by adenoids and the prevalence of adenoid tissue intruding into the nasal cavity (AINC) in pediatric patients with sleep-disordered breathing (SDB) and identify factors associated with these two findings.
　Methods: One hundred and sixty-nine patients (118 males and 51 females) undergoing initial adenoidectomy for SDB were enrolled. In each patient, the degree of adenoidal choanal coverage was estimated intraoperatively based on the levels of the choanal structures hidden by the hypertrophic adenoids, and the existence of AINC was determined during powered adenoidectomy. The associations between the presence of severe choanal coverage/AINC and various etiological factors including gender, age, underlying nasal diseases, preoperative apnea hypopnea index (AHI) and combined surgical procedures were retrospectively assessed.
　Results: The patients whose adenoids hid the inferior turbinate displayed a significantly lower prevalence of AINC. In addition, the patients diagnosed as having allergic rhinitis (AR) showed a significantly higher AINC prevalence than those without AR. In contrast, the group of patients diagnosed as having bacterial rhinosinusitis (BRS) showed a higher number of adenoids hiding the inferior turbinate than those without BRS.
　Conclusions: The present results demonstrated that in pediatric SDB patients, the prevalence of AINC is negatively versus positively associated with severe choanal coverage by adenoids and AR, respectively, suggesting the existence of preferential directions for adenoid growth.