Background: Radiology, endoscopy, and clinical evaluation are the three most used diagnostic modalities for adenoids. This research aimed to evaluate the most accurate method for assessment of adenoid hypertrophy (radiological versus endoscopic Assessment).

Patients and methods: We carried out this cross-sectional study on 60 children with chronic adenoid hypertrophy recruited from the ENT outpatient clinic in Zagazig university hospital for management their problem. During the initial assessment, a diagnostic nasal endoscopy was conducted utilizing both rigid and flexible endoscopes. X-ray nasopharynx lateral view was done for all patients.

Results: By X ray 30% of the cases were Grade I, 31.7% were Grade II, 18.3% were Grade III and 20 % were Grade IV. By endoscope 30% of the cases were Grade I, 31.7% were Grade II, 28.3 were Grade III and 10% were Grade IV. Statistically significant agreements were revealed between the clinical grading and X ray (p<0.001), the clinical grading and endoscope (p=0.003), X ray and endoscope (p<0.001).

Conclusion: The X-ray alone can rule out adenoidal hypertrophy, but alone it could be insufficient for assessment of the degree of adenoidal obstruction. Endoscopy was found to be more reliable, convenient, correlate well with the volume of adenoid tissue and allow estimation of adenoidal hypertrophy with degree of obstruction. This study demonstrates that combining clinical grading with endoscopy and radiology is important for the evaluation of adenoid hypertrophy.