Acoustic rhinometry for the assessment of adenoid hypertrophy: A systematic review.

BACKGROUND: Adenoid hypertrophy is a common condition in children and a leading cause of upper airway obstruction, associated with sleep-disordered breathing, recurrent otitis media, and chronic rhinosinusitis. Although nasal endoscopy is the most widely used diagnostic tool, its invasiveness and limited correlation with functional obstruction in intermediate cases highlight the need for alternative methods. Acoustic rhinometry (AR) is a non-invasive technique that measures nasal and nasopharyngeal geometry and may overcome several limitations of conventional assessments. OBJECTIVE: To systematically review the evidence on the role of acoustic rhinometry in the diagnosis and evaluation of adenoid hypertrophy in pediatric patients. METHODS: A systematic review was conducted following PRISMA and AMSTAR-2 guidelines, with a registered PROSPERO protocol. PubMed, Cochrane Library, EMBASE, Scopus, SciELO, and Trip Database were searched up to December 2023. Clinical studies evaluating AR in children with adenoid hypertrophy were included. Outcomes included nasopharyngeal area and volume, minimal cross-sectional area, and changes after adenoidectomy. RESULTS: Thirteen studies encompassing 650 participants (563 patients and 87 controls) met inclusion criteria. Most studies demonstrated significant differences between patients and controls and moderate to strong correlations between AR measurements and adenoid size assessed by endoscopy, radiography, or excised tissue. The majority also reported significant increases in nasopharyngeal dimensions following adenoidectomy. However, no studies evaluated test-retest or inter-rater reliability, and evidence correlating AR with nasal obstruction or symptoms was limited. CONCLUSIONS: Acoustic rhinometry is a promising, rapid, and non-invasive adjunct for assessing adenoid hypertrophy. Nevertheless, the lack of standardized protocols, normative pediatric data, and clear correlations with functional obstruction limits its current clinical implementation. Further well-designed studies are required before routine use can be recommended.