The Correlation Between Tonsil Size and Adenoid Size in School-Aged Children in Kut City, Wasit Province, Iraq
DOI:
https://doi.org/10.65420/sjphrt.v1i2.199Keywords:
Adenoid hypertrophy, Tonsil size, Nasoendoscopy, Brodsky grading, Parikh grading, Upper airway obstructionAbstract
Adenoid hypertrophy and tonsillar enlargement are among the most frequent causes of upper airway obstruction in children. This study aimed to assess the correlation between tonsil size and adenoid size and to examine whether tonsillar grading can be used to estimate adenoid size. A prospective observational study was conducted at the ENT clinic of Al-Zahraa Teaching Hospital, Kut City, Wasit, Iraq, from January 2023 to December 2025. Children aged 3–16 years presenting with symptoms suggestive of adenoid and/or tonsillar hypertrophy were enrolled. Tonsil size was graded using the Brodsky scale, and adenoid size was graded endoscopically using the Parikh system. Data were analyzed using cross-tabulation, Fisher’s exact test, Cramér’s V, and Spearman’s rank correlation, with p < 0.05 considered significant. A total of 120 children were evaluated (58.3% male). Grade 4 adenoids were found in 53.3% of cases, and grade 2 was the most frequent tonsillar grade (36.7%). Adenoid and tonsil grades were significantly associated (Fisher’s exact test, p < 0.001; Cramér’s V = 0.379), whereas the rank correlation was positive but weak (ρ = 0.230, p = 0.011). Grade 4 tonsils predicted grade 4 adenoids with a specificity of 96.4% and a positive predictive value of 92.6%, but the sensitivity was only 39.1%. Thus, large tonsils are a reliable indicator of severe adenoid hypertrophy, although small tonsils do not exclude it. Tonsillar assessment may help clinicians estimate adenoid size when endoscopic evaluation is not feasible, as in uncooperative children or those with cognitive impairment, and may support family counseling.
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