DOI: 10.32322/jhsm.2010588 ISSN: 2636-8579

Agreement between a radiologist and an otolaryngologist in adenoid-to-nasopharyngeal ratio measurement on lateral cephalometric radiographs and its association with tympanometric findings in children undergoing adenoidectomy

Pınar Atabey, Şeref Barbaros Arık
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Aims: Adenoid hypertrophy is a common pediatric condition associated with Eustachian tube dysfunction and middle ear disease. Although the adenoid-to-nasopharyngeal (A/N) ratio is widely used for radiographic assessment of adenoid size, its reproducibility between observers from different clinical disciplines and its association with middle ear dysfunction remain uncertain. This study aimed to evaluate the agreement between a radiologist and an otolaryngologist in A/N ratio measurement and the association between the A/N ratio and tympanometric findings in children undergoing adenoidectomy.Methods: This retrospective study included 171 pediatric patients who underwent adenoidectomy and had preoperative lateral cephalometric radiographs and tympanometric examinations. A/N ratios were independently measured by one radiologist and one otolaryngologist. Agreement was assessed using the intraclass correlation coefficient (ICC), Bland-Altman analysis with formal testing for proportional bias, and Cohen’s kappa after dichotomisation at published thresholds. Associations between the A/N ratio and tympanometric patterns were evaluated using nonparametric tests, receiver operating characteristic (ROC) analysis, and multivariable logistic regression.Results: Agreement between the two observers was good [ICC=0.796, 95% confidence interval (CI): 0.73-0.85; p

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