Zanco Journal of Medical Sciences
Skip Navigation Links
Available Issues
Editorial Board
Information for Authors
Review Process
Links and Contacts
  Zanko J Med Sci:  Dec. 2016; 20 (3): 1396-1403

The effect of adenoid size on tympanometric finding in children

Farhad Jalil Khayat*, Said Mustafa Said*, Hanna Hanano Kasho*, Bashir Jalal Jamil**

* Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.

** Directorate of Health, Erbil, Iraq.


Background and objective: There are controversial reports regarding the effect of adenoid size on middle ear conditions. Enlarged adenoid size may cause nasopharyngeal obstruction or may act as a reservoir for infection and cause tympanometric changes. This study aimed to determine the correlation between adenoid size and tympanometric findings in children.

Methods: This prospective study included 71 children aged 3-10 years old attending Rizgary Teaching Hospital for adenotonsillectomy between August 2013 to January 2014. Questions about upper airway obstruction symptoms were directed to parents and patients. Tympanometry and plane radiological study of lateral soft tissue of the neck were done for each case. Tympanometric type A and C1 were considered normal while B and C2 as abnormal. The adenoid size was measured by using adenoidal/nasopharyngeal ratio. 

Results: Of 71 children (142 ears), 20 children (40 ears) had gross adenoid enlargement, of which tympanometry was found to be normal in 75% and abnormal in 25%. In 28 children (56 ears) with moderate adenoid enlargement, tympanometry was normal in 78.6% and abnormal in 21.4%. Twenty three children (46 ears) had minimal adenoid enlargement, in which tympanometry was normal in 91.3% and abnormal in 8.7%. 

Conclusion: The study showed that adenoid size in children had an effect on tympanometric readings. Although the incidence of abnormal tympanometry was higher with the increased adenoid size but it was statistically non-significant. 

Keywords: Adenoiditis; Adenoid hypertrophy; Nasopharyngeal tonsil; Tympanometry.


1. Michael G, George GB, Martin JB, Ray C, John H, Nicholas SJ, et al. The adenoid and Adenoidectomy. Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery, 7th ed; 2008. 

2. Kindermann CA, Roithmann R, Lubianca Neto JF. Obstruction of the Eustachian tube orifice and pressure changes in the middle ear: are they correlated? Ann Otol Rhinol Laryngol 2008; 117(6):425-9.

3. Acharya, Bhusal CL, Guragain RP. Endoscopic grading of adenoid in otitis media with effusion. J Nepal Med Assoc 2010; 49(177):47

4. Gross CW, Harrison SE. Tonsils and Adenoids. Paediatr Rev 2000; 21(3):75-8.

5. Maria V. Management of Adenotonsillar Disease. In: Anil K, editor. CURRENT Diagnosis &Treatment in OTOLARYNGOLOGY-Head & Neck surgery.3rded. New York: PR Donnelly; 2011. P. 362.

6. Chien CYChen AMHwang CFSu CY. The clinical significance of adenoid-choanae area ratio in children with adenoid hypertrophy. Int J Pediatr Otorhinolaryngol 2005; 69(2): 235-9.

7. Britta RD, Kareen A. The nasopharynx and the middle ear. Inflammatory reactions in middle ear disease. Vaccine 2001; 19 (Suppl 1): S26-31.

8. Egeli E, Oghan F, Ozturk O, Harputluoglu U, Yazici B. Measuring the correlation between adenoidal-nasopharyngeal ratio ( AN ratio) and tympanogram in children. Int J Pediatr Otorhinolaryngol 2005; 69 (2):229-33.

9. Nguyen LHP, Manoukian JJ, Yoskovitch A, Al- Sebeih KH. Adenoidectomy- selection criteria for surgical cases of otitis media. The Laryngoscope 2004; 114:863-6.

10. Ren DD, Wang WQ. Assessment of middle ear effusion and audiological characteristics in young children with adenoid hypertrophy. Chin Med J (Engl) 2012; 125(7):1276-81.

11. Di Francesco R, Paulucci B, Nery C, Bento RF. Craniofacial morphology and otitis media with effusion in children. Int J Pediatr Otorhinolaryngol 2008; 72:1151-8.

12. Becker S, Koch T, Philipp A. Allergic origin of recurrent middle ear effusion and adenoids in young children. HNO 1991; 39(5):182-4.

13. Pelikan Z, Chronic otitis media (secretary) and nasal allergy. Scripta medica (Brno) 2006; 79(4):177-98.

14. Khayat FJ, Dabbagh LA. Incidence of otitis media with effusion in children with adenoid hypertrophy. Zanco J Med Sci 2011; 15(2):57-63.

15. Deyun W, Peter C, Leonard K, Marie PD. Fiberoptic examination of the nasal cavity and nasopharynx in children. J Otolaryngol 1994; 23(1):57-60.

16. Da Costa JL, Navarro A, Branco Neves J, Martin M,. Otitis media with effusion: association with the Eustachian tube dysfunction and adenoiditis. The case of central hospital of Maputo Acta Otorhinolaryngol Esp 2005; 56(7):290-4.

17. Satsih SH, Sarojamma, Anjan Kumar AN. A study on role of adenoidectomy on otitis media with effusion. Journal of Dental and Medical Sciences 2013; 4(6):20-4.

18. Orji FT, Ezeanolue BC. Evaluation of adenoidal obstruction in children: clinical symptoms compared with roentgenographic assessment. J Laryngol Otol 2008; 122(11):1201-5.

19. Modrzynski, Mierzwinski MJ, Piziewicz A. Additional diagnostic methods for recording of adenoid hypertrophy in children with allergic rhinitis. Przegl Lek 2004; 61(2):74-7.

20. Abdollahi FS, Naderpoor M, Shahid N, Javadrshdi R, Mashrabi O, Ravaghi M. Aseessment of adenoid size in children. Res J Biol Sci 2008; 3(7):747-9.

21. Calay R, Betas D, Atalay C, Korkmaz O. Prevalence and risk factors of otitis media with effusion in Trabzon, a city in north eastern Turkey with an emphasis on the recommendation of otitis media with effusion screening. Eur Arch Otorhinolaryngol 2006; 263:404-8.

 22. Yockel NJ. A comparison of audiometry and audiometry with tympanometry to determine middle ear status in school-age children. J Sch Nurs. 2002 Oct;18(5):287-92.

23. Browning G, Otitis media with effusion. In : Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones N, Lund V, Luxon L, Watkinson J (eds). Scott- Brwon’s Otolaryngology, Head and Neck Surgery, 7th edition. New Work: Hodder Arnold; 2008. P. 877.

24. Khayat FJ, Shareef LA. Relation between size of adenoid and otitis media with effusion among a sample of primary school age children in Erbil city [Thesis]. Erbil: Hawler Medical University; 2010.

25. Onusko E. Tympanometry. American Family of Physicians 2004; 70 (9):1713-20.

26. Rushton BA, Tong MCF, Yue V, Wormald PJ, Van Hasselt CA. Prevalence of otitis media with effusion in multicultural scholls in Hong Kong J Laryngol Otol 1997; 111: 804-6.

27. Zeiluis GA, Rach GH, Van den Bosch A, Van den Broek P. The prevalence of otitis media with effusion. AS critical review of literature. Clin Otolaryngol 1990; 15: 283-8.

28. Abdul Baqi J, Shakhatreh F, Qasim K. Use of adenoidectomy and adenotonsillectomy in children with otitis media and effusion. ENT J 2001; 120: 284-8.

29. Cengel S, Akyol MU. The role of topical nasal steroids in children with otitis media and effusion and/or adenoid hypertrophy. Int J Pediatr Otorhinolaryngol 2006; 70(4):639- 45.

30. Yssan H, Doru H, Tuz M, Ĉandir Ő,Uygur K, Yarikta M. Otitis media with effusion and histopathology properties of adenoid tissue. Int J Pediatr Otorhinolaryngol 2003; 67(11):1179-83.

31. Agidir B, Bozova S, Alper T, Turhan M. Chronic otitis media with effusion and helicobacter pylori. Int J Pediatr Otorhinolaryngol. 2006;70(5):829-34.

32. Tong MC, Yue V, Ku PK, Lo PS, Wong EN, Van Hasselt. Risk factors for otitis media with effusion in China’s school children; a nested case-control study and review of literature. Int J Pediatr Otorhinolaryngol. 2006; 70(2):213-19.

33. Tanpowpomg K, Saisukul I, Kittimanont H, Rattanasiri S. Outcome of maringotomoy with ventilation tube for otitis media with effusion in Thai children. J Med Assoc Thai. 2007; 90(9):1866-70.

34. R.A. Alhady, M.E. Sharnoubi, Tympanometric findings in patients with adenoid hyperplasia, chronic sinusitis and tonsillitis, J. Laryngol Otol. 1984; (98): 671-6.

35. Toros SZ, Kilicoglu G, Noseri H, Naiboglu B, Kalaycik C, Kulekci S, et al. Does adenoid hypertrophy really have effect on tympanometry? Int Journ Pediatr Otorhinolaryngol. 2010; 74: 365-8.

36. Wright ED, Pearl AJ, Manoukian JJ. Laterally hypertrophic adenoid as a contributing factor in otitis media. ? Int Journ Pediatr Otorhinolaryngol 1998; 45(3): 207-14.

 37. Abdul Latif K, Spilsbury K, Semmens J, Coates H, Lannigan F. Adenoidectomy for middle ear effusion. The American laryngological, Rhinological and ontological society, Inc. 007; 117(3): 427-33.

38. Stewart IA. Evaluation of factors affecting outcome of surgery for otitis media with effusion in clinical practice. Int J Pediatr Otorhinolaryngol 1999;49: 243-5.

39. Takahashi H, Fujita A, Kurata K, Honjo I. Adenoid and otitis media with effusion –mini review. International Congress Series 2003; 1257:207-11.

40. Balram, Rani, Mansour Jafar. Medical management of otitis media with effusion. Kuwait Med J 2001; 33(4):317-2.

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.


Slightly know the replica watches uk fashionable women, even if you do not understand the replica watches also know that Cartier tanks, after all, this is the rolex replica royal family, film stars, literary celebrities, and rolex replica uk even political places are wearing watches.