Correlation between nasopharyngoscopy and cephalometry in the diagnosis of hyperplasia of the pharyngeal tonsils

Int. Arch. Otorhinolaryngol. 2012;16(2):209-216. DOI: 10.7162/S1809-97772012000200009 Original Article Correlation between nasopharyngoscopy and cephalometry in the diagnosis of hyperplasia of the pharyngeal tonsils Correlação entre a nasofibrofaringoscopia e a cefalometria no diagnóstico de hiperplasia de tonsilas faríngeas Rodrigo Agne Ritzel1, Luana Cristina Berwig2, Ana Maria Toniolo da Silva3, Eliane Castilhos Rodrigues Corrêa4, Eliane Oliveira Serpa5. 1) Master. Otolaryngologist from Hospital Universitário de Santa Maria - Santa Maria University Hospital. 2) Master. Resident Speech Therapist for Multidisciplinary Integrated Management and Health Care Residency Program from Universidade Federal de Santa Maria Federal University at Santa Maria. 3) Doctor. Professor Member from Speech Therapy Course of Universidade Federal de Santa Maria/ Federal University of Santa Maria. 4) Doctor. Adjunct Professor of Physical Therapy Course of Universidade Federal de Santa Maria/ Federal University of Santa Maria. 5) Master. Orthodontics Clinical. Institution: Federal University of Santa Maria. Santa Maria / RS - Brazil. Mailing address: Rodrigo Agne Ritzel - Pinheiro Machado Street, 2350/806 - Bairro Centro - Santa Maria / RS - Brazil - Zip-code: 97050-600 - Telephone: (+55 55) 3028-9507 - E-mail: Article received in August 17, 2011. Article approved in February 6, 2012. SUMMARY RESUMO Introduction: Hyperplasia of the pharyngeal tonsil is one of the main causes of mouth breathing, and accurate diagnosis of this alteration is important for proper therapeutic planning. Therefore, studies have been conducted in order to provide information regarding the procedures that can be used for the diagnosis of pharyngeal obstruction. Objective: To verify the correlation between nasopharyngoscopy and cephalometric examinations in the diagnosis of pharyngeal tonsil hyperplasia. Method: This was a cross-sectional, clinical, experimental, and quantitative study. Fifty-five children took part in this study, 30 girls and 25 boys, aged between 7 and 11 years. The children underwent nasofibropharyngoscopic and cephalometric evaluation to determine the grade of nasopharyngeal obstruction. The Spearman’s rank correlation coefficient at the 5% significance level was used to verify the correlation between these exams. Results: In the nasopharyngoscopy evaluation, most children showed grade 2 and 3 hyperplasia of the pharyngeal tonsil, which was followed by grade 1. In the cephalometry assessment, most children showed grade 1 hyperplasia of the pharyngeal tonsil, which was followed by grade 2. A statistically significant regular positive correlation was observed between the exams. Conclusion: It was concluded that the evaluation of the pharyngeal tonsil hyperplasia could be carried out by fiber optic nasopharyngoscopy and cephalometry, as these examinations were regularly correlated. However, it was found that cephalometry tended to underestimate the size of the pharyngeal tonsil relative to nasopharyngoscopy. Keywords: mouth breathing, nasopharynx, diagnosis, comparative study. Introdução: A hiperplasia de tonsila faríngea é uma das principais causas da respiração oral. O diagnóstico preciso desta alteração é importante para o correto planejamento terapêutico. Em vista disso, estudos têm sido desenvolvidos a fim de fornecer subsídios quanto aos procedimentos que podem ser utilizados para o diagnóstico de obstrução faríngea. Objetivo: Verificar a correlação entre os exames de nasofibrofaringoscopia e cefalometria no diagnóstico de hiperplasia de tonsila faríngea. Método: Estudo transversal, clínico e experimental. Participaram deste estudo 55 crianças, 30 meninas e 25 meninos, com idades entre 7 e 11 anos. As crianças foram submetidas à avaliação nasofibrofaringoscópica e cefalométrica para a determinação do grau de obstrução da nasofaringe. Para verificar a correlação entre esses exames foi utilizado o coeficiente de correlação de Spearman ao nível de significância de 5%. Resultados: Na nasofibrofaringoscopia a maioria das crianças apresentou hiperplasia de tonsila faríngea graus 2 e 3, seguidas de grau 1. Na cefalometria a maior parte das crianças apresentou hiperplasia de tonsilas faríngeas grau 1, seguida de grau 2. Na correlação entre os exames, evidenciou-se correlação regular e positiva. Conclusão: A avaliação da hiperplasia de tonsilas faríngeas pode ser realizada pela nasofibrofaringoscopia e pela cefalometria, pois estes exames apresentam uma relação regular e positiva. No entanto, verificou-se que a cefalometria tende a subestimar o tamanho da tonsila faríngea em relação à nasofibrofaringoscopia. Palavras-chave: respiração bucal, nasofaringe, diagnóstico, estudo comparativo. Int. Arch. Otorhinolaryngol., São Paulo - Brazil, v.16, n.2, p. 209-216, Apr/May/June - 2012. 209 Correlation between nasopharyngoscopy and cephalometry in the diagnosis of hyperplasia of the pharyngeal tonsils. INTRODUCTION The breathing process, which begins at the upper airway and culminates in gas exchange inside the alveoli, is essential for the human organism to survive. When breathing begins through the nose, the air is prepared in order to reach the lungs with the ideal conditions, that is, warmed, moistened, and filtered, thus activating immunological processes such as mucociliary transport and microbicidal activity that protect the lower airway. When breathing begins through the mouth, despite air warming and moistening, no filtering or immunological activity occurs (1). When mouth breathing occurs in childhood, a period during which intense facial muscular and skeletal growth occurs, it promotes a pathological adaptation of the structures of the stomatognathic system, to the detriment of the usually harmonious morphological and functional growth of these structures (2). The main causes of mouth breathing in childhood are the hypertrophy of the pharyngeal and/or palatine tonsil, nasal mucosa and turbinate edema, nasal septal deviation, extended suction habits, and others (3). Morphological adaptations in mouth-breathing children occur with the aim of facilitating the necessary arrival of the air to the alveoli. Thus, it is possible to observe maxillary hypoplasia and posterior mandibular demotion/ rotation, which lead to dental occlusion alterations, higher mandibular inclination, and a vertical facial growth pattern, with alterations in normal facial proportions and hard palate elevation, head anteriorization, and muscular deharmonization, occurring mainly in the nasofacial region. These adaptations generate functional changes in the stomatognathic system, which are observed through alterations in speech, chewing, and deglutition (4,6). The complexity of the consequences of mouth breathing that are associated with various etiologies justifies the participation of several professionals, including otorhinolaryngologists, odontologists, phonoaudiologists, physiotherapists, pediatricians, among other (...truncated)