A lateral soft tissue radiograph of the neck in a 4-year-old with mouth breathing and hyponasal speech shows the adenoid shadow occupying more than 80 percent of the nasopharyngeal airway. How should this finding be interpreted?
- A Normal adenoid size for age
- B Retropharyngeal abscess
- C Significant adenoid hypertrophy correlating with symptoms ✓
- D Antrochoanal polyp
Correct answer: C. Significant adenoid hypertrophy correlating with symptoms
Explanation
The adenoid to nasopharyngeal ratio on lateral neck radiography quantifies adenoid enlargement, and a ratio above 0.7 to 0.8 is conventionally taken as significant hypertrophy that correlates with nasal obstruction and sleep disordered breathing. Indian examination convention treats this ratio as the standard objective measure. An antrochoanal polyp arises from the maxillary antrum and appears as a separate soft tissue mass, not diffuse nasopharyngeal filling.
Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.
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