An 8-year-old child has persistent mouth breathing and snoring. Anterior rhinoscopy is inconclusive because the child cannot tolerate endoscopy. The simplest imaging investigation to demonstrate adenoid hypertrophy and assess the degree of nasopharyngeal airway obstruction is:

• A CT scan of the paranasal sinuses
• B MRI of the nasopharynx
• C Lateral soft tissue radiograph of the nasopharynx ✓
• D Frontal sinus view (Caldwell view)

Explanation

A lateral soft tissue radiograph of the nasopharynx taken during quiet breathing demonstrates the adenoid mass and allows measurement of the adenoid-nasopharyngeal ratio, giving a simple objective estimate of airway obstruction. It remains the standard screening image when endoscopy is not feasible. CT and MRI provide far more detail than needed for this decision and expose the child to cost, radiation, or sedation without changing management.

Reference: Diseases of Ear, Nose and Throat (Dhingra), 7th ed.

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Written and medically reviewed by the StethoPrep medical team.