Estimating Adenoidal Obstruction of the Nasopharyngeal Airway in Children (Nasal Obstruction Index of Paradise et al)

Description

Children with adenoidal obstruction of the nasopharyngeal airway will show increased mouth breathing and hyponasality in speech. A clinical index based on mouth breathing and nasality of speech correlates with the degree of obstruction seen on X-ray. The study was done at the University of Pittsburgh.

Parameters for nasal obstruction index:

(1) mouth breathing: The degree of mouth breathing was observed throughout the clinical assessment and included times when the patient was distracted or in repose. The lips are closed when there is no mouth breathing, slightly apart with mild mouth breathing, and widely separated with marked mouth breathing.

(2) hyponasality in speech during alternating opening and closing of the nares: With normal speech, nasal resonance is heard when phrases are spoken with the nares open; this is markedly reduced when the nares are pinched close. With hyponasal speech, resonance is poor when the nares are open; little change is noted when the nares are pinched close.

Parameter	Finding	Points
mouth breathing	none	1
	slight	2
	moderate	3
	marked	4
hyponasality	none	1
	mild	2
	moderate	3
	marked	4

nasal obstruction index =

= ((points for mouth breathing) + (points for hyponasality)) / 2

In addition, the anterior nasopharynx is examined.

Parameter	Finding	Points
nasal secretions	none	1
	slight	2
	moderate	3
	marked	4
mucosal edema	none	1
	mild	2
	moderate	3
	marked	4
erythema of the nasal mucosa	none	1
	mild	2
	moderate	3
	marked	4
compromise of the intranasal airway	none	1
	mild	2
	moderate	3
	marked	4

Interpretation:

• minimum nasal obstruction index: 1.0

• maximum nasal obstruction index: 4.0

• The anterior nasopharynx should show no or minimal change in order to ascribe evidence of nasal obstruction to enlarged adenoids.

• The higher the nasal obstruction index, the greater the degree of adenoidal obstruction.

Nasal Obstruction Index	Degree of Obstruction on X-rays
1.0 and 1.5	low
2.0 and 2.5	intermediate
3.0, 3.5 and 4.0	high

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Description

Specialty

ICD-10