{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:52:32Z","timestamp":1777877552498,"version":"3.51.4"},"reference-count":33,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Otolaryngology - Head &amp; Neck Surgery"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Adenoid enlargement in preschool children is commonly cited as a cause of nasal obstruction and sleep-disordered breathing, yet age-related lymphoid development complicates differentiation between physiological growth and clinically significant hypertrophy. Existing endoscopic grading schemes lack consensus on age-specific normative limits and clear management thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to determine endoscopic adenoid-to-choanae (A\/C) ratio cut-offs that discriminate symptomatic from asymptomatic preschool children and to propose a practical, management-oriented grading scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>STROBE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>We performed a retrospective analysis of 225 preschool children (age 3-7). Standardized history-taking, flexible nasopharyngoscopy, MASNA (Mucus on Adenoid Scale by Nasopharyngoscopy Assessment) mucus scoring, and tympanometry were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Children were classified as symptomatic (\u22652 \u201cyes\u201d responses to core symptom items) or asymptomatic (no more than one \u201coccasionally\u201d response). Adenoid size was quantified from blinded video review as the A\/C ratio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Receiver operating characteristic (ROC) analysis identified an optimal A\/C threshold for symptomatic status; multivariable logistic regression evaluated independent predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median A\/C ratio was greater in symptomatic versus asymptomatic children. Symptomatic children also had higher MASNA mucus scores, greater reported rhinorrhea frequency, and less favorable tympanometric profiles. ROC analysis identified an A\/C ratio of 60% as the optimal cut-off to discriminate symptomatic from asymptomatic children. An A\/C ratio &gt;60% emerged as the sole independent predictor of symptomatic status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this cohort, the endoscopic A\/C ratio strongly discriminated symptomatic from asymptomatic presentations. An A\/C threshold of 60% reliably separated predominantly asymptomatic from symptomatic children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance<\/jats:title>\n                    <jats:p>These findings, in conjunction with clinical experience and results from our previous studies, form the basis for a proposed three-tier, management-oriented endoscopic scale for preschool patients: Degree I (A\/C \u226460%)\u2014within age-appropriate norm; Degree II (A\/C 65%-75%)\u2014hypertrophy amenable to conservative management\/observation; Degree III (A\/C \u226580%)\u2014hypertrophy for which we suggest that surgical intervention ought to be considered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19160216261421112","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T09:58:15Z","timestamp":1773827895000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["From Physiology to Intervention: Endoscopic Adenoid-to-Choanae Ratio Thresholds for Symptomatic Adenoid Hypertrophy in Preschool Children"],"prefix":"10.1177","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5824-8709","authenticated-orcid":false,"given":"Aleksander","family":"Zwierz","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9779-4123","authenticated-orcid":false,"given":"Krystyna","family":"Masna","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pawe\u0142","family":"Burduk","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krzysztof","family":"Domagalski","sequence":"additional","affiliation":[{"name":"Department of Immunology, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University, Torun, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.moo.0000247525.56076.54"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-5998(98)70376-6"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.5541121413"},{"issue":"3","key":"e_1_3_2_5_2","first-page":"180","article-title":"Complications of adenotonsillectomy revisited in a large pediatric case series","volume":"35","author":"Abou-Jaoude PM","year":"2006","unstructured":"Abou-Jaoude PM, Manoukian JJ, Daniel SJ, et al. Complications of adenotonsillectomy revisited in a large pediatric case series. J Otolaryngol. 2006;35(3):180-185.","journal-title":"J Otolaryngol"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2018.0614"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2024.e32116"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjpo-2022-001710"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.it.2009.04.003"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics12071734"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.14639\/0392-100X-N1832"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2003.07.018"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2006.05.003"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0031-3955(16)36806-7"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0165-5876(97)00159-6"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/7920907"},{"key":"e_1_3_2_17_2","first-page":"133","article-title":"Is it important to evaluate the size of adenoid vegetations?","volume":"55","author":"Boleslavsk\u00e1 J","year":"2006","unstructured":"Boleslavsk\u00e1 J, Koprivov\u00e1 H, Kom\u00ednek P. Is it important to evaluate the size of adenoid vegetations? Otorinolaryng Foniat Prague. 2006;55:133-138. 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