{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:59:14Z","timestamp":1785405554851,"version":"3.56.0"},"reference-count":30,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T00:00:00Z","timestamp":1783209600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"VICTOR BABES UNIVERSITY OF MEDICINE AND PHARMACY TIMISOARA"},{"id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Eustachian tube (ET) dysfunction links adenoidal disease to persistent middle ear dysfunction in children, yet the independent contribution of ET orifice obstruction grade to audiological outcomes and health-related quality of life remains unquantified after adjustment for anatomical and inflammatory confounders. Because conventional anatomical grading (e.g., the Cassano classification) does not directly characterize the degree of ET orifice compromise, it may underestimate the functional threat to middle ear ventilation; this study is the first to quantify the independent predictive value of endoscopic ET obstruction grade. This study aimed to evaluate ET obstruction grade as an independent determinant of hearing thresholds, middle ear pressure, and quality-of-life impairment in children with chronic adenoiditis and otitis media with effusion. Materials and Methods: A retrospective cohort of 236 children (aged 3\u201312 years) was analyzed. ET orifice obstruction was graded endoscopically as none, partial, or complete. Primary outcomes included pure tone average (PTA), middle ear pressure (MEP), and OSA-18 total score. Multivariate linear and logistic regression models were fitted, adjusting for age, sex, Cassano grade, neutrophil-to-lymphocyte ratio (NLR), allergic status, and acute otitis media frequency. The modifying role of mucosal appearance (edematous versus fibrotic\/remodeling) on quality-of-life outcomes was also assessed. Results: ET obstruction was absent in 42 (17.8%), partial in 114 (48.3%), and complete in 80 (33.9%) children. PTA increased progressively across groups (22.2 \u00b1 5.5 to 36.2 \u00b1 6.7 dB; p &lt; 0.001), as did OSA-18 scores (44.9 \u00b1 7.9 to 80.4 \u00b1 10.3; p &lt; 0.001). In adjusted analysis, each obstruction increment independently predicted a 5.57 dB PTA increase (95% CI 4.37\u20136.77; p &lt; 0.001), a 14.89-point OSA-18 increase (95% CI 12.87\u201316.92; p &lt; 0.001), and 5.12-fold higher odds of PTA &gt; 30 dB (95% CI 2.84\u20139.24; p &lt; 0.001). Persistent middle ear dysfunction at six months occurred in 7.1%, 26.3%, and 61.3% across obstruction grades. Among children with complete obstruction, fibrotic mucosa was associated with higher OSA-18 scores than edematous mucosa (82.3 vs. 76.8; p = 0.02). Conclusions: ET obstruction grade independently determines audiological and quality-of-life outcomes in pediatric chronic adenoiditis. Mucosal remodeling further amplifies quality-of-life burden in complete obstruction. These findings support routine ET endoscopic grading in pediatric otorhinolaryngology risk stratification.<\/jats:p>","DOI":"10.3390\/medicina62071297","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T08:05:38Z","timestamp":1783325138000},"page":"1297","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Eustachian Tube Obstruction Grade as an Independent Determinant of Audiological and Quality-of-Life Outcomes in Pediatric Chronic Adenoiditis: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"62","author":[{"given":"Diana","family":"Szekely","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5755-179X","authenticated-orcid":false,"given":"Flavia","family":"Zara","sequence":"additional","affiliation":[{"name":"Department II of Microscopic Morphology, Discipline of Histology, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raul","family":"Patrascu","sequence":"additional","affiliation":[{"name":"Department of Functional Sciences, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8933-3060","authenticated-orcid":false,"given":"Cristina Stefania","family":"Dumitru","sequence":"additional","affiliation":[{"name":"Department II of Microscopic Morphology, Discipline of Histology, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina Cristina","family":"Barb","sequence":"additional","affiliation":[{"name":"Department II of Microscopic Morphology, Discipline of Histology, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2520-7636","authenticated-orcid":false,"given":"Dorin","family":"Novacescu","sequence":"additional","affiliation":[{"name":"Department II of Microscopic Morphology, Discipline of Histology, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Armega Anghelescu","sequence":"additional","affiliation":[{"name":"Department II of Microscopic Morphology, Discipline of Histology, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3410-3870","authenticated-orcid":false,"given":"Alexia","family":"Manole","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Iovanescu","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3690-8048","authenticated-orcid":false,"given":"Gheorghe","family":"Iovanescu","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,5]]},"reference":[{"key":"ref_1","first-page":"e30985","article-title":"The Correlation Between Otitis Media with Effusion and Adenoid Hypertrophy among Pediatric Patients: A Systematic Review","volume":"14","author":"Mashat","year":"2022","journal-title":"Cureus"},{"key":"ref_2","first-page":"S1","article-title":"Clinical Practice Guideline: Otitis Media with Effusion (Update)","volume":"154","author":"Rosenfeld","year":"2016","journal-title":"Otolaryngol.\u2013Head Neck Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"18","DOI":"10.3329\/kyamcj.v12i1.53362","article-title":"Correlation of Adenoid Hypertrophy on Nasoendoscopy and Audiological Parameters in Children","volume":"12","author":"Mahbub","year":"2021","journal-title":"KYAMC J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1007\/s00405-023-08188-2","article-title":"Different Techniques of Adenoidectomy and Its Impact on Middle Ear Pressure: A Randomized Controlled Study","volume":"281","author":"Seleim","year":"2024","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s00106-023-01299-6","article-title":"Adenoid Hypertrophy\u2014Diagnosis and Treatment: The New S2k Guideline","volume":"71","author":"Ahmad","year":"2023","journal-title":"HNO"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Piotto, M., Gambadauro, A., Rocchi, A., Lelii, M., Madini, B., Cerrato, L., Chironi, F., Belhaj, Y., and Patria, M. (2023). Pediatric Sleep Respiratory Disorders: A Narrative Review of Epidemiology and Risk Factors. Children, 10.","DOI":"10.3390\/children10060955"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"101629","DOI":"10.1016\/j.smrv.2022.101629","article-title":"Neurocognitive Outcomes of Children with Sleep-Disordered Breathing: A Systematic Review with Meta-Analysis","volume":"63","author":"Menzies","year":"2022","journal-title":"Sleep Med. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.2147\/NSS.S506720","article-title":"Impact of Adenotonsillectomy on Quality of Life in Pediatric Obstructive Sleep Apnoea (OSA): Insights from the OSA-18 Questionnaire","volume":"17","author":"Alhelou","year":"2025","journal-title":"Nat. Sci. Sleep"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"257","DOI":"10.14639\/0392-100X-N1832","article-title":"Update of Endoscopic Classification System of Adenoid Hypertrophy Based on Clinical Experience on 7621 Children","volume":"42","author":"Cassano","year":"2022","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1007\/s12070-022-03438-x","article-title":"Endoscopic Grading, Radiological Grading and Clinical Features in Children with Chronic Adenoid Hypertrophy: A Correlational Study","volume":"75","author":"Peedikakkal","year":"2023","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"6","DOI":"10.31612\/2616-4868.8.2023.01","article-title":"Clinical and Morphological Characteristics and Evaluation of Torus Tubarius in Children with Pharyngeal Tonsil Hypertrophy","volume":"8","author":"Lyakh","year":"2023","journal-title":"Clin. Prev. Med."},{"key":"ref_12","unstructured":"(2010). Acoustics\u2014Audiometric Test Methods\u2014Part 1: Pure-Tone Air and Bone Conduction Audiometry (Standard No. ISO 8253-1:2010)."},{"key":"ref_13","unstructured":"(2018). Specification for Audiometers (Standard No. ANSI\/ASA S3.6-2018)."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1001\/archotol.1970.04310040005002","article-title":"Clinical Experience with Impedance Audiometry","volume":"92","author":"Jerger","year":"1970","journal-title":"Arch. Otolaryngol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1097\/AUD.0000000000000802","article-title":"Minimal and Mild Hearing Loss in Children: Association with Auditory Perception, Cognition, and Communication Problems","volume":"41","author":"Moore","year":"2020","journal-title":"Ear Hear."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1097\/AUD.0000000000000519","article-title":"Hearing Loss in Children with Otitis Media with Effusion: Actual and Simulated Effects on Speech Perception","volume":"39","author":"Cai","year":"2018","journal-title":"Ear Hear."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1067\/mhn.2003.4","article-title":"Evaluation of Sleep-Disordered Breathing in Children","volume":"128","author":"Sohn","year":"2003","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1007\/s12070-018-1506-1","article-title":"A Case-Control Study on the Association Between Endoscopic ACE Grade of Adenoid Hypertrophy and Hearing Loss in Children and Its Impact on Speech and Language Development","volume":"71","author":"Syed","year":"2019","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Almutairi, A.A., Aljabr, I.K., Alsindi, Z.S., Alkhawajah, A.A., Aljasem, J.M., Alzahrani, M.M., and Almaqhawi, A. (2025). Blood Inflammatory Markers as Predictors of Effusion Characteristics and Postoperative Hearing Outcomes in Children with Otitis Media with Effusion: A Retrospective Study. Medicina, 61.","DOI":"10.3390\/medicina61091520"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e244","DOI":"10.1097\/SCS.0000000000003452","article-title":"The Predictive Value of Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratio for the Effusion Viscosity in Otitis Media with Chronic Effusion","volume":"28","author":"Elbistanli","year":"2017","journal-title":"J. Craniofac. Surg."},{"key":"ref_21","first-page":"e13805","article-title":"Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios in Otitis Media with Effusion in Children: Diagnostic Role and Audiologic Correlations","volume":"75","author":"Kaplama","year":"2021","journal-title":"Int. J. Clin. Pract."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"100860","DOI":"10.1016\/j.waojou.2023.100860","article-title":"Allergy in Pathogenesis of Eustachian Tube Dysfunction","volume":"17","author":"Yu","year":"2024","journal-title":"World Allergy Organ. J."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Vlastos, I.M., Tsotsiou, N., Almomani, M., Doulaptsi, M., Karatzanis, A., and Prokopakis, E. (2025). Is Allergic Rhinitis Related to Otitis Media with Effusion in Adults and Children? Applying Epidemiological Guidelines for Causation. Cells, 14.","DOI":"10.3390\/cells14110805"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Shin, J.M., Yang, H.W., Park, J.H., and Kim, T.H. (2023). Role of Nasal Fibroblasts in Airway Remodeling of Chronic Rhinosinusitis: The Modulating Functions Reexamined. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24044017"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"111718","DOI":"10.1016\/j.ijporl.2023.111718","article-title":"An Assessment of the Effects of Adenoid Hypertrophy on Mucociliary Clearance and Nasal Cytology in Children","volume":"174","author":"Berkiten","year":"2023","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e603","DOI":"10.1055\/s-0044-1786832","article-title":"The Impact of Adenotonsillectomy on the Quality of Life of Children with Obstructive Sleep Apnea","volume":"28","author":"Sukumaran","year":"2024","journal-title":"Int. Arch. Otorhinolaryngol."},{"key":"ref_27","first-page":"83","article-title":"Adenoid Hypertrophy in Pediatric Sleep Disordered Breathing and Craniofacial Growth: The Emerging Role of Dentistry","volume":"1","author":"Major","year":"2014","journal-title":"J. Dent. Sleep Med."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Lee, K., Tai, J., Lee, S.H., and Kim, T.H. (2021). Advances in the Knowledge of the Underlying Airway Remodeling Mechanisms in Chronic Rhinosinusitis Based on the Endotypes: A Review. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22020910"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.21037\/tp-2025-189","article-title":"A New Modified Endoscopic Evaluation System and Its Diagnostic Accuracy of Adenoid Hypertrophy in Children","volume":"14","author":"Pu","year":"2025","journal-title":"Transl. Pediatr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1002\/ohn.159","article-title":"Expert Consensus Statement: Management of Pediatric Persistent Obstructive Sleep Apnea After Adenotonsillectomy","volume":"168","author":"Ishman","year":"2023","journal-title":"Otolaryngol. Head Neck Surg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/7\/1297\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T10:30:37Z","timestamp":1783333837000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/7\/1297"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,5]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["medicina62071297"],"URL":"https:\/\/doi.org\/10.3390\/medicina62071297","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,5]]}}}