Background:
Adenoid hypertrophy is common in the paediatric population. While endoscopy is the gold standard for diagnosis, lateral post-nasal space (PNS) radiography remains widely used. This study evaluated the clinical utility of PNS radiographs over a 5-year period in the management of paediatric adenoid hypertrophy, with particular attention to their impact on referral pathways and surgical decision-making.
Methods:
We conducted a retrospective review of all PNS radiographs performed for suspected adenoid hypertrophy or related symptomatology between June 2020 and May 2025. We collected data on referral source, technical adequacy, and adenoid-nasopharyngeal (AN) ratios. We tracked subsequent otolaryngology referrals and surgical outcomes.
Results:
Over the five-year period, 548 radiographs were performed, with 98% originating from non-surgical specialities. The mean patient age was 6.3 years; the maximum average AN ratio was 0.61 in three-year-olds. Suboptimal positioning was identified in 23% of films. Only 13% of the total cohort ultimately proceeded to adenoidectomy, underscoring the limited direct impact of the radiographs on operative management.
Conclusion:
Lateral PNS radiography remains a frequently utilised first-line investigation despite technical limitations and only moderate diagnostic utility. Because most requests originate from non-surgical specialities, it appears to serve primarily as an accessible triage tool before an ENT specialist referral rather than as a definitive guide to surgical decision-making.