Age-dependent differences in adenoid size, nasopharyngeal depth, and symptom severity in children with adenoid hypertrophy: a radiographic and clinical correlation study

Abstract

The natural history of adenoid hypertrophy involves complex age-dependent changes in both adenoid tissue and nasopharyngeal dimensions, yet comprehensive age-stratified analyses in African populations remain limited. Objectives: To characterise age-dependent differences in adenoid size, nasopharyngeal depth, adenoid-nasopharyngeal ratio (ANR), and clinical symptom severity in Nigerian children with adenoid hypertrophy. Methodology: This prospective cross-sectional study enrolled 200 children (aged 3-12 years) with clinically suspected adenoid hypertrophy from the University of Maiduguri Teaching Hospital between April 2024 and March 2026. Participants were stratified into three age groups: 3-5 years (n = 98), 6-8 years (n = 62), and 9-12 years (n = 40). ANR was calculated using Fujioka's method,13 and clinical symptoms were scored using a standardised questionnaire. Age-associated patterns were analysed using Pearson's correlation, one-way ANOVA, and multiple regression analysis. Due to the crosssectional design, findings represent age-associated patterns rather than individual growth trajectories. results: Mean adenoid size showed minimal age-related change (2.14±0.38 cm, r=0.058, 95% CI: -0.080 to 0.193, p=0.412), while nasopharyngeal depth increased significantly with age (2.52±0.42 cm to 3.41±0.47 cm, r=0.781, 95% CI: 0.722-0.829, p<0.0001). ANR demonstrated a strong negative correlation with age (r=-0.795, 95% CI: -0.836 to -0.744, p<0.0001). Clinical symptom scores decreased significantly with age (r=-0.812, 95% CI: -0.850 to -0.764, p<0.0001), with 86.7% of 3–5-year-olds having severe symptoms versus 22.5% of 9–12- year-olds. Conclusion: In this cross-sectional study, nasopharyngeal depth was significantly greater in older age groups relative to adenoid size, a pattern associated with lower symptom severity in older children. These cross-sectional associations do not directly demonstrate individual growth trajectories, but they support age-appropriate interpretation of radiographic measurements in adenoid hypertrophy assessment. Prospective longitudinal studies are needed to confirm within-subject developmental patterns.