Radiographic Response to Medical Therapy in Pediatric Adenoid Hypertrophy: An Exploratory Study of Systemic Inflammatory Indices
Abstract
Abstract Objective : To characterize radiographic change after combined medical therapy for pediatric adenoid hypertrophy and explore associations with pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Methods : In this prospective single-arm study, children aged 1–12 years received three months of intranasal fluticasone plus oral levocetirizine/montelukast. Adenoid-to-nasopharynx (A/N) ratios were measured on baseline and month-3 lateral radiographs using the Fujioka method. Paired change was assessed with the Wilcoxon signed-rank test. Biomarker associations were evaluated using Spearman correlations, bootstrap confidence intervals, and Holm correction. Results : Twenty-four children had complete data. Mean A/N ratio decreased from 73.1 ± 13.3% to 65.6 ± 17.8%; median absolute reduction was 8.7 percentage points (interquartile range, 1.4–15.3; p = 0.021). Eighteen children improved, one was unchanged, and five worsened. PLR correlated inversely with relative reduction (ρ = −0.407; unadjusted p = 0.048; bootstrap 95% CI, −0.751 to 0.035), but not after Holm correction (adjusted p = 0.097). NLR was not significantly associated with radiographic change (ρ = −0.350; p = 0.094). Conclusion : In this small complete-case cohort, the A/N ratio decreased modestly after combined therapy, with substantial individual variability. Higher pretreatment PLR showed a hypothesis-generating inverse association with radiographic improvement, but the…
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