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Short Communication Volume 18 Issue 2
Modification of endoscopic adenoid grading: introduction of Grade 5 Adenoids
Sangeet Kumar Poddar
Received: May 02, 2026 | Published: July 1, 2026
Citation: Poddar SK. Modification of endoscopic adenoid grading: introduction of Grade 5 Adenoids. J Otolaryngol ENT. 2026;18(2):54-55. DOI: 10.15406/joentr.2026.18.00587
Abstract
Background: Adenoid hypertrophy is a common cause of upper airway obstruction in children and is associated with mouth breathing, Halitosis, recurrent upper respiratory infections, otitis media with effusion, sleep-disordered breathing, and craniofacial changes.1 Existing radiological and endoscopic grading systems, such as the Fujioka adenoid– nasopharyngeal ratio and the Clemens and McMurray endoscopic classification, primarily assess the degree of choanal obstruction and aid in determining the need for adenoidectomy. However, these systems do not adequately address the surgical difficulty encountered in extremely large adenoids. Objective: To propose a modification of the existing endoscopic grading system by introducing a Grade 5 category for massive adenoid hypertrophy and to highlight its surgical implications. Methods: Based on intraoperative endoscopic observations, a new Grade 5 classification is proposed for adenoids that extend anteriorly into the nasal cavity, resulting in nonvisualization of surgical instruments such as the curette or coblation wand during transnasal endoscopic assessment under general anesthesia. The surgical challenges and technical considerations associated with these cases were analyzed. Results: Grade 5 adenoids represent a subset of severe hypertrophy not encompassed by current classifications. These adenoids significantly increase operative complexity and often require modification of the surgical approach, including transoral visualization with angled endoscopes, retropalatal debulking and staged clearance under direct vision. Recognition of this category allows surgeons to anticipate technical difficulties, select appropriate instruments, and plan operative strategies to achieve complete adenoid removal while minimizing residual tissue and recurrence. Conclusion: Massive adenoid hypertrophy extending into the nasal cavity is not uncommon and poses unique surgical challenges. This necessitates a modification of existing classification of Adenoids to anticipate and circumvent surgical challenges.
Keywords: adenoids, surgical techniques and challenges, residual adenoids
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