Lateral neck radiography: the case is not closed

We read the letter to the editor by Servos Li et al¹ regarding our recently published paper.² We would like to clarify that our article did not aim to promote the use of lateral neck radiography in children with persistent obstructive sleep apnea and history of adenotonsillectomy as a gold standard. We clearly indicated that direct visualization via nasopharyngoscopy is the gold standard for assessment of adenoidal tissue hypertrophy, and we fully agree that drug-induced sleep endoscopy, when available, can identify other levels of obstructions beyond the adenoids, as the authors highlighted in their letter. To our knowledge, there were no previous studies that evaluated the role of lateral neck radiography in evaluating recurrent/residual adenoid hypertrophy in pediatric patients with obstructive sleep apnea proven by polysomnography following adenotonsillectomy, and our study aimed to address this gap in knowledge. Also, we acknowledge the inherent limitations of retrospective studies, including ours, given the potential variability in interpretation of adenoid enlargement by different radiologists and different interpretation methodologies, which we discussed in our paper.² In our experience, lateral neck radiography can be helpful in selected patients to guide an expedited management while awaiting pediatric otolaryngology evaluation, which can take at least a few months to complete from time of referral. Also, globally in some areas with limited resources and expertise, lateral neck radiography can be a readily available tool in the evaluation process of these selected patients.

DISCLOSURE STATEMENT

All authors have seen and approved this manuscript. This manuscript does not report any off-label or investigational work. The authors report no conflicts of interest.