Anatomical perspective on nasal obstruction in pediatric and adolescent patients

M.V. Markeeva¹, O.Yu. Aleshkina¹, N.V. Tarasova², T.M. Zagorovskaya¹, O.V. Syrova¹, O.V. Konnova¹, G.F. Andreeva¹

Markeeva Marina Viktorovna, e-mail: mmarina-2011@mail.ru

¹Saratov State Medical University named after V.I. Razumovsky, Saratov

²Volgograd State Medical University, Volgograd

Background: impairment of nasal breathing during childhood may arise fr om various pathologies involving the nasal cavity, paranasal sinuses, and nasopharynx. Adenoidectomy (the surgical excision of hypertrophied pharyngeal tonsils) remains one of the most prevalent procedures in pediatric clinical practice. To ensure precise diagnosis and the selection of optimal therapeutic interventions, otorhinolaryngologists require a comprehensive understanding of age-specific anatomical variations within the upper respiratory tract.

Aim: to characterize variations in the size of the pharyngeal tonsil and the degree of its hypertrophy across different pediatric and adolescent age groups using computed tomography (CT), specifically focusing on identifying causes of nasal obstruction and the timeline of tonsillar involution.

Materials and Methods: a retrospective analysis was performed on 425 clinical records and CT images of pediatric and adolescent patients (ages 1 to 21 years) presenting with nasal obstruction, with data stratified by gender. The linear dimensions of the pharyngeal tonsil (height and length) were determined, and the degree of its hypertrophy was assessed.

Results: in female subjects, the height and length of the pharyngeal tonsil demonstrated consistent growth from infancy through adolescence. In males, tonsillar height increased between the ages of 2–3 and 16 years, while the length remained relatively stable from infancy to adolescence. Involution of the nasopharyngeal lymphoid tissue occurred during adolescence in females and during the adolescence in males. Although the pharyngeal tonsil was present in all infants, the frequency of its absence increased with age, exceeding 50% (58.7%) by the adolescence stage. Between the ages of 1 and 16 years, grade III hypertrophy was the predominant finding. In older patients wh ere the tonsil persisted, grade II hypertrophy was most common, while grade III was identified less frequently.

Conclusion: pharyngeal tonsil hypertrophy is the primary etiology of nasal obstruction in children under 16 and in nearly half of the adolescent population. These findings are critical for the differential diagnosis of nasal obstruction and the involution analysis of tonsillar involution.

Keywords: pediatric age, youth, pharyngeal tonsil, morphometry, computed tomography, nasal obstruction, adenoidectomy.

For citation: Markeeva M.V., Aleshkina O.Yu., Tarasova N.V., Zagorovskaya T.M., Syrova O.V., Konnova O.V., Andreeva G.F. Anatomical perspective on nasal obstruction in pediatric and adolescent patients. RMJ. 2026;1:39–42. DOI: 10.32364/2225-2282-2026-1-8