Abstract
<title>Abstract</title> <p> <bold>Objective</bold> : 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). <bold>Methods</bold> : 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. <bold>Results</bold> : 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). <bold>Conclusion</bold> : 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 finding was not robust to multiplicity correction or bootstrap uncertainty and should not be considered predictive. </p>