[Observation of the intra-adenoid cysts in the nasopharynx]. / Nabliudenie intraadenoidnykh kist nosoglotki.

The objective of the present study was to demonstrate the clinical significance and possibilities of diagnostics and treatment of the intra-adenoid cysts in the nasopharynx as exemplified by an original observation of an individual case. The cystic structures in the nasopharynx rarely manifest themselves clinically and are known to produce the non-specific symptoms. The patients admitted to the L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology for the surgical treatment of nasopharyngeal cysts account for 0.05% of the total number of the hospitalized subjects. This article reports a case of two large intra-adenoid cysts in the nasopharynx of one patient complicated by bilateral exudative otitis media. The successful outcome of the surgical treatment of this condition was achieved by means of endonasal marsupilization of the cysts under the laser-assisted endoscopic control with simultaneous bilateral shunting of the tympanic cavity.

[Differential diagnostics and the treatment strategy for the management of the nasopharyngeal cystic lesions]. / Differentsial'naia diagnostika i taktika lecheniia kistoznykh obrazovanii nosoglotki.

The nasopharyngeal cystic lesions are quite common (affecting up to 14% of the general population) even though the majority of the cases are asymptomatic. Sometimes this condition is associated with the obstruction of nasal breathing, runny nose, hearing impairment, and other non-specific clinical manifestations. The endoscopic examination of the nasal cavity allows the preliminary clinical diagnosis to be established, however, MRI and CT visualization are necessary for more reliable differential diagnostics of this pathology and adequate planning of its treatment. The nasopharyngeal cysts require the surgical treatment, with endoscopic transnasal marsupialization in the combination with coblation, radiowave or laser irradiation being the main currently available option.

Diagnosis of glossopharyngeal obstruction using nasopharyngeal tube versus CT scan in obstructive sleep apnea-hypopnea syndrome.

The polysomnography after nasopharyngeal tube insertion (NPT-PSG) was used to assess glossopharyngeal airway obstruction in patients with moderate-to-severe obstructive sleep apnea-hypopnea syndrome (OSAHS), and was compared with that obtained using spiral computed tomography (CT). A total of 125 patients diagnosed with moderate-to-severe OSAHS using PSG were subjected to PSG after NPT insertion, and spiral CT was used for continuous scan of the upper respiratory tract. The NPT-PSG and CT scan results were subjected to correlation analysis. In addition, the two sets of data were used separately to determine whether there was glossopharyngeal airway stenosis or obstruction, and the results were compared. Neither apnea hypopnea index (AHI) nor lowest oxygen saturation (LSaO2) obtained from the first PSG was significantly correlated with the cross-sectional area or the inner diameter of the glossopharyngeal airway. NPT-PSG AHI was significantly correlated with the cross-sectional area and anteroposterior diameter of the glossopharyngeal airway, with correlation coefficients of 0.264 and 0.185, and P values of 0.003 and 0.039, respectively. NPT-PSG AHI was not significantly correlated with the left-right diameter of the airway, and NPT-PSG LSaO2 was not significantly correlated with the cross-sectional area or the inner diameter of the glossopharyngeal airway. With NPT-PSG, 52 patients showed obvious glossopharyngeal airway stenosis while 73 patients did not, and with CT scan 41 patients showed obvious glossopharyngeal airway stenosis while 84 patients did not. The two methods reached the same diagnosis in 86 cases, with a consistency rate of 68.8 %. Spiral CT and NPT-PSG show certain degrees of consistency by assessing the presence of glossopharyngeal airway stenosis or obstruction, and there are also notable differences. Clinical assessment on glossopharyngeal airway obstruction should be based on a combination of multiple methods.

Importance of viruses in acute otitis media.

PURPOSE OF REVIEW: Acute otitis media occurs as a complication of viral upper respiratory tract infection. Bacterial otopathogens and respiratory viruses interact and play important roles in acute otitis media development. A better understanding of viral and bacterial interactions may lead to innovative ways to lessen the burden of this common childhood disease. RECENT FINDINGS: There has been increasing evidence that acute otitis media occurs during upper respiratory infection, even in the absence of nasopharyngeal bacterial colonization. Among the types of viruses associated with acute otitis media, respiratory syncytial virus continues to be the most commonly detected. It is still unclear whether viral load plays an important role in acute otitis media development, but symptomatic upper respiratory tract infection (as opposed to asymptomatic viral infection) is crucial. Widespread use of bacterial and viral vaccines in young children, including pneumococcal conjugate and influenza vaccines, has led to the reduction in otitis media-related healthcare use between 2001 and 2011. There has been no new vaccine against respiratory viruses other than influenza. SUMMARY: Progress has been made toward the reduction of the burden of acute otitis media in the last decade. Success in reducing acute otitis media incidence will rely mainly on prevention of nasopharyngeal otopathogen colonization, as well as reduction in the incidence of viral upper respiratory tract infection.

[Clinical analysis of abnormal acoustic admittance in preschool children with nasal and nasopharyngeal disorders].

OBJECTIVE: To investigate the risk factors of related disorders, which could lead to potential otitis media by observing the abnormal configuration of drum and abnormal acoustic immittance without symptoms in preschool children. METHODS: Eighty-one cases (162 ears) received flexible pharyngorhinoscopy, skin prick test, CT examination of sinus, and were diagnosed as allergic rhinitis, chronic sinusitis, adenoid hypertrophy. They had no complaints of ear related symptoms, but were observed to have abnormality in ear drum by physical examined. Acoustic immittance measurement were performed, so as to estimate whether they were accompany with potential otitis media. The changes of examination and tests were analyzed before and after the treatment. RESULTS: There were 15 cases (29 ears) with abnormal acoustic admittance among 81 cases (162 ears) who had no ear related symptoms but had different degree abnormality in ear drum. The morbidity rate of these 15 patients was 13.6% (6/44 ears) in allergic rhinitis patients, 18.2% (12/66 ears) in chronic sinusitis patients, and 21.2% (11/52 ears) in adenoid hypertrophy patients, respectively. The differences among the three diseases had statistical significance (χ² = 63.02,P < 0.05). Among 29 ears, 28 ears whose type of tympanic pressure curve were transferred from type C to type A two weeks after treatment. One ear whose type of tympanic pressure curve transferred from type B to type C four weeks after treatment. All cases had been followed up with no recurrent cases. CONCLUSIONS: Some preschool children with nasal and nasopharyngeal disorders had abnormal configuration of drum and abnormal acoustic immittance, and had potential risk for otitis media. Among the disorders, adenoid hypertrophy impact more on middle ear function. The early intervention of related diseases could prevent the developing trend of otitis media.

Palatal eversion: a new technique in treatment of nasopharyngeal stenosis.

OBJECTIVE: The treatment of nasopharyngeal stenosis is challenging because of a high incidence of recurrence after surgical correction. Therefore, many treatment modalities are being tried to cure this problem. The aim of this study is to assess the efficacy of palatal eversion as a new technique for treatment of nasopharyngeal stenosis after adenotonsillectomy. STUDY DESIGN: Case series. METHODS: This study was conducted on 12 patients with nasopharyngeal stenosis after adenotonsillectomy were subjected to treatment by palatal eversion by dividing the soft palate in the midline and removal of the fibrous tissue causing stenosis followed by evertion and fixation of the two palatal division on either side for six weeks to allow complete epithelialization of the stenotic area followed by another operation to reunion the soft palate in the midline. Post-operative follow up was done for one year by flexible nasopharyngoscopy, perceptual speech analysis and polysomnography. RESULTS: Flexible nasopharyngosopic examination of the 12 patients at the end of post-operative period revealed a freely mobile soft palate with no nasopharyngeal stenosis or palatal fistula. Velopharyngeal function and speech assessment by perceptual speech analysis was normal in all 12 cases. No obstructive episodes were recorded in polysomnograms. CONCLUSIONS: Palatal eversion is a promising technique in treatment of post-adenotonsillectomy nasopharyngeal stenosis and it is recommended to be used in a wider scale of patients and other indications as nasopharyngeal stenosis following uvulopalatoplasty and post nasopharyngeal radiotherapy. LEVEL OF EVIDENCE: 4 (case series).

Wasabi nose: an underreported complication of cyclophosphamide infusions.

Wasabi nose, a term used to describe the nasopharyngeal discomfort experienced during cyclophosphamide infusions, is a rare phenomenon, previously described in case reports of adult oncology patients typically receiving high-dose chemotherapy regimens. The underlying mechanism by which this phenomenon occurs is unknown. We report four cases of children with rheumatic diseases afflicted by profound nasopharyngeal discomfort secondary to low-dose cyclophosphamide infusions. We additionally review the literature regarding potential medical management of these complications and describe our experience using these interventions.

Effect of head and neck position on pharyngeal diameter in horses.

Dynamic nasopharyngeal collapse with upper airway obstruction is an important cause of exercise intolerance in performance horses. Its underlying pathophysiology is not fully understood. We hypothesize that head position affects pharyngeal diameter, and thus head position may be a contributing factor to nasopharyngeal obstruction. Fifteen adult healthy horses were subjected to endoscopy and radiography at rest. The pharyngeal diameter was measured at nine different head and neck positions. The effect of sedation and breathing cycle on the pharyngeal diameter was determined, and the relationship between the head angle and the pharyngeal diameter was analyzed. There was a significant influence of head and neck position on pharyngeal diameter, with head position having the major effect (P < 0.001); neck position was less important, but still significant (P < 0.05). The smallest pharyngeal diameter was found at the dorsal, flexed position, which is a clinically important head position in dressage horses. The largest pharyngeal diameter was found at the extended midway position. At each head level, the pharyngeal diameter decreased with flexing the head and it increased with extending the head. The head angle was not associated with pharyngeal diameter, and neither sedation status nor breathing cycle significantly affected pharyngeal diameter. A decrease in pharyngeal diameter will limit the airflow through the upper respiratory tract, and it may result in turbulence with subsequent dynamic collapse. Head and neck position should therefore be considered a possible contributing factor in horses with suspected nasopharyngeal dysfunction.

Evaluation of adenoidal obstruction in children: clinical symptoms compared with roentgenographic assessment.

BACKGROUND: Obstructive adenoid enlargement is commonly implicated as the major cause of chronic nasal obstruction in children. Although clinical assessment is considered essential, there is little consensus over its reliability. This study was conducted to determine the correlation between graded symptomatology assessment and roentgenographic assessment of adenoidal obstruction. METHOD: Symptoms assessed included snoring, mouth-breathing and obstructive breathing during sleep. Each symptom was rated on a four-point scale (absent = zero, mild = one, moderate = two and severe = three). We summed the ratings for each child to obtain the symptomatology score. We used an adenoidal-nasopharyngeal ratio parameter to classify roentgenographic assessment into minimal, moderate or marked obstruction. RESULTS: Sixty-four children, 42 boys and 22 girls, aged one to 12 years were enrolled. The clinical symptomatology scores correlated significantly with the roentgenographic ratings of nasopharyngeal airway obstruction (r = 0.419; p = 0.001). The correlation was significant at roentgenographic ratings of minimal obstruction (p < 0.05) and gross obstruction (p < 0.001). Both the symptomatology score and the roentgenographic rating showed significant correlations with patient age (r = -0.657, p < 0.01 and r = -0.340, p < 0.01, respectively). CONCLUSION: Clinical rating of adenoidal symptoms in children provides a reasonably reliable assessment of the presence and severity of nasopharyngeal airway obstruction. This technique of assessment is easy to use and is particularly valid when obstruction is either minimal or gross.

Bacterial toxins and Multiple Sclerosis.

The primary pathogenetic mechanism responsible for the distinctive demyelinating lesions in the Central Nervous System (CNS) in Multiple Sclerosis (MS), first described in remarkable detail by Charcot more than 170 years ago, remains one of the most baffling conundrums in medicine. A possible role for bacterial cell molecules and transportable proteins in the pathogenesis of MS is reviewed. The ability of bacterial toxins to distort immunity and to cause distinctive toxic damage in the nervous system is discussed in the light of largely forgotten data linking bacterial nasopharyngeal infections with optic neuritis, optochiasmatic arachnoiditis and MS. While the blood-brain barrier substantially protects the CNS from hematogenous toxins, there is a route by which the barrier may be by-passed. Data is reviewed which shows that the CSF and extra-cellular fluid circulation is bi-directionally linked to the lymphatic drainage channels of the nasopharyngeal mucosa. While this provides a facility by which the CNS may mount immunological responses to antigenic challenges from within, it is also a route by which products of nasopharyngeal infection may drain into the CNS and be processed by the immune cells of the meninges and Virchow-Robin perivascular spaces. If potentially toxic bacterial products are identified in early MS tissues at these sites, this would provide an entirely new insight into the pathogenetic mechanisms of this frustratingly enigmatic disease.

Manifestaciones de la sarcoidosis en el tracto respiratorio superior / Manifestations of sarcoidosis in the upper respiratory tract

La sarcoidosis es una enfermedad multisistémica de etiología desconocida, caracterizada por inflamación granulomatosa no caseificante de los órganos implicados. Afecta de forma predominante al aparato respiratorio, con predilección por el tracto inferior, y menos frecuentemente afecta al tracto respiratorio superior (nariz, senos paranasales y laringe). Se manifiesta de forma muy inespecífica, con síntomas secundarios a la obstrucción de la vía aérea y puede confundirse con otros desórdenes más comunes en nuestro medio, como puede ser la tuberculosis. Realizamos una revisión centrándonos fundamentalmente en el diagnóstico y tratamiento por la dificultad que conllevan

Sarcoidosis is a multisystemic disease having unknown cause, characterized by non-caseating granulomatous inflammation of the organs involved. It predominantly affects the respiratory tract, with preference for the lower tract and less frequently affects the upper respiratory tract (nose, paranasal sinuses and larynx). It manifests non-specifically, with symptoms secondary to the obstruction of the airway. It can be confused with other more common disorders in our setting, such as tuberculosis. We conduct a review, fundamentally focusing on the diagnosis and treatment due to their difficulty

Estudo da fase faríngea da deglutição em voluntários sadios através da fibronasoscopia / Study of Faringeal Fase of Deglutition in Healthy Volunteers by Fibronasoscopy

Foi realizado um estudo da fase faríngea da deglutição em voluntários sadios através da fibronasoscopia, com a finalidade de observar os parâmetros de normalidade para este exame. Resultados: Os resultados estão de acordo com a literatura. Conclusão: O exame mostrou ser de fácil realização, rápido e eficaz em mostrar a anatomia e a função dos músculos envolvidos nesta fase da deglutição, bem como a presença de aspiração ou penetração do bolo alimentar na laringe.

This study was made of the pharingeal fase of deglutition in healthy volunteers by fibronasoscopy with the intention of seen the normality pattern of this exam. Liquid iogurt was used like contrast. Results: The results were agreed with the literatura. Conclusion: The exam was showed to be of easy execution, fast and great for seen the action and anatomy of the muscles involved in this fase of deglutition, as well as to show the aspiration or penetration of the contrast into the larynx.

Microendoscopic endonasal approach in treating diseases of nasal cavity, paranasal sinuses, and adjacent structures--a preliminary communication.

Since the beginning of 1997 the authors has introduced routinely in their practice a method of combined nasal endoscopy and microrhinoscopy in the diagnosis and minimally invasive surgery of diseases of nasal cavity, paranasal sinuses, and adjacent structures. The results of the method applied in 25 patients (19 males and 6 females) aging from 2 months to 77 years with doubtful initial diagnosis are analysed. In 17 of the patients the initial diagnosis was confirmed, in 5 the diagnosis was revised, and in 3 no pathology of the nasal cavity and paranasal sinuses was found. In 13 patients minimally invasive surgery was successfully performed using this modern method. The results obtained are compared to the related literature data.

Swallowing dysfunction and aspiration in neonates and infants.

In children, swallowing dysfunction and aspiration are common causes of recurrent pneumonia and can be fatal. The underlying mechanism is still unknown. In this study, we evaluated the swallowing function in 72 neonates and infants by fluoroscopy and followed the course of 39 patients for more than one year. The results of all the examinations were recorded on videotape or a digital imaging system. All 10 patients with neurologic disorder presented cricopharyngeal dysfunction. Of the 12 patients with near miss sudden infant death syndrome, 10 showed nasopharyngeal reflux, and 5 demonstrated cricopharyngeal dysfunction. In the 50 patients without neurologic disorder, 29 revealed cricopharyngeal dysfunction. Laryngeal elevation was not seen in 75%. Three of these 29 patients had no other abnormality. All patients without neurologic disorder recovered well. Seven patients demonstrated prolonged aspiration. Four of them had neurologic disorder, and the rest had near miss sudden infant death syndrome. Fluoroscopic examination showed two types of aspiration: one was caused not only by pharyngeal but also by lingual muscles. It was not associated with any neurologic disorders and the symptoms were transient. The other was caused by cricopharyngeal dysfunction and most of these patients had neurologic diseases and prolonged symptoms.

The assessment of hypertrophy of nasopharyngeal tonsil by acoustical methods.

The possibilities for using acoustical analysis as a noninvasive measure of the degree of obstruction created by an enlarged pharyngeal tonsil (adenoid) are discussed. The method capitalizes on the relationship which exists between a specific obstruction of the respiratory tract and the resulting respiratory sound. Results indicate that as the adenoid increases in size relative to the size of the nasopharynx, the dominant components of the respiratory sound spectrum shift towards a higher frequency range. Furthermore, the correlation found between the assessments of the obstruction due to various sizes of the adenoid by radiological methods and acoustical analyses supports the theoretical prediction that information on the size of the constriction is carried by the respiratory sound. Therefore, careful analyses of the acoustic patterns in the respiratory sound can assist in identifying constrictions and monitoring the constriction changes in the upper respiratory tract.

Fiberoptic examination of the nasal cavity and nasopharynx in children.

In this prospective study, a flexible fiberoptic nasolaryngoscope with color video camera was used to examine the nasal cavity and nasopharynx in 180 pediatric patients. The relative size of the adenoid tissue was judged by endoscopy, which lead to a classification into 3 types according to the distance from the vomer to the adenoid tissue. The condition of the nasopharyngeal orifice of the Eustachian tube was also described and differentiated into 3 types relating to the condition of adenoid tissue. Assessment was performed by correlating these measurements with the tympanogram, lateral X-ray and clinical complaints. The authors conclude that: (1) fiberoptic examination allows direct visualization of the size and condition of the adenoid tissue, as well as of the condition of the nasopharyngeal orifice of the Eustachian tube. (2) The size of the adenoid tissue correlates very well with the nasal obstruction complaints as well as with the type of tympanogram. (3) The condition of the nasopharyngeal orifice of the Eustachian tube significantly corresponds with the type of tympanogram. (4) For the indication of adenoidectomy, fiberscopy gives more accurate information than standard X-ray. (5) With a correct choice of premedication and local anesthesia, it is a minor invasive technique which is very well tolerated by children. It is possible in all cases, provided it is performed by a skilled endoscopist and preceded by careful explanation to the child. (6) Finally, thanks to the possibility of direct visualization of the fiberscopic image via a monitor, it allows a better explanation of the indication for adenoidectomy to the child's parents.

[Variation pulsometry during surgery of Vidian nerve]. / Variatsionnaia pul'sometria pri peresechenii Vidieva nerva.

This paper describes a method for assessing the efficacy of Wilde's incision based on mathematical analysis of cardiac rhythms. In patients with chronic polypous rhinosinusitis, the parasympathetic nervous system tonicity is found to be predominant. After Wilde's incision through a transmaxillary subperiosteal approach cardiac rhythms change, suggesting the predominance of sympathetic innervation.