Acquired nasopharyngeal stenosis after radiation treatment for nasopharyngeal carcinoma.

INTRODUCTION: Nasopharyngeal stenosis (NPS) is a rare and morbid complication following radiation therapy for nasopharyngeal carcinoma. This review provides an update on management and prognosis. METHODS: A comprehensive PubMed review using the terms "nasopharyngeal stenosis," "choanal stenosis," and "acquired choanal stenosis" was performed. RESULTS: Fourteen studies identified 59 patients who developed NPS after radiotherapy for NPC. 51 patients underwent endoscopic nasopharyngeal stenosis excision by cold technique (80-100% success). The remaining 8 underwent carbon dioxide (CO2) laser excision with balloon dilation (40-60% success). Adjuvant therapies included postoperative topical nasal steroids in 35 patients. The need for revision was 62% in the balloon dilation group, vs 17% in the excision group (p-value <0.01). CONCLUSION: When NPS occurs after radiation, primary excision of scarring is the most effective method of management with less need for revision surgery relative to balloon dilation.

Treatment of acute traumatic nasopharyngeal stenosis with balloon dilation in two dogs.

CASE HISTORY: Two dogs were referred to Veterinary Specialists Aotearoa for evaluation and treatment after sustaining significant head trauma. Case 1 was a 7-month-old, female Staffordshire Bull Terrier who was hit by a car at low speed. Case 2 was a 2-year old, male neutered German Shepherd who sustained a gunshot wound to the head whilst on duty for the New Zealand Police Dog Unit. CLINICAL FINDINGS: The dog in Case 1 suffered numerous facial fractures which caused collapse of the ventral nasal meatus and dorsal nasopharyngeal wall. The dog in Case 2 had extensive osseous and soft tissue damage to the nose, nasopharynx and cervical region with severe narrowing of the ventral meatuses, nasopharyngeal meatus and rostral nasopharynx due to multiple fracture fragments and shrapnel pieces. A diagnosis of traumatic nasopharyngeal stenosis was made in each case by computed tomography. Mechanical balloon dilation was used to treat the stenosis in both dogs. The balloon dilations were performed using a 12-mm balloon dilation catheter inserted in an antegrade fashion. In the first dog, the procedure was performed blind and was repeated three times with 5- and 9-day intervals between dilations. In the second dog, the procedure was performed under endoscopic guidance and again, was repeated three times with a 7-day interval between dilations. Clinical success was reported in both patients following treatment and the second dog also underwent a follow-up computed tomography scan which confirmed resolution of the stenosis. DIAGNOSIS: Traumatic nasopharyngeal stenosis that was successfully treated with balloon dilation. CLINICAL RELEVANCE: Findings suggest that balloon dilation may be an effective technique for the treatment of traumatic nasopharyngeal stenosis in dogs. Multiple dilation procedures are likely required, but the procedure can ultimately result in long term clinical resolution.Abbreviations: CT: Computed tomography; VSA: Veterinary Specialists Aotearoa.

Evaluation of the intranasal steroid treatment outcomes in adenoid tissue hypertrophy with or without allergic rhinitis.

PURPOSE: To compare the intranasal steroid (INS) treatment outcomes in patients with adenoid tissue hypertrophy (ATH) with or without allergic rhinitis (AR). MATERIALS AND METHODS: Medical records of 96 children diagnosed with ATH were retrospectively examined. The pediatric version of the Score for Allergic Rhinitis (SFAR) questionnaire was used to determine the AR status of the patients and classify them. The children were divided into two groups based on the questionnaire: Group 1, low probability of AR (SFAR<9); and Group 2, high probability of AR (SFAR≥9). Intranasal mometasone furoate (100 µg/mL) was used to treat ATH for at least 3 months. The severity of nasal obstruction and snoring was evaluated using the visual analog scale (VAS) score, the adenoid/choana (A/C) ratios before and after treatment were compared, and the rate of patient referral to surgery was recorded among groups. RESULTS: The change in the A/C ratio within the group between before and after treatment was significant (both P < 0.001). However, the reduction in the adenoid size was more significant in Group 1 than in Group 2 (P = 0.025). A significant improvement in the VAS scores was observed between before and after treatment in both groups (P < 0.001). Furthermore, the rate of surgical referral of Group 1 was significantly lower than that of Group 2 (P = 0.035). CONCLUSIONS: INS treatment was found more successful for reducing A/C ratio in ATH without AR. Related with this, when considering the INS treatment for ATH, AR status should be kept in mind for predicting the treatment success.

[Nasopharyngeal hairy polyp in a newborn with intermittent airway obstruction. Case report]. / Pólipo piloso nasofaríngeo en un recién nacido con obstrucción intermitente de la vía aérea. Presentación de un caso.

Nasopharyngeal hairy polyps are rare benign tumors. We present a newborn case with a hairy polyp mass causing cyanosis and respiratory distress due to obstruction of the upper airway during the first 24 hours of life. The patient required resuscitation and endotracheal intubation. Diagnostic studies confirmed the presence of a mass in the lateral pharyngeal wall. Surgical treatment and removal of the mass was performed with satisfactory evolution of the patient.

Los pólipos pilosos nasofaríngeos son tumores benignos poco frecuentes. Se presenta el caso de esta patología en una paciente recién nacida, quien presentó cianosis y dificultad respiratoria por obstrucción de la vía aérea superior, durante las primeras 24 horas de vida. La paciente requirió maniobras de reanimación e intubación endotraqueal. Estudios diagnósticos confirmaron la presencia de una masa en la pared lateral de la faringe. Se realizó la extirpación quirúrgica exitosa con evolución satisfactoria de la paciente.

Obstructive sleep apnea in 2-6 year old children referred for adenotonsillectomy.

PURPOSE: Adenotonsillectomy is one of the most common surgical procedures performed in children. The indications for surgery are either frequent recurrent throat infections or hypertrophy of the tonsils/adenoid vegetation, which can cause obstructive sleep apnea (OSA). There is disagreement regarding the need for sleep studies before adenotonsillectomy to confirm a diagnosis of OSA. Several studies have evaluated questionnaires and physical examination as tools to identify OSA, with conflicting results. The aim of this study was to evaluate the prevalence of OSA among children referred for adenotonsillectomy and whether questionnaires or physical examination can help identify OSA. METHODS: This is a prospective cohort study of children aged 2-6 years, referred for adenotonsillectomy. Polysomnography and an otorhinological examination were performed. Tonsillar size and the oral cavity were graded using Friedman's classification and Mallampati score, respectively. The Pediatric Sleep Questionnaire (PSQ) and OSA-18 were also completed. RESULTS: 100 children were included. The prevalence of OSA was 87%, with 52% having moderate to severe OSA. The usefulness of the PSQ and OSA-18 for detecting OSA was evaluated using multiple cutoff points, but none yielded acceptable values for both sensitivity and specificity. In logistic regression analyses predicting different levels of OSA severity, age, Friedman tonsillar size and Mallampati score were weakly associated with OSA. CONCLUSIONS: The prevalence of OSA is high among children referred for adenotonsillectomy and questionnaires and clinical characteristics are not sensitive enough to detect the presence or severity of OSA.

Hairy polyps: A new case presentation and a pathogenetic hypothesis.

Hairy polyps are benign lesions found in the oropharynx or nasopharynx that are thought to be present at birth and can lead to upper airway obstruction in infants. Also known as naso-oropharyngeal choristoma, they are increasingly viewed as aggregates of bigeminal tissue, likely from the first or second branchial arches, found in aberrant locations. They are benign lesions that are usually successfully treated by surgical excision. Here we present a rare case of a hairy polyp originating in the eustachian tube of a 7-week-old male, discuss our management of the patient, and put forth a new hypothesis as to the origin of these lesions. Laryngoscope, 129:2398-2402, 2019.

Roles of T follicular helper cells in the pathogenesis of adenoidal hypertrophy combined with secretory otitis media.

The aim of this study was to investigate the roles of T follicular helper (Tfh) cells in secretory otitis media (SOM) combined with adenoidal hypertrophy (AH).Patients with AH or AH combined with SOM admitted to the Yancheng No. 1 People's Hospital from December 2012 to December 2014 were included. Fourteen age-matched healthy individuals received physical examinations in the hospital served as control. The venous Tfh was determined using flow cytometry, and CD3 + CD4 + CXCR5 + T lymphocytes were defined as Tfh cells. Serum inflammatory factors including IL-8, IL-1b, IL-6, IL-10, TNF, IL-12p70, IL-21, and IgE were determined using commercial kits.Compared with the AH group, the number of CD4 + CXCR5 + T cells in peripheral blood of the AH combined with SOM group showed significant increase. Statistical differences were noticed in the number of the number of CD4 + CXCR5 + T cells in moderate and severe AH groups compared with that of the control group. Statistical differences were identified in the proportion of CD4 + CXCR5 + T cells in the adenoidal tissues between the AH combined with SOM group and AH group (P < .05). For the CD4 + CXCR5 + T cells in adenoidal tissues, no statistical differences were noticed between the moderate and severe AH groups (P > .05). The number of CD4 + CXCR5 + T cells was positively correlated to the serum IL-21. Nevertheless, no correlation was noticed between CD4 + CXCR5 + T cell and serum IL-8, IL-6, IL-10, and IgE.Tfh is involved in the AH combined with SOM in children. Besides, serum IL-21, IL-8, IL-6, IL-10, and IgE may be involved in the onset of SOM in children.

[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.

Superficial punctate keratopathy in a pediatric patient was related to adenoid hypertrophy and obstructive sleep apnea syndrome: a case report.

BACKGROUND: Known causes of superficial punctuate keratopathy (SPK) in children include entropion, viral infection, blepharokeratoconjunctivitis (BKC), and toxicity of eye drops. However, there are some SPK patients whose causes could not be identified well. Herein, we describe the history, diagnosis, treatment, and prognosis of a rare case. CASE PRESENTATION: To report a case of superficial punctate keratopathy (SPK) which coexisted with floppy eyelid syndrome (FES) and presented as intermittent red eye and blurred vision in an 11-year-old boy who slept in the prone position. His condition did not improve despite treatment with topical antibiotics (levofloxacin, tobramycin), steroid eye drops (prednisolone), and artificial tears. The patient was diagnosed with tonsil hypertrophy and nasopharyngeal adenoid hypertrophy and obstructive sleep apnea syndrome (OSAS). He underwent tonsillectomy and adenoidectomy. Then he started sleeping in the supine position postoperatively. The SPK, red eye and blurred vision completely resolved after surgery without additional treatment. The corneal sensation also recovered gradually during the next 7 years. However, the floppy eyelid did not resolve. CONCLUSION: Recurrent SPK of childhood might be related to tonsil hypertrophy, adenoid hypertrophy and OSAS, which can be rehabilitated by a surgical approach.

[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.

A huge Thornwaldt's cyst causing hearing loss in an adult patient.

Nasopharynx (NP) is anatomically difficult to explore adequately. The pharyngeal bursa (PB) is a recess lined with respiratory epithelium along the posterior wall of the nasopharynx between the longus capitis muscles. If the opening through which the bursa drains into the nasopharynx becomes obstructed, a Thornwaldt's cyst (TC) might develop. Small-sized cysts are mostly asymptomatic, whereas large-sized cysts may lead to various nasal and otologic symptoms depending on their localization. In this report, we present a 71-year-old case with a huge TC who presented to our clinic with the complaints of snoring, nasal obstruction, periodic halitosis, postnasal drip, headache, and hearing loss in the left ear and underwent total excision of the cyst through transnasal endoscopy. The diagnosis and treatment characteristics of the case are presented with the review of the literature.

Head and neck inflammatory pseudotumor: Case series and review of the literature.

Inflammatory pseudotumor (IP) is an uncommon idiopathic lesion that often imitates malignancy clinically and radiologically. Inflammatory pseudotumors have been found to occur in various sites but rarely in the head and neck. The histopathology, imaging, and treatment of three unique cases of head and neck inflammatory pseudotumors are described in this case series. Patients in Cases 1 and 2 presented with right level II neck mass and left parotid tail mass, respectively. The patient in Case 3 presented with otalgia, jaw pain and trismus, and a left parapharyngeal space mass. The tumors in Cases 1 and 3 significantly decreased in size with tapered courses of oral corticosteroids. The tumor in Case 2 was surgically excised without disease recurrence. Malignancy must be ruled out with incisional or excisional biopsy. Treatment includes surgical excision, oral corticosteroids, or both. The literature shows that radiotherapy and small-molecule inhibitors may be promising alternatives.

MRI of nasopharyngeal adenoid hypertrophy.

Nasopharyngeal adenoid hypertrophy (NAH) is a typical benign lesion. Due to involution, nasopharyngeal lymphatic tissue usually is not found in adults beyond the 30th to 40th year of life. However, occasionally NAH has been recognized after the 50th or 60th year. The aim of this study is to identify the frequency of NAH and to analyze its MRI findings in different age groups. From 2007 to 2011, 6693 MR investigations of the head were performed at our institution. MRI was obtained with a 1.5 T MRI device. NAH was identified in 18.0% of the patients. The frequency of NAH varied from 60.3% to 1.0% in the different age groups. The mean size of NAH was 23.2 ± 4.5 mm in cranio-caudal, 31.1 ± 5.2 mm in left-right, and 14.2 ± 4.1 mm in the anterior-posterior direction. The left-right and cranio-caudal sizes of NAH were largest in the 0-9 age group and decreased with age. On T1-w images most lesions (95.4%) were hypointense in comparison to the adjacent musculature. On T2-w fat-saturated images 82.4% of the lesions were hyperintense. After intravenous administration of contrast medium most lesions showed a slight enhancement (58.6%). Moderate enhancement was seen in 32.4% and a marked enhancement was identified in 9.0%. In the 0-9 age group most lesions showed a slight enhancement. Cysts within NAH were identified in 433 cases (35.9%). The frequency of cysts increased continuously with age, namely from 10.9% to 65.2%.

The inferior turbinate, an unusual site for a choanal polyp: Two case reports and a review of the literature.

Choanal polyps are unilateral sinonasal lesions that are classified according to their site of origin. The aim of this report is to highlight an unusual form of choanal polyp and to present a thorough literature review. To the best of our knowledge, only 6 cases of a choanal polyp originating in the inferior turbinate have been previously reported in the literature. We describe 2 new cases. One patient was a 14-year-old boy who presented with nasal obstruction, facial headaches, and obstructive sleep apnea; the other patient was a 70-year-old man who presented with right mucopurulent rhinorrhea and right nasal obstruction. In both cases, nasal fibroscopy detected a polyp arising from the right inferior turbinate and extending toward the right choana. Endoscopic sinus surgery was performed in both cases to ensure a complete excision. Cases of choanal polyp arising from the inferior, middle, and superior turbinates and the septum are rare, although some appear to be more common than is generally believed, especially in the pediatric population. We therefore recommend that unusual forms of choanal polyp be included in the differential diagnosis of a unilateral sinonasal mass.

Correlation between adenoidal nasopharyngeal ratio and symptoms of enlarged adenoids in children with adenoidal hypertrophy.

BACKGROUND: Adenoid hypertrophy is one of the most common health problems affecting the paediatric population. This study aims to correlate adenoidal nasopharyngeal ratio (ANR) with symptoms of enlarged adenoids in children with enlarged adenoids. MATERIALS AND METHODS: It was a year, cross-sectional, hospital-based study conducted at Lautech Teaching Hospital, Osogbo. ANR was determined by dividing adenoidal depth with nasopharyngeal depth on the plain lateral radiographs. RESULTS: A total of 90 consecutive children consisting of 61 males and 29 females were included in the study with M:F ratio of 2.1:1. Their ages ranged from 8 months to 11 years. All the patients presented with nasal obstruction, mouth breathing and noisy breathing. Majority (64.5%) had severe obstructions with preponderance among children of 3-5 years (39.9%). Linear regression analysis showed significant association between age and ANR (t = 10.447, P < 0.001). There was high significant association (P < 0.05) between presenting symptoms and degree of nasopharyngeal airway obstruction; for snoring (r = 0.251, P = 0.000), sleep apnoea (r = 0.594, P = 0.000), nasal discharge (r = 0.314, P = 0.001), excessive daytime sleepiness (r = 0.219, P = 0.019) and failure to thrive (r = 0.240, P = 0.011). CONCLUSION: Lateral X-ray of the nasopharynx is an effective tool to evaluate children with suspected adenoid hypertrophy. It correlates well with patients' symptoms and provides objective measures of adenoid hypertrophy.

Tuberculosis of the cavum revealed by acute facial pain.

An 85-year-old woman presented for assessment of recurring episodes of intense hemifacial pain, mimicking trigeminal neuralgia, associated with tinnitus. A necrotic tumour of the cavum with compression of the left Eustachian tube and skull-base invasion was discovered on brain MRI. Although the tumour was initially thought to be malignant, the histopathological findings on the biopsy were compatible with tuberculosis, later confirmed by the cultures. F-18-fluorodeoxyglucose positron emission tomography (PET)/CT showed an intense signal of the cavum, cervical and mediastinal lymph nodes, and also of two small nodules of the apex of each lung. Currently, after 9 months of combined antituberculosis antibiotics, the initial lesion has almost disappeared from both PET scan and MRI. This case highlights the importance of systematically screening for tuberculosis in the assessment of nasopharyngeal tumours.