Residual adenoid tissue post‐curettage: role of nasopharyngoscopy in adenoidectomy

Objective: Curettage adenoidectomy is one of the most common methods of adenoidectomy. This study reports the incidence of residual adenoid tissue after curettage and grades the degree of post‐nasal space obstruction using fibre‐optic nasopharyngoscopy. Methods: A retrospective study of 425 consecutive patients undergoing curette adenoidectomy in a 5‐year period. Results: Of the 425 patients, 288 (68%) had some residual adenoid tissue evident with nasopharyngoscopy, of which 104 (24%) had significant obstruction (grade 2 or 3). No age or sex difference was found in the likelihood or severity of residual adenoid tissue. Conclusions: A significant proportion of patients will have residual adenoid tissue following curette adenoidectomy alone. Nasopharyngoscopy permits a more complete resection in a cost‐effective, quick and easily performed additional step.     

腺样体大小及圆枕类型对儿童分泌性中耳炎的影响

目的 探讨腺样体大小及圆枕类型对儿童分泌性中耳炎的影响。 方法 选择120例分泌性中耳炎患儿为病例组,同期体检的正常儿童120例为对照组,对2个组儿童进行听力及电子鼻咽镜检查,比较两组腺样体大小、圆枕类型的差异及与听力损失程度的相关性。 结果 病例组Ⅲ~Ⅳ度腺样体及Ⅱ~Ⅲ型圆枕的比例均为77.5%,明显高于对照组的37.5%、46.7%,发病风险明显高于本组Ⅰ~Ⅱ度腺样体及Ⅰ型圆枕,差异有统计学意义(P<0.05)。对两组的腺样体大小、圆枕类型行趋势χ2检验,差异有统计学意义(P<0.05)。但病例组腺样体大小及圆枕类型与听力损失程度无相关性(r值分别为0.135、0.049,P值均>0.05)。 结论 腺样体肥大及Ⅱ~Ⅲ型圆枕是儿童分泌性中耳炎的危险因素。腺样体及圆枕类型的常规检查和评估,有助于儿童分泌性中耳炎的尽早诊治。     

X-Rays in the evaluation of adenoid hypertrophy: It's role in the endoscopic era

Objectives  To evaluate the reliability of X-rays in the diagnosis of adenoid hypertrophy and to validate this with flexible nasopharyngoscopy which is the existing gold standard. Method  Lateral radiograph of the neck and a flexible nasopharyngeal endoscopy was done to evaluate adenoid enlargement in children aged 3–12 years who were included in a S week randomized double-blind placebo controlled study for the effect of beclomethasone in adenoid hypertrophy. These were graded independently by both the co-investigor and investigator X-ray and nasal endoscopy for reevaluation of adenoid size was done at the completion of the study. Variables of both the procedures were scored at the beginning and end of the study. The agreement between the two groups was assessed using weighted kappa statistic. Results  There were 26 patients in the study, 17 of them had complete correlation between the X-ray and endoscopy findings. The agreement between these findings was statistically significant (p<01) with the weighted kappa 0.51. Conclusion  This study shows that lateral X-rays of the neck, besides being a noninvasive procedure, still remains a very reliable and valid diagnostic test in the evaluation of hypertrophied adenoids.     

鼻咽部美蓝染色的临床研究

用纤维鼻咽镜对８０例患者行鼻咽部美蓝染色检查，其中鼻咽癌３５例，炎症４５例，常规纤维鼻咽镜检查鼻咽癌４０例，结果正常粘膜不着色，鼻咽癌９７．１％着色，炎症２．２％着色，鼻咽癌着色明显高于炎症着色，经ｘ＾２检验，有极显著的差异（Ｐ〈０．０１），染色区鼻咽癌活检阳性率为９４．３％，常规镜检阳性率约为７７．５％，两者有显著的差异（Ｐ〈０．０５）。因此认为鼻咽部美蓝染色可作为常规镜检的附加检查应用于临床。     

The role of nasopharyngeal examination and biopsy in the diagnosis of malignant diseases

IntroductionIn direct proportion to the increasing rate of nasopharynx examinations applied, the early diagnosis and treatment of lesions in this region is possible. At times the clinical findings and the biopsy results are not consistent, so biopsies may have to be repeated.ObjectivesThe aim of this study was to evaluate the distribution of pathology test results obtained from cases of nasopharynx biopsy, to determine with which methods determination most often was made, and to investigate which kinds of cases required the biopsy to be repeated.MethodsThe study included a total of 1074 patients (500 female, 574 male) who underwent nasopharyngeal biopsy in our clinic between June 2011 and June 2017. Data were obtained from patient records of age, gender, clinical findings, imaging findings if available and pathological diagnosis. The pathological diagnoses were separated into 3 main groups as chronic nasopharyngitis, benign cytology and malignant cytology.ResultsThe examinations resulted in 996 cases reported as chronic nasopharyngitis, 47 as benign cytology and 31 as malignant cytology. Of the 31 malignant lesions, diagnosis was made in 15 patients (48.4%) with a single biopsy, and in 16 patients (51.6%), as a result of the pathology report when 2 or more biopsies were taken. In the comparison of the benign and malignant lesions in respect of the need for repeated biopsies, the cases determined with malignancy were found to have a statistically significantly higher rate of repeated biopsy (p < 0.001).ConclusionIn comparison with cases of benign tumor, a statistically significantly greater number of repeated biopsies were required in cases diagnosed as malignant tumors to confirm the pathological diagnosis or when there was continued suspicion of malignancy. Therefore, when there is clinical suspicion, even if there are no findings of malignancy on the first biopsy, the biopsy should be repeated expeditiously.     

纤维鼻咽镜下鼻咽部检查及留取鼻咽部肿物病理标本的配合与护理

目的 探讨纤维鼻咽镜下鼻咽部检查及留取鼻咽部肿物病理标本的配合技巧与护理.方法 使用OLMPUS(奥林巴斯)纤维鼻咽镜检查耳鼻喉科疾病患者4 800例,对其中56例鼻咽部肿瘤疑为鼻咽癌者行纤维鼻咽镜下取病理.结果 56例鼻咽部肿瘤患者经纤维鼻咽镜下取病理诊断为鼻咽癌,其中,一次病理确诊49例(一次确诊率87.5％),两次或两次以上确诊7例；鼻咽癌原发灶位于顶壁者33例(58.9％)、后壁者14例(25.0％)、咽隐窝9例(16.0％).结论 纤维鼻咽镜下鼻咽部检查对鼻咽癌的早期诊断及早期治疗具有重要意义,较好的配合医生取病理能提高其检出率,对患者检查前后进行必要的护理,可确保检查及操作的顺利、安全完成.