Neoplasms of the nasopharynx in children.

Neoplasms of the nasopharynx are rare in children, but they threaten the child's life when they do occur. The nasopharynx tends to harbor dysontogenetic neoplasms. After classification into benign and malignant groups, nasopharyngeal neoplasms in children can be further characterized according to the age of the patients in which the clinical manifestations usually appear. Dermoids and teratomas are the most frequently encountered neoplasms of the nasopharynx in infants and may produce airway obstruction and dysphagia. Among the benign tumors of the nasopharynx in children, the juvenile angiofibroma deserves the most attention. With the onset in puberty, these neoplasms may cause recurrent massive bleeding and orbital and intracranial complications. Evaluation of the extent of the neoplasm and the source of the blood supply has been improved with bilateral selective internal and external carotid angiography. Intracranial and orbital invasion is regarded as an indication for radiotherapy. Surgery has been made somewhat safer by preoperative estrogen therapy and angiographic embolization of the major arterial supply. Patients with squamous cell carcinoma of the nasopharynx have immunologic similarities to patients with Burkitt's lymphomia and infectious mononucleosis; The etiologic role of the Epstein-Barr virus is considered. The parts played by radiation therapy, surgery, chemotherapy, and cryosurgery in the treatment of children with carcinoma of the nasopharynx are discussed. The value of radical neck dissection after radiation therapy is critically reviewed. The prognosis in patients with carcinoma of the nasopharynx is better in females than in males and better in children than in adults.     

Human bocavirus in the nasopharynx of otitis-prone children

Objectives

Human bocavirus (HBoV) is frequently identified in children with respiratory tract infections, and its role in acute otitis media (AOM) has been suggested. The disease associations for the closely related bocaviruses HBoV2-4 remain unknown. Increasing evidence shows that probiotics may reduce the risk of AOM of viral origin. Objectives of the study was to examine the prevalence and persistence of bocaviruses in consecutive nasopharyngeal samples (NPS) of otitis-prone children, and whether an association exists between HBoV and the child's characteristics, respiratory symptoms, and AOM pathogens, and whether probiotics reduce the occurrence of HBoV.

Methods

In a double-blind, placebo-controlled, randomized, 6-month intervention study, 269 otitis-prone children (aged 9 months to 5.6 years), consumed daily either one capsule of probiotics (Lactobacillus rhamnosus GG, L. rhamnosus Lc705, Bifidobacterium breve 99 and Propionibacterium freudenreichii JS) or placebo. After a clinical examination and NPS collected at three-time points, the presence and persistence of HBoV1-4 DNA in NPS was determined by RT-qPCR at the baseline, after 3, and 6 months.

Results

A high load (>10,000 copies/ml) of HBoV DNA was detected in 26 (17.1%) of 152 children, and 16 (10.5%) showed a prolonged presence of HBoV for at least 3 months. None had DNA of HBoV2-4. Higher number of siblings associated with increased HBoV prevalence (p = 0.029). Prevalence or persistence of HBoV was not significantly associated with other characteristics, respiratory symptoms, or AOM pathogens. Probiotic intervention significantly reduced the number of HBoV DNA-positive samples (probiotic vs. placebo: 6.4% vs. 19.0%, OR = 0.25, CI 95% = 0.07-0.94, p = 0.039).

Conclusions

HBoV, but not HBoV2-4, DNA occurs often in the nasopharynx of otitis-prone children, and may persist for 3-6 months. Probiotic treatment possibly reduced the presence of HBoV.     

Bacterial adherence to epithelial cells in the nasopharynx in children

The presence of attached bacteria to epithelial cells from the nasopharyngeal surface of the soft palate, from the adenoid surface and from the secretions covering the adenoid was studied in 10 children undergoing adenoidectomy. Large numbers of bacteria were seen to attach to mature normal squamous epithelial cells from the soft palate and in the secretions, whereas attachment to adenoid epithelial cells was rare. Using differential interference contrast microscopy, bacteria-carrying epithelial cells were seen to have their surface covered by microridges characteristic of normal mature squamous epithelial cells. Sections of adenoid tissue showed bacterial infiltration of adenoid tissue to be virtually nonexistent in the patient group.     

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.     

经面罩鼻咽部加压预防高压舱耳气压伤

目的:探讨人体在高压舱进行环境增压时,鼻咽部压力大于咽鼓管通气阻力能否预防耳气压伤。方法:咽鼓管通气阻力<6kPa的男性健康志愿者8例,分为4组,每组2例,互为被试者和对照者。被试者经面罩给予6kPa的鼻咽部正压,对照者正常呼吸,高压舱以0.5kPa/s的速率增压至5kPa,被试者和对照者均不采用其他任何主动或被动开放咽鼓管的措施,测鼓室腔压力;高压舱以同样速率增压至20kPa,被试者条件不变,对照者可进行主动或被动开放咽鼓管的措施,测鼓室压。结果:高压舱增压至5kPa时,被试者和对照者鼓室压分别为(-11.2±5.3)daPa和(-168.6±71.5)daPa,差异有统计学意义(P<0.01);增压至20kPa时,被试者和对照者鼓室压分别为(-8.3±6.1)daPa和(-7.6±6.4)daPa,差异无统计学意义(P>0.05)。结论:当人体的环境压力增加时,经面罩提供大于咽鼓管通气阻力的鼻咽部压力可预防耳气压伤的发生。     

Patency of nasopharynx and a cephalometric image in the children with orthodontic problems

Objectives

To study a possible impact of adenoidectomy on malocclusion on the base of cephalometry.

Methods

Retrospective analysis of 148 patients qualified into the orthodontic treatment (77 girls and 71 boys) at the age of 9-11 years (an average age: 10 years and 3 months). Material was divided into three groups, equalized regarding sex and age. The first one consisted of the patients after adenoidectomy, at the moment of orthodontic assessment without any organic pathology within a nasal cavity or nasopharynx. To the second group were included children who for different reasons were not a subject of adenoidectomy despite clinical diagnosis of adenoid hypertrophy. In the third group were patients whose only problem was malocclusion. X-ray pictures taken on a cephalostate were scanned and given to cephalometric assessment. In statistics Bartlett's test, Tukey's test and Pearson's correlation coefficients were used.

Results

The significant differences with respect to many skull parameters appeared among the groups. The inappropriate respiratory habits find their reflection mainly within anterior and lower anterior facial height, angle of mandibular plane, nasopharyngeal flow and dental parameters. An evident beneficial influence of adenoidectomy is observed within a period of 36-41 months after an operation. Nasopharyngeal flow is the most sensitive parameter indicating the respiratory conditions, and is strongly connected with the key cephalometric parameters.

Conclusions

In cases of malocclusion of skeletal character, coexisting with adenoid hypertrophy, adenoidectomy should be carried out as early as possible.     

In vitro bacterial interference in the nasopharynx of otitis media-prone and non-otitis media-prone children

OBJECTIVE: To compare the frequency of recovery of potential pathogens and aerobic- and anaerobic-interfering bacteria in the nasopharynx of otitis media-prone (OMP) with that in non-OMP (N-OMP) children. PATIENTS AND METHODS: Nasopharyngeal cultures were obtained from 20 OMP and 20 N-OMP children. Potential pathogens and aerobic and anaerobic bacteria with interfering capabilities against these organisms were identified. RESULTS: Eighteen potential pathogens were isolated from 12 of the 20 OMP children, and 9 were recovered from 5 of the 20 N-OMP children (P<.05). Fifty-eight aerobic and anaerobic isolates with interfering capability against 4 potential pathogens were recovered from 5 of the OMP group, and 139 from 17 of the N-OMP group (P<.05). These interfering organisms included alphahemolytic streptococci, nonhemolytic streptococci, Prevotella species, and Peptostreptococcus species. CONCLUSION: The nasopharyngeal flora of N-OMP children contains more aerobic and anaerobic organisms with interfering capability and less potential pathogens than that of OMP children.     

Carcinoma of the nasopharynx

Carcinoma of the nasopharynx usually presents with widespread regional lymph node metastases, and there is frequently damage to important midline structures. The management of these patients in the multidisciplinary clinics of The Princess Margaret Hospital is outlined. Radiation therapy remains the mainstay of treatment. Experimental approaches combining chemotherapy and radical radiation therapy are being introduced. The results of treatment by radiation therapy in 140 patients seen in the period 1970-76 are reviewed. The overall five year survival rate (all causes) is 37%. Distant metastatic disease is present at relapse in 20%. Prognosis correlated generally with extent of disease by TNM staging.     

Bacterial interference in the nasopharynx and nasal cavity of sinusitis prone and non-sinusitis prone children

The aim of this study was to compare the frequency of recovery of potential pathogens and aerobic and anaerobic interfering bacteria in the nasopharynx and nasal cavity of sinusitis prone (SP) children, with their recovery in non-sinusitis prone (N-SP) children. Nasopharyngeal and nasal cultures were taken from 20 SP and 20 N-SP children. Potential pathogens and aerobic and anaerobic bacteria with interfering capabilities against these micro-organisms were identified. Twenty-one potential pathogens (1.05 patient) were isolated from nasopharyngeal cultures from 14 of the 20 SP children, and 10 (0.5 patient) were recovered from 6 of the 20 NSP (p < 0.05). Bacterial interference between two aerobic (alpha and non-haemolytic streptococci) and two anaerobic species (Prevotella and Peptostreptococcus species) and four potential pathogens was observed. Bacterial interference was noted in 64 instances against 4 potential pathogens by 24 normal flora isolates that were recovered from 7 of the SP group and in 144 instances by 47 isolates from 18 of the NSP group (p < 0.05). Nineteen potential pathogens (0.95/patient) were isolated from nasal cultures of 13 of the 20 SP children and 8 (0.4/patient) were recovered from 5 of the 20 NSP (p < 0.05). Bacterial interference by similar micro-organisms was noted in 21 instances by 9 normal flora isolates that were recovered from 5 of the SP group, and in 63 instances by 26 isolates from 15 of the NSP group (p < 0.05). Our findings illustrate for the first time that the nasopharyngeal and nasal flora of NSP children contains more aerobic and anaerobic micro-organisms with interfering capability and less potential pathogens than that of SP children.     

Gastric heterotopia in the nasopharynx

Heterotopic gastrointestinal mucosa is rare in head and neck area. Most cases are described in oral cavity especially in the floor of the mouth. We present herein the case of an 8-month old infant with a tumor-like mass in the cavum which consisted of an heterotopic gastric mucosa. This case is the first described in this localisation. A brief review of the literature and histopathologic differential diagnoses will be study.     

Tuberculoma of the nasopharynx

When a patient of oriental extraction was seen with a mass in the nasopharynx, squamous cell carcinoma appeared to be the obvious diagnosis. Histologic examination, however, proved the mass to be a tuberculoma. This condition, which was not rare in the past, is almost always secondary to pulmonary tuberculosis. It responds to antituberculous medications.