平阳霉素注射治疗鼻咽部血管畸形1例报告

患者,女,32岁,鼻咽部有异物感3个月来院.患者3月前无明显诱因自觉鼻咽部异物感,初始时不明显,后逐渐加重,影响生活,遂来医院就诊.病程中无鼻腔出血、鼻腔阻塞、流脓涕、发热及头痛等症状.鼻内镜下检查无殊,而鼻咽顶后壁黏膜下隆起明显,用剥离子压迫后肿块体积变小,穿刺可穿出暗红色血液,提示血管畸形可能.MRI增强提示鼻咽部血管瘤样病变,与周围组织界限清楚.结合以上检查临床诊断为鼻咽部血管畸形,遂在内镜下行鼻咽部血管畸形注射,将平阳霉素8 mg溶解于2％利多卡因2mL中一次性注射到鼻咽部隆起处,1个月后再次以同法注射一次,半个月后患者自觉症状完全消失.2年后随访,经鼻内镜及MRI检查提示鼻咽病变已完全消失.     

儿童阻塞性睡眠呼吸暂停低通气综合征两种腺样体检查方法的对比研究

目的比较观察两种检查方法对阻塞性睡眠呼吸暂停低通气综合征患儿腺样体大小的评估和诊断效果。方法33例阻塞性睡眠呼吸暂停低通气综合征患儿，分别行多导睡眠仪监测、立卧位鼻咽侧位照片、纤维鼻咽镜检查及鼻内镜检查，比较各项检测结果，分析仰卧位和立（坐）位时腺样体体积与鼻咽部、后鼻孔相互关系的变化规律。结果立位和卧位检查时，患儿鼻咽侧位片所显示的腺样体体积无明显差异（P〉0．05）；立位鼻内镜及纤维鼻咽镜检查、卧位鼻内镜结果配对t检验P〈0．05，差异具有统计学意义且呈线性相关。结论鼻内镜检查对腺样体与鼻咽部、后鼻孔相互关系的评价效果明显优于鼻咽侧位片，而在立位、仰卧位时，腺样体与鼻咽部、后鼻孔的相互关系有显著差异。仰卧位鼻内镜检查对腺样体的评估效果更理想。     

鼻咽部检查方法

本文对鼻咽部的检查方法进行了综述,包括间接鼻咽镜检查及活检,纤维鼻咽镜检查及活检,鼻内镜检查及活检,放大喉镜检查及活检以及鼻咽部影像学检查,分析总结了各种检查方法的优、缺点.     

鼻咽部检查方法

本文对鼻咽部的检查方法进行了综述,包括间接鼻咽镜检查及活检,纤维鼻咽镜检查及活检,鼻内镜检查及活检,放大喉镜检查及活检以及鼻咽部影像学检查,分析总结了各种检查方法的优、缺点.     

鼻咽部检查方法

本文对鼻咽部的检查方法进行了综述,包括间接鼻咽镜检查及活检,纤维鼻咽镜检查及活检,鼻内镜检查及活检,放大喉镜检查及活检以及鼻咽部影像学检查,分析总结了各种检查方法的优、缺点.     

鼻内镜检查在鼻咽癌诊断中的应用价值

目的评价鼻内镜检查对鼻咽癌的诊断价值. 方法对耳鼻咽喉科就诊的2 300例患者施行经鼻腔鼻内镜下鼻咽部检查,连接影像工作系统记录图像文字资料,可疑病变在鼻内镜直视下取活检. 结果 28例患者经鼻内镜检查及活检病理诊断为鼻咽癌,其中25例1次活检明确诊断,3例2次活检明确诊断.鼻内镜检查前行间接鼻咽镜检查的病例中,23例发现病变,5例阴性.CT扫描病例中25例显示异常,3例阴性. 结论鼻内镜检查光亮度强,分辨率高,能早期发现鼻咽部黏膜细微病变.鼻内镜直视下取活检准确率高.该检查对鼻咽癌诊断、鼻咽癌放疗后监控和病例随访具有重要价值.     

鼻咽部检查方法

本文对鼻咽部的检查方法进行了综述，包括间接鼻咽镜检查及活检，纤维鼻咽镜检查及活检，鼻内镜检查及活检，放大喉镜检查及活检以及鼻咽部影像学检查，分析总结了各种检查方法的优、缺点。     

鼻内镜下鼻咽活检术在鼻咽癌诊断中的价值

我科自2000年以来,通过对120例鼻咽部CT检查提示鼻咽部有黏膜下软组织肿物,而间接鼻咽镜下未能窥清鼻咽部病灶者,采用了鼻内镜引导下鼻咽活检术,取得了重要的临床诊断资料.现总结报告如下.     

鼻咽部髓外浆细胞瘤1例CSCD

1临床资料患者,女,54岁,主因渐进性鼻塞1年余入院。患者夜间睡眠时张口呼吸伴打鼾,偶有头痛,无发热、血涕、耳鸣及听力下降。鼻内镜检查:右侧鼻咽部淡红色新生物,表面不光滑,质韧,堵塞全部右侧后鼻孔及大部分、左侧后鼻孔,基底位于右侧咽隐窝处(图1A)。耳内镜检查发现右耳鼓膜内陷,入院诊断为鼻咽部肿物。     

鼻咽部淀粉样变性病的诊治分析

目的探讨鼻咽部淀粉样变性病的发病机制、分类、诊断及治疗。方法通过MRI、腹壁脂肪活检及病理学检查确诊的1例鼻咽淀粉样变性病患者，全麻鼻内镜下切除病变并结合文献进行分析。结果结合影像学资料经鼻内镜下完整切除病变，术后病检示黏膜下见大量无定型样物质，刚果红染色（＋＋），术后随访1年无复发。结论鼻咽部淀粉样变性病需病理切片确诊，MRI是诊断与鉴别诊断该病的最佳辅助检查，其首选治疗方式为鼻内镜下手术切除。     

Classification of nasopharyngeal microvessels detected by narrow band imaging endoscopy and its role in the diagnosis of nasopharyngeal carcinoma

Conclusions: The new NBI classification of nasopharyngeal mucosal microvessels was helpful in differential diagnosis for benign and malignant lesions of the nasopharyngeal region. NBI endoscopy facilitates the detection of superficial nasopharyngeal lesions and might enable early diagnoses of NPC.

Objectives: To propose a new microvessel diagnostic classification using narrow band imaging (NBI) endoscopy and to investigate the role of an NBI classification in the diagnosis of nasopharyngeal carcinoma (NPC).

Methods: Between January 2009 and December 2010, a total of 290 patients with a suspected nasopharyngeal tumor were enrolled in this study. The NBI endoscopic system was used to examine the nasopharynx. Each lesion was observed by NBI endoscopy and judged according to the detailed morphologic findings of epithelial microvessels. The superficial microvessel patterns were classified into five types (types I–V). The diagnostic effectiveness of NBI for benign and malignant nasopharyngeal lesions was evaluated.

Results: Approximately 93.5% (29/31) of lymphoid hyperplasia appeared as the type II microvessel pattern under NBI endoscopy, whereas 96.2% (51/53) of nasopharyngeal radiation-induced inflammation exhibited the type III or IV microvessel pattern. The characteristics of NPC under NBI endoscopy mainly appeared as a type V microvessel pattern (79.5%, 167/210), and the sensitivity, specificity, predictive value (PPV), and negative predictive value (NPV) of type V in the diagnosis of NPC were 79.5%, 91.3%, 96.0%, and 62.9%, respectively. NBI endoscopy could significantly improve the detection of superficial lesions (χ^2?=^?12.789, p?=?.000).     

Endoscopic diagnosis value of narrow band imaging Ni classification in vocal fold leukoplakia and early glottic cancer

ObjectivesTo explore the diagnostic value and the correlation between histological diagnosis and the Ni classification under narrow band imaging (NBI) for vocal fold leukoplakia (VFL) and early glottic cancer.MethodsA total of 91 patients with 119 vocal fold lesions were selected from January 2017 to May 2020. All these patients were subsequently examined by white light imaging (WLI) and NBI endoscopy, and then all lesions were classified by the Ni classification according to the characteristics of intraepithelial papillary capillary loop (IPCL) observed. The gold standard of diagnosis was histopathological results. Eventually, the chi-square and kappa test were applied, respectively, to evaluate the diagnostic value of NBI endoscopy and the consistency of Ni classification and pathological results.ResultsThe accuracy and sensitivity of NBI endoscopy were significantly higher than that of WLI endoscopy (P < 0.05). For the diagnosis of precancerous lesions under the NBI, the sensitivity, specificity, positive and negative predictive value were 69.6% (16/23), 90.6% (87/96), 64.0% (16/25) and 92.6% (87/94), which for malignant lesions were 84.4% (65/77), 92.9% (39/42), 95.6% (65/68) and 76.5% (39/51). Moreover, for patients with low-grade intraepithelial neoplasia (mild and moderate dysplasia), type IV lesions accounted for the most (69.6 vs 30.4%; χ² = 36.961, P < 0.001). For high-grade intraepithelial neoplasia or carcinoma in situ, type Va lesions were predominant (χ² = 30.526, P < 0.001), while type Vb and Vc lesions were dominant in invasive carcinoma (χ² = 64.373, P < 0.001). Besides, the kappa test revealed that there was a high consistency between Ni classification and pathological diagnosis (Kappa = 0.667, P < 0.001).ConclusionsThe Ni classification can improve the diagnosis accuracy of vocal fold lesions which enables clear visualization of mucosal microvasculature. This is essential for the early diagnosis of VFL and early glottic cancer during routine endoscopic examination.     

啮蚀艾肯菌致鼻咽颅底感染1例报道

目的 总结1例啮蚀艾肯菌引起鼻咽颅底感染的诊疗经验,提高对该菌感染病的认识。方法 回顾性分析1例啮蚀艾肯菌致鼻咽颅底感染患者的病例资料,并结合文献进行讨论。结果 本例患者完善内镜检查、影像学检查以及实验室检查,鼻咽颅底组织2次病理报告均为慢性肉芽肿性炎,经实验室确诊为啮蚀艾肯菌感染,予清创引流、口服抗生素2个月后,患者痊愈,术后随访3个月未复发。结论 鼻咽颅底感染临床少见,临床症状、影像学检查与鼻咽癌相似。啮蚀艾肯菌为罕见致病菌,发病率低。诊治上,需结合病理学、病原学检查明确诊断,及早清创引流、选取合适的抗感染药物。     

A transnasal foreign body penetrating the spinal cord from the nasopharynx

Objective and importanceThis is the first article regarding a transnasal Foreign bodies (FB) penetrating the spinal cord. We tried to remove it safely with a bilateral approach by performing a nasal endoscopy and partial laminectomy.Clinical presentationDuring logging work, a tree hit the occipital region of a 47-year-old man, producing unconsciousness with left paresis. Although he did not remember his injuries due to traumatic amnesia, a computed tomography (CT) scan showed a metal rod lodged from the left side wall of the nasopharynx to the spinal column at the cranial–cervical transition.InterventionA C1 laminectomy, partial occipital bone resection, and endoscopic intranasal extirpation were done jointly by an otolaryngologist and neurosurgeon under general anesthesia to safely remove the FB. All procedures were performed in the right lateral decubitus position so we could approach both the nasopharynx and occipital sides. The otolaryngologist withdrew the FB from the nasal cavity using an endoscope while the neurosurgeon monitored the occipital bone side. The FB was safely removed.ConclusionThe site of penetration at the nasopharynx contracted gradually to a scar with no cerebrospinal fluid (CSF) leak. The patient was finally discharged 39 days after surgery with no motor/sensory paralysis.     

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.     

Adenoid measurement accuracy: A comparison of lateral skull film,flexible endoscopy,and intraoperative rigid endoscopy (gold standard)

ObjectiveTo compare the accuracy of lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy in assessment of adenoid size.MethodsA cross-sectional study was conducted in 43 pediatric patients undergoing ENT surgery from July 2017 to December 2018. All patients underwent preoperative lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy.ResultsThe average adenoidal-nasopharyngeal (A/N) ratio obtained from lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy was 72.9, 79.5, and 81.6, respectively. There was a moderate correlation between A/N ratio from lateral skull film and intraoperative rigid endoscopy (Pearson's correlation: 0.567, p?0.001). Whereas, the A/N ratio from flexible endoscopy compared to intraoperative rigid endoscopy showed a stronger correlation (Pearson's correlation: 0.791, p?0.001). From linear regression analysis, the intraoperative adenoid measurement was estimated from the results of flexible endoscopy (intraoperative rigid endoscopy: 0.72 [flexible endoscopy] +24.47) and lateral skull film (intraoperative rigid endoscopy = 0.65 [lateral skull film] + 34)ConclusionFlexible endoscopy yields the most accuracy in the assessment of adenoid size and nasopharynx visualization, without radiation exposure or anesthesia. Despite less accuracy, lateral skull film is more availability in every hospital. The correlation of adenoid size measurement in this study can also be applied for the actual size of adenoid.     

Evaluating hypopharyngeal carcinoma using narrow band imaging and oxygen-injected laryngoscope: New technique

ObjectiveTo evaluate the diagnostic value of narrow band imaging (NBI) endoscopic classification for hypopharyngeal lesions and to lay the groundwork for practical applications of oxygen-injected laryngoscope for hypopharyngeal carcinoma (HC).MethodsA total of 140 subjects with suspected 146 hypopharyngeal lesions were selected for pathological examination. Subsequently, NBI and white light imaging (WLI) endoscopy were performed to observe and classify lesions into 7 types according to our modified NBI classification. Pathological results were used as the gold standard to assess the diagnostic value of the NBI classification. The value of oxygen-injected laryngoscope for accurate assessment of lesion extension was evaluated based on the exposure of hypopharyngeal lesions before and after use.ResultsThe accuracy, sensitivity, and negative predictive value of NBI endoscopy in diagnosing hypopharyngeal lesions were 95.9 %, 96.7 %, and 84.6 %, respectively, which were higher than those of WLI mode (p < 0.05). NBI endoscopy was more accurate than WLI in diagnosing malignant lesions (p < 0.05), especially for high-grade dysplasia (HGD) (p < 0.05). There was remarkable consistency between NBI classification and pathological results (Kappa = 0.855). Type Va and type Vb-c accounted for 72.7 % and 92.8 % of HGD and invasive carcinoma, respectively. Moreover, the oxygen-injected laryngoscope was found to provide a more accurate assessment of HC extension (P < 0.001).ConclusionWe propose a more appropriate NBI endoscopic classification for hypopharyngeal lesions, which can effectively improve diagnostic accuracy, especially for the early diagnosis of hypopharyngeal cancer. Moreover, the application of oxygen-injected laryngoscope is essential for the accurate assessment of HC and has a high clinical utility.     

14例阿司匹林耐受不良三联征临床分析

目的 探讨阿司匹林耐受不良三联征(AIT)的临床特点,治疗方法,总结最新诊疗经验。方法 采用回顾性研究方法, 对14例AIT患者的用药特点、临床特点、鼻窦CT、鼻镜、鼻腔鼻窦手术史等结果及治疗情况进行统计分析,并进行相关文献复习。结果 14例患者中1例患者因哮喘急性发作,经术前评估后暂缓手术治疗;13例患者行手术治疗,术后6个月随访,其中11例未见复发,病情基本得到控制;2例患者鼻部症状复发,1例再次行手术治疗,另1例继续药物综合治疗。结论 AIT因其伴有哮喘及相关药物过敏情况,鼻窦炎症状较重,多为全组鼻窦炎,易复发,远期失嗅,早期临床多误诊。能够早期明确诊断,早期围术期规范用药,早期进行彻底清除病灶,并进行规律术后药物治疗是本病的治疗关键。     

鼻腔鼻窦孤立性纤维性肿瘤1例报道及文献复习

目的 探讨发生于鼻腔鼻窦的孤立性纤维性肿瘤(SFT)的临床诊治经验.方法 结合1例鼻腔及鼻窦SFT患者的病例资料,并回顾性分析国内外文献,对SFT的临床特点、诊断与治疗进行讨论.本例患者术前CT提示:左侧鼻腔鼻窦肿物性质不明,鼻腔息肉可能.予以鼻腔新生物活检后鼻腔出血量大,随即全麻下行鼻内镜左侧鼻腔鼻窦新生物切除术,并...     

EBV-positive mucocutaneous ulcer presenting as a nasopharyngeal tumor in an immune suppressed patient

BackgroundWe describe an unusual presentation of EBV-associated mucocutaneous ulcer presenting as a large tumor of the nasopharynx in an immune suppressed child. This condition is newly characterized and has not been well-studied in the otolaryngology literature.Case reportOur patient is a 12-year-old female undergoing chemotherapy for T-cell acute lymphoblastic leukemia who presented with progressively severe headaches, nasal obstruction, facial pain/pressure, photophobia, fever and otalgia associated with neutropenia and refractory to empiric antibiotic therapy. Bedside nasal endoscopy and imaging revealed signs of acute sinusitis and a large nasopharyngeal mass suspicious for neoplasm. The mass was eccentric to the right and distending the right fossa of Rosenmuller. She underwent endoscopic sinus surgery and biopsy of her nasopharyngeal mass. Pathologic analysis of the nasopharyngeal mass revealed EBV-positive mucocutaneous ulcer.ConclusionThis is an unusual presentation of a rare entity. EBV-positive mucocutaneous ulcer warrants awareness among otolaryngologists and is not well-described in our literature.