In Vivo Diagnosis of Persistent and Recurrent Nasopharyngeal Carcinoma by Contact Endoscopy

Objective To evaluate the potential use of contact endoscopy for the diagnosis of persistent and recurrent nasopharyngeal carcinoma in postirradiated patients. Study Design Prospective study to examine 64 consecutive patients who have been irradiated for nasopharyngeal carcinoma in a clinic setting using contact rhinoscopes (Karl Storz, Tuttlingen, Germany [7215 AA, 0°, and 7215 BA, 30°; 23 cm long. 4 mm in diameter]). Methods The superficial cells of the posterior walls of the nasopharynx were stained with 1% methylene blue and examined with contact rhinoscopes with the patient under local anesthesia at high magnifications (×60 and ×150). Biopsy of the areas under examination was performed. The contact endoscopic images were analyzed and correlated with the corresponding histological sections of the biopsy tissues. Results Contact endoscopy was performed in 64 patients (54 men; mean age, 42 y) with the use of local anesthesia. Four patterns of contact endoscopic findings were identified: squamous metaplasia (43 cases), postirradiation atypia (10), granulation tissue (6), and malignancy (5). In the last group, the nasopharynx appeared normal in two patients (40%). The findings of contact endoscopy correlated well with the histological findings (kappa reliability coefficient = 0.847;P <.001; diagnostic accuracy, 92.1%). For prediction of persistent and recurrent disease, the sensitivity and specificity of endoscopic findings were both 100%. Conclusion Contact endoscopy is an accurate, reliable office‐based procedure that allows for in vivo and in situ diagnosis of persistent and recurrent nasopharyngeal carcinoma in postirradiated patients.     

接触式显微内窥镜下声带检查与手术

目的 探讨接触式显微内窥镜进行声带检查与手术的价值。方法 应用接触式显微内窥镜经支撑喉镜进行声带全景检查及活体染色接触式显微检查,并对部分病例进行相应的显微手术。结果 接触式显微内窥镜能清楚地显示活体原位状态下粘膜表层上皮细胞及毛细血管的形态结构及分布排列。所观察７３例不同病变的声带表层上皮细胞血管存在一定的特征与差异。在支撑喉镜下应用显微内窥镜进行显微手术,可作得更加精细、彻底、喉功能保存。结论     

Nasopharyngeal teratoma associated with cleft palate in a newborn

Teratomas of the head and neck are rare congenital lesions comprising less than 10% of reported cases. Nasopharyngeal teratomas (NPT) are even rare. A case presented of a newborn with NPT associated with cleft palate. The most common presenting symptom of NPT is respiratory distress. The management of choice for NPT is surgical excision. Overall, the prognosis for NPT is excellent. Recurrences are rare, and are felt to be due to incomplete surgical resection.     

Correlations Between Virtual Endoscopy and Otoendoscopy of the Retrotympanum

The aim of this study was to examine the anatomical landmarks of the retrotympanum using two different techniques, virtual endoscopy (VE) and fiberoptic endoscopy, and to correlate the results furnished by the two methods. Ten otosclerotic patients who were due to undergo stapedectomy were scanned using high-resolution spiral CT. Selected CT datasets were processed with Navigator 2.0 software to obtain virtual endoscopic views of the retrotympanum. Subsequently, during the surgical procedure, fiberoptic endoscopy was performed with 2.7-mm 0° and 30° rigid endoscopes. The ability of the two imaging methods to identify specific anatomical structures was then compared. In all cases the pyramidal eminence, pyramidal crest and sinus tympani were clearly identified in both VE images and otoendoscopy recordings, while fiberoptic endoscopy seemed to be less satisfactory than VE for studying the facial sinus, sinus of Proctor and fossula of Grivot. The two techniques proved to be equally sensitive for visualizing the ponticulus and subiculum, while the stapedius tendon could be visualized only by means of fiberoptic endoscopy. Overall, VE imaging appears promising for rendering important anatomical details of the retrotympanum, allowing identification of osseous landmarks and exploring recesses that are difficult to visualize via otoendoscopy.     

Nasopharyngeal neuroglial heterotopy - Choristoma: Case report and review of the literature

We describe the case of a nine-month-old patient with a nasopharyngeal choristoma. The case presented includes the retrospective review of the historical, radiological, surgical and histological assessment of this pathology as well as a literature review of this entity. This case was presented in an infant with difficulty feeding, nasal obstruction and failure to thrive, evaluated with flexible nasal endoscopy, CT and MRI. The lesion was then surgically removed without complications. Nasopharyngeal choristoma is a rare congenital non-malignant mass, which may present within a range of symptoms and severity according to its size, growth and location.     

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.     

鼻内镜下治疗慢性泪囊炎

目的：总结鼻内镜下手术治疗慢性泪囊炎和术中切开泪囊时瘘口处理的经验。方法：选择鼻泪管堵塞、慢性泪囊炎（包括术后复发）患者90例、105眼,均行鼻内镜下处理。造瘘口采用EC耳脑胶粘合固定成形72眼,术中置硬膜外导管10眼,用银夹吻合泪囊后瓣与鼻黏膜瓣13眼,造瘘口用碘仿纱条填塞扩张成型5眼,用一次性5?ml注射器乳头将前后瓣撑开成型5眼。同期行鼻中隔高位偏曲矫正7眼,钩突肥大切除10眼,中鼻甲前端息肉样变切除9眼,鼻息肉6眼。结果：完全无溢泪92眼,好转8眼,无效5眼,有效率95.24% 。结论：泪囊鼻腔造口术造瘘口的处理可根据术者的习惯及手术经验、设备条件及术中切开泪囊后泪囊鼻腔黏膜瓣具体情况而定。     

Outcome of Acute Otitis Media and its Relation to Clinical Features and Nasopharyngeal Colonization at the Time of Diagnosis

Children ( n = 115; age range 1-9 years) with a diagnosis of acute otitis media (AOM) were eligible for this study and were enrolled within 24 h of the onset of symptoms signs. A nasopharyngeal culture was obtained at the initial visit. Children were treated with a single oral antibiotic for 7 days. Changes in symptoms signs and tympanic membrane features assessed by a scoring system were monitored for 1 month and related to the nasopharyngeal pathogen recovered on Day 1. More than 80% of children had no symptoms signs by Day 3, and 60% of cases had normal tympanic membranes by Day 29. Children without any symptoms signs on Day 3 had significantly lower symptom sign scores on Day 1 ( p = 0.005). Seventy-nine percent of cases carried middle ear pathogens in the nasopharynx at diagnosis: Streptococcus pneumoniae (48%); Haemophilus influenzae (24%); and Moraxella catarrhalis (16%). Children with S. pneumoniae showed significantly higher tympanic membrane scores than children with no pathogen at Days 8, 15 and 29 ( p < 0.01 for each comparison). Multivariate regression analysis revealed that lower tympanic membrane score on Day 1, the absence of S. pneumoniae in the nasopharynx and treatment with amoxillin were independent factors for rapid normalization of the tympanic membrane. These data suggest that the clinical course of AOM may be predicted, in part, at the time of diagnosis by means of careful evaluation of symptoms signs and the tympanic membrane as well as knowledge of pathogens harbored in the nasopharynx.     

慢性鼻及鼻窦炎鼻内镜手术疗效及黏膜上皮化分析

目的总结鼻内镜手术治疗慢性鼻及鼻窦炎的疗效和术腔黏膜上皮化规律,探讨影响疗效和术后黏膜上皮化的相关因素。方法对520例慢性鼻及鼻窦炎接受鼻内镜手术患者的手术疗效和术后黏膜上皮化规律进行临床分析。疗效分析应用X~2检验,黏膜上皮化时间分析用非参数秩和检验。结果治愈率74.4%,好转率21.0%,总有效率95.4%。术后平均黏膜上皮化时间为14.0周。疾病的分型分期、是否合并哮喘、变应性鼻炎和疗效与黏膜上皮化时间有相关性(P<0.05)。结论鼻内镜手术治疗慢性鼻及鼻窦炎是有效和安全的,术后黏膜上皮化时间平均需要3个月。病情重、合并哮喘或变应性鼻炎的患者疗效较差,黏膜上皮化时间长。鼻腔粘连通过定期合理的复查和处理,大多数能够得到有效的解除。     

Evaluation of young smokers and non-smokers with Electrogustometry and Contact Endoscopy

Background

Nasopharyngeal non-Hodgkin lymphomas (NNHL) are extremely rare. In this study, we will report the progress achieved in the management of this disease in our institute.

Methods

We retrospectively reviewed the records of 26 patients having primary NNHL who were managed between January 1997 and December 2008, to evaluate and compare their clinical characteristics and treatment outcome. Clinical variables, including age, sex, stage, and treatment modality, were assessed. Disease free survival and overall survival were measured. Survival curves were constructed using the KaplanMeier method. The log-rank test was used to compare them.

Results

Median age of our patients was 52.7 years. Nasal obstruction, nasal discharge and epistaxis were the frequent symptoms in NNHL patients. Histology of NNHL were mainly large B-cell and follicular lymphoma. Four patients (15.4%) were at stage I, 15 (57.6%) at stage II, and 7 (27%) were at stage III/IV. The patients were treated with chemotherapy alone (27%) or chemotherapy plus radiotherapy (73%). At early stage (stage I/II), the patients were managed with chemo-radiotherapy. When the whole treatment was completed, 18 patients (69.2%) achieved complete response and remained disease free. After 25.9 months median follow-up, overall survival at 1 year was 87% and disease free survival at 1 year was 71%. The difference in term of overall and disease free survival between stage I, II, III and IV was significant (Log rank test: p = 0.02 for overall survival and p = 0.01 for disease free survival).

Conclusion

From our study, we conclude that histological characteristics, principle of treatment and outcome of primary NNHL patients are particular and more studies have to be directed.     

Virtual Endoscopy of the Paranasal Sinuses Using Perspective Volume Rendered Helical Sinus Computed Tomography

Our goal was to use three-dimensional information obtained from helical computed tomographic (CT) data to explore and evaluate the nasal cavity, nasopharynx, and paranasal sinuses by simulated virtual endoscopy (VE). This was done by utilizing a new image reconstruction method known as perspective volume rendering (PVR). Thin-section helical CT of the nasal cavity, nasopharynx, and paranasal sinuses was performed on a conventional CT scanner. The data were transferred to a workstation to create views similar to those seen with endoscopy. Additional views not normally accessible by conventional endoscopy were generated. Key perspectives were selected, and a video “flight” model was choreographed and synthesized through the nasal cavity and sinuses based on the CT data. VE allows evaluation of the nasal cavity, nasopharynx, and paranasal sinuses with appreciation of the relationships of these spatially complex structures. In addition, this technique allows structural visualization with unconventional angles, perspectives, and locations not conventionally accessible. Although biopsies, cultures, and lavages routinely done with endoscopy cannot be performed with VE, this technique holds promise for improving the diagnostic evaluation of the nasal cavity, the nasopharynx, and the paranasal sinuses. The unconventional visual perspectives and very low morbidity may complement many applications of simple diagnostic endoscopy.     

Nasopharyngeal choristoma: An unusual and rare cause of acute respiratory distress in the newborn. Case series and review of the literature

To describe three cases of newborn acute respiratory distress caused by a nasopharyngeal choristoma. The cases presented include the radiological, surgical, histological and historical perspective of this entity. Retrospective chart review of three cases and review of the literature. Three cases of nasopharyngeal choristoma are reported each presenting with neonatal respiratory distress during the first day of life. All cases were assessed initially with cross-sectional imaging (CT or MRI) and subsequently confirmed on nasopharyngoscopy/laryngoscopy and surgically removed. Nasopharyngeal choristoma is a rare congenital nasopharyngeal mass which may present with rapid onset of acute upper airway obstruction by virtue of its relative size and anatomic position.     

Upper Airway Collapsibility in Habitual Snorers and Sleep Apneics: Evaluation with Drug-induced Sleep Endoscopy

Increased upper airway collapsibility has been suspected of being involved in the pathogenesis of sleep-related diseases. It is assumed that patients with severe obstructive sleep apnea syndrome (OSAS) show a stronger collapse of the upper airway compared with habitual snorers. It was the objective of this study to analyze the patterns of upper airway collapse in habitual snorers and patients with OSAS and to correlate these results with data from polysomnography. Endoscopy was carried out during drug-induced sleep (with propofol) and collapsibility was analyzed at two major levels (palatal and tongue base). A total of 207 habitual snorers and 117 patients with OSAS underwent endoscopy after overnight polysomnography in our sleep laboratory. In 95% of cases we were able to induce snoring during drug-induced sleep. The collapsibility in the area of the base of the tongue correlated with higher values of the respiratory disturbance index (RDI) as recorded by standard polysomnography. Patients with OSAS showed significantly stronger collapsibility compared with snorers. The difference was more evident at the tongue-base level. We found no significant correlation between the applied CPAP pressure and collapsibility in patients with OSAS. These results show that collapsibility at the tongue-base level is a factor relevant in sleep-related breathing disorders.     

Contact granulomas of the larynx

Ten cases of intubation granulomas and eight cases of contact granulomas not related to intubation were reviewed for the purpose of clinical analysis and pathological investigation. Granulomas were located primarily at the vocal process of the arytenoid cartilage. Additionally, 58 hemilarynges obtained from 37 cadavers with intubation granulomas were evaluated grossly and histopathologically. The intubation granulomas had no side predilections. All eight contact granulomas occurred in males and had a higher incidence of recurrence (three of eight cases) despite complete removal with laser surgery. In an attempt to explain recurrences of these contact granulomas, all three cases were studied clinically and pathologically. Results indicated that they recurred in singers and vocal abusers, and presumably resulted from the continued hammering of one vocal process against the other. Analysis also demonstrated that vocal rehabilitation was essential prior to or immediately after removal of the granuloma to prevent its recurrence. Pathological evaluation of the contact granulomas revealed focal ulceration and a covering of necrotic tissue with desquamating epithelium. The propria mucosa was edematous and infiltrated by chronic inflammatory cells and neutrophils forming focal granulation tissue in a stroma containing proliferated capillaries. Pathological features around local ulcerations were typical of a secondary granuloma while underlying arytenoid cartilage was partially necrotic.This paper was adapted from an extraordinary meeting of Colloquia and Workshops on Laryngeal Disorders, Johns Hopkins Medical Institutions, Baltimore, Md., USA, 10–12 September 1992     

慢性鼻窦炎对咽鼓管咽口黏膜上皮超微结构的影响

目的探讨慢性鼻窦炎对咽鼓管咽口黏膜上皮超微结构的影响,进一步反映对中耳、咽鼓管功能的影响。方法取6例慢性鼻窦炎患者和4例健康人咽鼓管咽口的组织做透射电镜标本,对比观察两类组织黏膜上皮的超微结构。结果①健康人咽鼓管咽口黏膜上皮为假复层纤毛柱状上皮,可见亮颗粒分泌细胞,各类细胞可见表面活性物质样板层体。②慢性鼻窦炎咽鼓管咽口可出现部分假复层纤毛柱状上皮脱落,细胞的纤毛、微绒毛倒伏、脱落,胞质泡状系统融合、扩张、溶解,分泌颗粒、杯状细胞增多。细胞间隙增大,有瘢痕,有炎症细胞浸润。表面活性物质样板层体减少、消失。结论正常咽鼓管咽口黏膜上皮为假复层纤毛柱状上皮,慢性鼻窦炎可引起咽鼓管咽口上皮、上皮各类细胞的超微结构发生改变,表面活性物质样板层体减少、消失。     

软带骨桥在双侧小耳畸形患者中的应用

目的 探讨佩戴软带骨桥在双侧小耳畸形患者中的临床应用效果。 方法 选取36例双侧小耳畸形患者,每例患者分别佩戴软带骨桥与软带骨锚式助听器(BAHA),佩戴前后分别测量声场纯音测听,并随访观察佩戴软带骨桥后患者的日常交流及对声音的反应情况。 结果 36例双侧小耳畸形患者佩戴软带骨桥后行声场纯音测听结果显示,平均气导听力提高38.8 dB,佩戴软带BAHA后行声场纯音测听结果显示,平均气导听力提高34.5 dB,二者比较差异无统计学意义(P>0.05),患者日常生活交流情况明显改善。 结论 对于先天性双侧小耳畸形患者,佩戴软带骨桥后,听力提高显著,效果良好。     

Exclusive Endoscopic Resection of Nasopharyngeal Papillary Adenocarcinoma via Combined Transnasal and Transoral Approach

Low grade nasopharyngeal papillary adenocarcinoma (LGNPPA) is an extremely rare variant of nasopharyngeal cancer, which exhibits distinct clinicopathological characteristics. Surgical resection has been regarded as the principal treatment. For this, transpalatal or transfacial approach has been classically used for exposure of the field. Up for now, there has been no report on applying endoscopic approach for this disease, which could be an effective alternative to minimize possible morbidities of palatotomy or maxillotomy. Endoscopic approach can be justified considering narrow extent and indolent behavior of LGNPPA. We report a patient with LGNPPA, which was successfully resected exclusively by endoscopic visualization. Our case exhibited narrow-based exophytic features with compatible immunopathologic profiles of LGNPPA. Exclusive endoscopic resection can be effective and less-morbid modality for this rare disease as in this case.