Adenoid Hyperplasia Research Articles

Adenoid basal carcinoma cervix – A rare epithelial neoplasm

ABSTRACT Adenoid basal carcinoma of the uterine cervix is a rare epithelial neoplasm. Adenoid basal carcinoma constitutes less than 1% of all cervical adenocarcinomas and has a favorable prognosis. Adenoid basal carcinoma is assumed to arise from a multipotential basal or reserve cell layer in the cervical epithelium. We report a case of adenoid basal carcinoma of the uterine cervix with complaints of bleeding per vagina in a 40-year-old female. The carbohydrate antigen 125 level was elevated (100 U/ml), and the MRI abdomen and pelvis revealed increased signal intensity in the anterior lip of the cervix. The local examination revealed thickening of the anterior lip of the cervix and induration in the left fornix. The patient was diagnosed with carcinoma cervix stage IB2 (FIGO Stage). The patient was operated by a radical robotic hysterectomy. Microscopic examination revealed small basaloid tumor cell nests with peripheral cell palisading and microcyst formation. The tumor cells showed p63 immunoreactivity in basaloid tumor cells and were negative for CD117 and S-100P. This tumor should be differentiated from adenoid basal cell hyperplasia, which has a favorable outcome, and adenoid cystic carcinoma, with a dismal course.

Correlation between tympanometric findings and adenoid hypertrophy among children without hearing loss in tertiary care hospital

Adenoid hyperplasia is a common cause of nasal obstruction in children. Chronic infection and hypertrophy result in mouth breathing, snoring, sleep apnoea, hyponasality, sinusitis, and otitis media with effusion (OME). Some children with adenoid hypertrophy have OME in spite of having no complaints of hearing loss. Untreated OME may adversely affect the speech and intellectual development of the child.Aim To determine whether there is a correlation between tympanometric findings and various radiological and endoscopic grades of adenoid hypertrophy.To propose a combination of radiological and/or endoscopic assessment of adenoids and tympanometry as a screening program in patients with suspicion of adenoid hypertrophy.Materials and methods One hundred children, presenting with one or more complaints of upper airway obstruction (UAO), suggestive of adenoid hypertrophy, without a history of hearing loss, to the OPD, were chosen for the study. X-ray nasopharynx soft tissue lateral view was done for all patients. Rigid diagnostic nasal endoscopy with 0° endoscope was conducted in only children who were cooperative and with parental consent. Tympanometry was carried out for all patients and plotted on tympanograms.Results In our study, the mean age of children is 9.43 ± 2.430 years with gender distribution being 57% males and 43% females. The majority of children tend to present with nasal obstruction (100%), mouth breathing (83%), and snoring (56%). On both radiological and endoscopic evaluation of adenoids and correlation with tympanogram, a significantly higher number of patients with Grade 1 adenoids have a type A curve, while a significantly higher number of grade 3 adenoids patients have a type B curve and type C is significantly more prevalent in grade 2 and grade 4 adenoids (p < 0.05).Conclusion In our study, adenoid size as measured from both adenoid X-ray and adenoid endoscopy, showed a significant association with the presence of middle ear effusion and also with eustachian tube dysfunction. This helps in early detection, prior to the development of hearing loss, making it easy to plan early intervention, and curbing the possibility of aggravation of the condition and occurrence of complications.

Olfactory disorders in childhood: A comparative study of olfaction in children with adenoid hyperplasia versus a control group and the postoperative effects of adenoidectomy with respect to olfactory ability.

Hyposmia in childhood is poorly characterized. The "U-Sniff Test", validated for children with anosmia, can be used to objectify olfactory impairment but has not been used to distinguish between hyposmia and normosmia. Therefore, we investigated children with enlarged adenoids with respect to hyposmia, its correlation with adenoid size, and the sensitivity of questionnaires to predict olfactory impairment. In a prospective comparison, olfaction was assessed by "U-Sniff Test" (score 0-12; <8 hyposmia) in 41 children (5-18 years) with adenoid hyperplasia and compared with 196 children without any respiratory affection (control) after exclusion of previous SARS-Cov2-infection from December 2020 to December 2021. ENT-related complaints were collected using a self-designed questionnaire. We were able to include 13 children in a follow-up examination to compare preoperative performance in the "U-Sniff Test" with postoperative outcome after adenoidectomy. chi-square-test (p<0.05), odds-ratio, Spearman's rho, ROC-, cluster analysis. Severe hyposmia was present in 36.6% of children with adenoid-hyperplasia compared to 3.1% of the control-group. Adenoid-children scored significantly more often between 8 and 10 points (58.5%) than the control (31.6%; p<0.01). Adenoid size and olfactory performance correlate significantly (r: 0.83; CI -0.89 … -0.72). Hyposmia in the adenoid group is characterized predominately by loss of the odors banana, butter and rose. None of children with hyposmia or parents reported impaired olfactory performance. Postoperatively, olfactory function improved significantly in 85% of cases (p 0.01, SD ± 1.71, Δ3.54points). Questionnaires are insufficient to detect hyposmia in this cohort. In contrast, the "U-Sniff Test" detects even reduced olfactory performance without reaching the cut-off value, which represents the majority of test results in the adenoid group. Therefore, we recommend the classification of moderate hyposmia (8-10 points) to be included for our study population.

Possible Role of Helicobacter pylori in Ear Nose and Throat Diseases.

Helicobacter pylori is assumed to cause many gastric and extragastric diseases. We aimed to assess the possible association role of H. pylori in Otitis media with effusion (OME), nasal polyps and adenotonsillitis. A total of 186 patients with various ear, nose and throat diseases were included. The study comprised 78 children with chronic adenotonsillitis, 43 children with nasal polyps and 65 children with OME. OME patients were assigned to two subgroups: those who have and those who did not have adenoid hyperplasia. Among the patients with bilateral nasal polyps, 20individuals had recurrent nasal polyps and 23 had de novo nasal polyps. Patients who have chronic adenotonsillitis were divided into three groups: those with chronic tonsillitis and those who underwent tonsillitis, those with chronic adenoiditis and adenoidectomy was performed, and those with chronic adenotonsillitis and underwent adenotonsillectomy. In addition to examination of H. pylori antigen in stool samples of all included patients, real-time polymerase chain reaction (RT-PCR) for detection of H. pylori in the effusion fluid was performed, additionally, Giemsa stain was used for detection of H. pylori organism within the tissue samples when available. Frequency of H. pylori in effusion fluid was 28.6% in patients with OME and adenoid hyperplasia, while in those with OME it was only 17.4% with a p value of 0.2. Nasal polyp biopsies were positive in 13% patients of denovo, and 30% patients with recurrent nasal polyps, p=0.2. De novo nasal polyps were more prevalent in the positive stools than recurrent ones, p=0.7. All adenoid samples were negative for H. pylori, only two samples of tonsillar tissue (8.3%) were positive for H. pylori, and stool analysis was positive in 23 patients with chronic adenotonsillitis. Lack of association between Helicobacter pylori and occurrence of OME, nasal polyposis or recurrent adenotonsillitis.

Silent Secretory Otitis Media in Cases with Adenoid Hypertrophy

Objective: to determine the cases brought to the Otolaryngology Department with adenoidal hyperplasia.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: ENT Department, Combined Military Hospital, Multan Pakistan from Jan to May 2022.&#x0D; Methodology: The study was conducted on children of age more than 2.5 years having adenoid hypertrophy that was confirmed by an X-Ray lateral view of the nasopharynx for adenoids. Their tympanogram was obtained.&#x0D; Results: The study showed that 2(2%) cases had a Type-B curve in a single ear, and 14(14.3%) had a Type-B curve in both ears.PTA was normal in 32(32.7%) cases. Up to 25 decibels (dB) of hearing loss was seen in 6(6.1%) cases. In 8(8.2%) cases, hearing loss, was more than 25Db.&#x0D; Conclusion: The tympanometry test is an objective test which is very easy to carry out and can very easily detect patients having glued ears which can be managed, and possible complications of the disease can be avoided.

Analysis of adenoid hyperplasia and its influencing factors of neonates

Objective: To explore the characteristics of neonatal adenoid development and to study the relationship between neonatal adenoid development and disease. Methods: A retrospective analysis of neonates who received an electronic rhinopharyngolaryngoscope at Shenzhen Children's Hospital from January 2019 to December 2020 was conducted to track the children's medical history and to analyze the adenoid development status. All 131 neonates successfully completed the electronic laryngoscopy. According to the presence or absence of visible adenoid hyperplasia, they were divided into a hyperplasia group (81 cases, 61.83%) and an un-hyperplasia group (50 cases, 38.17%). Results: Compared with the un-hyperplasia group, the age and birth weight of the adenoid hyperplasia group were larger, and the difference was statistically significant (Z age=-4.634,Z weight=-2.273,all P<0.05), but there was no significant difference in gender and gestational age between the two groups. The number of neonates with rhinitis/sinusitis in the hyperplasia group were significantly more than those in the un-hyperplasia group (62.96% vs 48%). Conclusion: The development of neonatal adenoids is related to daily age, birth weight, but not significantly related to gender and gestational age.

Analysis of conductive olfactory dysfunction using computational fluid dynamics.

Conductive olfactory dysfunction (COD) is caused by an obstruction in the nasal cavity and is characterized by changeable olfaction. COD can occur even when the olfactory cleft is anatomically normal, and therefore, the cause in these cases remains unclear. Herein, we used computational fluid dynamics to examine olfactory cleft airflow with a retrospective cohort study utilizing the cone beam computed tomography scan data of COD patients. By measuring nasal–nasopharynx pressure at maximum flow, we established a cut-off value at which nasal breathing can be differentiated from combined mouth breathing in COD patients. We found that increased nasal resistance led to mouth breathing and that the velocity and flow rate in the olfactory cleft at maximum flow were significantly reduced in COD patients with nasal breathing only compared to healthy olfactory subjects. In addition, we performed a detailed analysis of common morphological abnormalities associated with concha bullosa. Our study provides novel insights into the causes of COD, and therefore, it has important implications for surgical planning of COD, sleep apnea research, assessment of adenoid hyperplasia in children, and sports respiratory physiology.

Вплив гіперплазії аденоїдів та аденотомії на імунітет і стан здоров’я дітей

В огляді сучасної літератури подані дані щодо впливу гіперплазії аденоїдів та аденотомії на імунітет і стан здоров’я дітей. Показано, що наявність у дитини гіперплазії аденоїдів створює умови для більш частої захворюваності на респіраторну патологію з тяжким перебігом за рахунок тривалої колонізації патогенними та умовно-патогенними мікроорганізмами на тлі морфофункціональної перебудови структур мукозального імунітету з його транзиторною недостатністю. Аденотомія справляє позитивний ефект лише як засіб усунення механічних перешкод носовому диханню, не впливаючи на інші компоненти патологічного процесу в носоглотці дітей із гіперплазією аденоїдів.

Surgical resection of extremely rare primary giant splenic angiomyolipoma: a case report

BackgroundAngiomyolipoma is a benign mesenchymal tumor that develops commonly in the kidney and rarely in other organs. The involvement of the spleen in angiomyolipoma is extremely rare, and only one such case has been reported in the English literature.Case presentationA 27-year-old man presented with adenoid hyperplasia and bilateral palatal tonsillar hyperplasia. During the treatment for adenoid hyperplasia, a 15-cm tumor was detected in the spleen using abdominal ultrasonography and enhanced computed tomography. Partial resection of the spleen was successfully performed. A giant tumor of approximately 13 cm with a smooth surface was observed in the upper left quadrant of the abdomen. The tumor was confirmed to be continuous with the upper spleen, and there was no invasion of the other organs. The postoperative course was good, and the patient was discharged on the 7th postoperative day. The excised specimen was a smooth, extremely soft tumor measuring 123 × 120 × 82 mm. The cleaved surface of the tumor was reddish brown, and a distressing yellow color was observed. Pathological examination revealed a proliferation of mature adipocytes and an increase in the number of blood vessels of various sizes. Furthermore, spindle-shaped cell proliferation foci were visible between the adipocytes and the surrounding blood vessels. Profuse leakage of erythrocytes from the blood vessels, hemosiderin deposition, and small round cell infiltration were also noted. Immunostaining disclosed that the spindle-shaped cells were weakly positive for smooth muscle antibody and were identified as smooth muscle cells. The adipocytes and spindle cells were negative for HMB 45, Melan A, MDM, and CDK4. However, some parts of the cells were positive for estrogen and progesterone receptors. Besides, vascular endothelial cells were positive for CD31 and CD34 and negative for CD8. Based on these findings, the patient was diagnosed to have primary angiomyolipoma of the spleen.ConclusionsWe have reported the surgical treatment for an extremely rare case of giant splenic angiomyolipoma in a young man. Globally, this is the second report on this condition. We believe that partial splenic resection is a feasible option for the management of giant tumors.

Microdebrider: a painless and effective technique for adenoidectomy; comparative study with curette assisted adenoidectomy

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Adenoid is a nasopharyngeal tissue which forms Waldeyer's ring as said by Meyer, 1968. Adenoids become demonstrable with signs of CSOM with adenoid hyperplasia, recurrent rhino-sinusitis, characteristic ‘adenoid facies’, nasal obstruction, mouth breathing, snoring, drooling of saliva and speech abnormalities and dental malocclusion. Adenoidectomyis the common surgery done using various techniques like curette, microdebrider and many more. In this study we evaluate and compare the efficacy of adenoidectomy by microdebrider verses curette assisted adenoidectomy. Aim of the study was to evaluate and compare the efficacy and benefits of adenoidectomy by microdebrider with curette assisted adenoidectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a prospective randomized single-blind study done for 1 year. Total 150 patients were included which were diagnosed as adenoid hypertrophy based on clinical and radiological examination and were equally divided in 2 group for both the procedures (curette and microdebrider).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients show good response to the treatment with microdebrider assisted adenoidectomy with less complication and early recovery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;We observe that proper examination and early surgical intervention using modern technique i.e., microdebrider reduces the time, residual tissue with less complication and promote early recovery.&lt;/p&gt;

Is flexible bronchoscopy necessary in the preoperative workup of patients with peripheral cT1N0 subsolid lung cancer? -a prospective multi-center cohort study.

BackgroundNecessity of flexible bronchoscopy (FB) examination as a routine preoperative work-up for peripheral clinical T1N0 subsolid lung cancer was unknown.MethodsThis was a prospective, multi-center clinical trial (NCT03591445). Patients with peripheral GGO nodules (GGNs) who were candidates for surgical resection were enrolled. FB examination was performed preoperatively. Surgical plan could be changed if any aberrant histologic and anatomic findings were detected by FB examination. Primary endpoint was the rate that surgical plan was changed by positive FB findings. Secondary endpoints were rate of positive FB findings and rate of procedural complications.ResultsSix hundred and fifteen patients with peripheral subsolid nodules detected by thoracic CT were enrolled. There were 187 (30.4%) male and 428 (69.6%) female patients, mean age was 54.85±10.41 y (range, 26–78). 262 (42.6%) patients had pure GGNs and 353 (57.4%) patients had part-solid nodules. Mean size of nodules was 13.87±6.37 mm (range, 5–30). FB examinations confirmed one (0.16%) adenocarcinoma, seven (1.14%) bronchial variations, one (0.16%) segmental bronchostenosis, one (0.16%) segmental bronchial occlusion and one (0.16%) bronchial inflammation. No complications of FB examinations occurred. 568 (92.35%) thoracoscopic and 47 (7.65%) open surgeries were performed. No established surgical plan was changed by positive FB findings. Final pathologies revealed 26 (4.2%) adenocarcinoma in situ (AIS), 240 (39%) minimal invasive adenocarcinomas (MIAs), 343 (55.8%) invasive adenocarcinomas (IADs), one (0.2%) adenosquamous cell carcinoma, one (0.2%) squamous cell carcinoma, two (0.3%) atypical adenoid hyperplasia and two (0.3%) inflammations.ConclusionsFB examination was unnecessary in the preoperative assessment of peripheral clinical T1N0 subsolid lung cancer.

Clinical case of mucopolysaccharidosis type II (Hunter syndrome)

The article presents a rare case of type II mucopolysaccharidosis (MPs) in children. From the age of one and a half, the child was observed by an ENT doctor for 2–3 degree adenoids. At the age of 2, an adenotomy was performed. In the future, a relapse of adenoid hyperplasia. 1 year of age according to the ultrasound revealed hepatosplenomegaly. At the age of three years, type 2 mucopolysaccharidosis was suspected, which was confirmed on the basis of increased levels of heparan sulfate and dermatansulfate in the urine, molecular genetic diagnostics (mutation in exon 3 of IDS Lis135Glu in the hemizygous state. Appointed replacement therapy: Elaprase. Clinical polymorphism, different severity of symptoms combined with rare occurrence cause certain difficulties in early identification of MPs-II. Timely diagnosis is extremely important for referral of such children to specialists of an interdisciplinary center who have experience in specific treatment that is most effective in the early stage of the disease.

30-day readmission rate in pediatric otorhinolaryngology inpatients: a retrospective population-based cohort study

ObjectivesAnalysis of frequency and reasons for planned and unplanned 30-day readmission in hospitalized pediatric otorhinolaryngology patients using German Diagnosis Related Group (G-DRG) system data.MethodsA retrospective population-based cohort study in Thuringia, Germany, was performed for the year 2015 with 2440 cases under 18 years (55.6% male) out of a total number of 15.271 inpatient cases. The majority of pediatric patients were from 2 to 5 years old (54.5%). The most frequent diagnoses were hyperplasia of adenoids or/and tonsils (26.6%). 36 cases (1.5%) experienced readmission within 30-days.Results30-day readmission was planned in 9 cases (25% of all readmission) and was unplanned in 27 cases (75%). The median interval between index and readmission treatment was 8 days. Postoperative bleeding after adenoidectomy, tonsillotomy/tonsillectomy or tracheostomy (33.4%) and infectious complications after surgery like acute otitis media, abscess formation or fever (36.2%) were the most frequent reasons for 30-day readmission. Compared to adults treated in 2015 in Thuringia, the readmission rate was higher in adult patients (8.9%) than in this pediatric cohort. In contrast to children, readmissions in adults were mainly planned (65.1%) with a different spectrum of underlying diseases and reasons for readmission.ConclusionThe 30-day readmission rate seemed to be lower for pediatric otolaryngology patients compared to adult patients. Unplanned readmissions dominated in pediatric patients, whereas planned readmissions dominated in adults.

Adenoid Basal Carcinoma of Cervix: A Rare Case Report

Adenoid basal carcinoma of the uterine cervix is a rare low-grade tumor and its cell origin is still obscure. Adenoid basal carcinoma can be confused with adenoid basal hyperplasia, adenoid cystic carcinoma, and basaloid squamous cell carcinoma of the cervix. We present here a case of a 59 year-old-female who initially presented with a high-grade squamous intraepithelial lesion on Pap smear. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathology revealed focal invasive adenoid basal carcinoma with extensive areas of a high-grade squamous intraepithelial lesion involving the endocervical gland. The immunohistochemical stain was positive for p16.

A deep‐learning‐based approach for adenoid hypertrophy diagnosis

Adenoid hypertrophy is a pathological hyperplasia of adenoids and may cause snoring, apnea, and impede breathing during sleep. In clinical practice, radiologists diagnose the severity of adenoid hypertrophy by measuring the ratio of adenoid width (A) to nasopharyngeal width (N) according to the lateral cephalogram, which indicates the locations of four keypoints. The entire diagnostic process is tedious and time-consuming due to the acquisition of A and N. Thus, there is an urgent need to develop computer-aided diagnostic tools for adenoid hypertrophy. In this paper, we first propose the use of deep learning to solve the problem of adenoid hypertrophy classification. Deep learning driven by big data has developed greatly in the image processing field. However, obtaining a large amount of training data is hard, making the application of deep learning to medical images more difficult. This paper proposes a keypoint localization method to incorporate more prior information to improve the performance of the model under limited data. Furthermore, we design a novel regularized term called VerticalLoss to capture the vertical relationship between keypoints to provide prior information to strengthen the network performance. To evaluate the performance of our proposed method, we conducted experiments with a clinical dataset from the First Affiliated Hospital of Anhui Medical University consisting of a total of 688 patients. As our results show, we obtained a classification accuracy of 95.6%, a macro F1-score of 0.957, and an average AN ratio error of 0.026. Furthermore, we obtained a macro F1-score of 0.89, a classification accuracy of 94%, and an average AN ratio error of 0.027 while using only half of the data for training. The study shows that our proposed method can achieve satisfactory results in the task of adenoid hypertrophy classification. Our approach incorporates more prior information, which is especially important in the field of medical imaging, where it is difficult to obtain large amounts of training data.

Association of snoring caused by adenoid hyperplasia with behavioural disturbances in school children

Association of snoring caused by adenoid hyperplasia with behavioural disturbances in school children

Obstructive sleep apnea and craniofacial appearance in MPS type I-Hurler children after hematopoietic stem cell transplantation

Mucopolysaccharidosis type I (MPS I) is an inherited lysosomal storage disorder characterized by severe multi-systemic organ manifestations including obstructive sleep apnea syndrome (OSAS). Hematopoietic stem cell transplantation (HSCT) is the treatment of choice in severe MPS I (MPS IH, Hurler syndrome). However, the effect of HSCT on OSAS in MPS IH still remains unclear. The purpose of this study was to analyze respiratory patterns during sleep following HSCT in MPS IH children and to relate these findings to craniofacial abnormalities. Overnight polysomnographies of nine MPS IH children (mean age: 8.2years) previously treated with HSCT were retrospectively analyzed. Magnetic resonance images of the head were assessed with regard to soft and hard tissue abnormalities of the upper respiratory tract. The mean apnea hypopnea index (AHI) was 5.3 events/h (range, 0.3-12.2), and the majority of apnea/hypopneas were obstructive. Whereas two patients had severe OSAS (AHI > 10) and two moderate OSAS (5 > AHI < 10), five patients had no evidence of OSAS (AHI < 2.0). Donor cell chimerism was significantly lower in MPS IH patients with OSAS as compared to patients without OSAS (p < 0.001). The upper airway space and the maxilla were significantly smaller and the adenoids larger in MPS IH patients with OSAS as compared to those of non-OSAS patients. OSAS was only observed in MPS IH patients with graft failure or low donor cell chimerism. Conversely, successful HSCT seems to ameliorate adenoid hyperplasia and maxillary constriction in MPS IH patients and thereby minimizes the risk of OSAS at least at younger ages.

Multimorbidities of Pediatric Allergic Rhinitis.

Most children and adolescents with allergic rhinitis (AR) present extra-nasal multimorbid conditions, including conjunctivitis, asthma, atopic dermatitis, rhinosinusitis, or seromucous otitis. Additionally, they may present nasal obstructive disorders, such as septal deformity, turbinate enlargement, and adenoidal hyperplasia, which worsen nasal symptoms, especially nasal obstruction. This is a narrative review on the current state of the concomitant presence of AR and one or more multimorbidities. The presence of AR and one or more accompanying multimorbidities is associated to a higher severity and duration of the disease, a negative impact on quality of life, with worse control and lack of improvement with medical treatment. Therefore, AR needs to be managed with a multidisciplinary collaborative approach. Pediatric AR needs to be considered in the context of a systemic disease, which requires a coordinated therapeutic strategy.

Is there any association between Helicobacter pylori and otitis media with effusion?

IntroductionIt is proposed that Helicobacter pylori can be responsible for the development of otitis media with effusion. ObjectiveThe aim of this study is to investigate the prevalence of H. pylori in the adenoid tissue and fluid of the middle ear in patients who suffer from adenoid hyperplasia and otitis media with effusion in comparison with those who suffer from adenoid hyperplasia without otitis media with effusion. MethodsThis is a case–control study that was carried out in 50 children of age 2–7 years old who were admitted with adenoid hyperplasia. Patients were divided into case and control groups. The study group included 25 patients with adenoid hyperplasia and otitis media with effusion and the control group included 25 patients with adenoid hyperplasia without otitis media with effusion. The patients in both groups underwent surgical adenoidectomy. For the case group we carried out myringotomy and placement of tympanostomy tube, and fluid samples were collected under sterile conditions. The samples were sent to the laboratory for polymerase chain reactions. ResultsIn the case group H. pylori was found to be positive in 18 samples of the middle ear fluid (70%) and in 1 polymerase chain reaction adenoid tissue sample (4%). In the control group H. pylori was positive in 3 samples of adenoid tissues (12%). There was no gender difference. ConclusionH. pylori is one of the important bacteria that plays a role in the pathogenesis of otitis media with effusion. Whether adenoid tissue may be a reservoir for H. Pylori is unclear.

Development and validation of an endoscopic images-based deep learning model for detection with nasopharyngeal malignancies

BackgroundDue to the occult anatomic location of the nasopharynx and frequent presence of adenoid hyperplasia, the positive rate for malignancy identification during biopsy is low, thus leading to delayed or missed diagnosis for nasopharyngeal malignancies upon initial attempt. Here, we aimed to develop an artificial intelligence tool to detect nasopharyngeal malignancies under endoscopic examination based on deep learning.MethodsAn endoscopic images-based nasopharyngeal malignancy detection model (eNPM-DM) consisting of a fully convolutional network based on the inception architecture was developed and fine-tuned using separate training and validation sets for both classification and segmentation. Briefly, a total of 28,966 qualified images were collected. Among these images, 27,536 biopsy-proven images from 7951 individuals obtained from January 1st, 2008, to December 31st, 2016, were split into the training, validation and test sets at a ratio of 7:1:2 using simple randomization. Additionally, 1430 images obtained from January 1st, 2017, to March 31st, 2017, were used as a prospective test set to compare the performance of the established model against oncologist evaluation. The dice similarity coefficient (DSC) was used to evaluate the efficiency of eNPM-DM in automatic segmentation of malignant area from the background of nasopharyngeal endoscopic images, by comparing automatic segmentation with manual segmentation performed by the experts.ResultsAll images were histopathologically confirmed, and included 5713 (19.7%) normal control, 19,107 (66.0%) nasopharyngeal carcinoma (NPC), 335 (1.2%) NPC and 3811 (13.2%) benign diseases. The eNPM-DM attained an overall accuracy of 88.7% (95% confidence interval (CI) 87.8%–89.5%) in detecting malignancies in the test set. In the prospective comparison phase, eNPM-DM outperformed the experts: the overall accuracy was 88.0% (95% CI 86.1%–89.6%) vs. 80.5% (95% CI 77.0%–84.0%). The eNPM-DM required less time (40 s vs. 110.0 ± 5.8 min) and exhibited encouraging performance in automatic segmentation of nasopharyngeal malignant area from the background, with an average DSC of 0.78 ± 0.24 and 0.75 ± 0.26 in the test and prospective test sets, respectively.ConclusionsThe eNPM-DM outperformed oncologist evaluation in diagnostic classification of nasopharyngeal mass into benign versus malignant, and realized automatic segmentation of malignant area from the background of nasopharyngeal endoscopic images.