Fiberoptic Nasal Endoscopy Research Articles

Implementation of a Nurse-led Paediatric Epistaxis Clinic at a tertiary hospital

IntroductionReferrals for recurrent epistaxis constitute a significant proportion of paediatric ENT consultations. In order to improve access to secondary care, a nurse-led paediatric epistaxis clinic (NPEC) was developed in collaboration with ENT specialist nurses. The purpose of this study was to describe the structure of NPEC at our institution and to assess the impact including safety, parental satisfaction and referral-to-clinic times. MethodsENT specialist nurses were trained by an ENT Consultant through teaching sessions and clinic observations. Standard operating procedure was developed, and competencies were granted before commencement of NPEC. Service evaluation was done to assess the impact of NPEC including safety, parental satisfaction and referral-to-clinic times. All patients who attended NPEC from March 2022-February 2023 were included. Parental satisfaction questionnaires completed at the end of the clinic visit were prospectively collected for first 25 consecutive patients. Patient chart review was performed to assess for complications, need for consultant reviews and waiting times. ResultsForty-seven patients attended NPEC during the study period (77 clinic visits). Median age was 10 years (range 3-16 years). Management included antibiotic ointment (25/77), silver nitrate cautery (28/77) and 3 were listed for nasal cautery under general anaesthesia. Among cases which underwent silver nitrate cautery, there was one minor complication reported. Consultant review was required in 18 clinic visits (23.3 %), including 5 patients requiring fiberoptic nasal endoscopy. Over the study period, median referral-to-clinic time for new patients was 77 days, compared to 229 days for consultant clinic (p= 0.003, Wilcoxon rank sum test). Overall quality of care in NPEC was described as "very satisfactory" and “fairly satisfactory” by 92% and 8% parents respectively. ConclusionNurse led paediatric epistaxis clinics are safe and is associated with high parental satisfaction. Critical to success of NPEC is appropriate patient selection, training and availability of clinician support. These clinics offer a sustainable option to improve access to secondary care for paediatric epistaxis patients.

Novel Classification System of Adenoids Based on Appearance and Its Relationship with Drug Therapy

Introduction: Adenoidectomy is a common procedure in children who have adenoid hypertrophy (AH), but anesthesia risks should be considered. We proposed a novel classification system for adenoids based on their appearance. Additionally, we explored whether the novel classification of adenoids correlates with the response to therapy and thus might be helpful for further treatment recommendations. Methods: We used fiberoptic nasal endoscopy to determine the degree and appearance of AH. Obstructive Sleep Apnea Questionnaire (OSA-18) was used to assess the quality of life of children with AH. The adenoids were divided into three types: edematous type, common type, and fibrous type. In adenoid tissues, the eosinophils were counted. Immunohistochemistry and Western blot were done to determine the expression of CysLTR1, CysLTR2, CGR-α, and CGR-β in different types of adenoids. Results: 70.67% (106/150) of AH patients presented with allergic rhinitis (AR), and of them, 68% (72/106) of adenoids were the edematous type. The expressions of CGR-α, CGR-β, and eosinophil count were higher in the edematous compared with the common and fibrous types. The expression of the leukotriene receptor was similar in all types. Upon montelukast combined with nasal glucocorticoid therapy, improvement of OSA-18 scores and AH grade was significantly compared to montelukast monotherapy for edematous type. There was not any statistically significant difference between the scores upon montelukast combined with nasal glucocorticoid and montelukast monotherapy for common and fibrous type. We observed a positive correlation between eosinophil count in the blood and in the adenoid tissue. Conclusion: AR was the risk factor for the development of edematous AH. All subtypes of AH responded to montelukast, while there was an additional effect of nasal glucocorticoid in the edematous type. A combination therapy of nasal glucocorticoid with leukotriene receptor antagonist can be recommended for AH patients with AR, patients with edematous adenoids, and/or patients with increased eosinophils in blood routine.

The importance of follow-up examinations in chronic rhinosinusitis with nasal polyposis

PurposeClinical examinations following functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis with nasal polyps (CRSwNP) are critical for physicians to assess results of the intervention and to early identify recurrences. However, no clear consensus on the frequency and timing of clinical examinations following surgery exists. The aim of this study was to analyze CRSwNP recurrences after FESS with a specific focus on the adherence to follow-up examinations. Materials and methodsSixty patients who underwent FESS for CRSwNP were enrolled. Clinical parameters were recorded. Adherence to follow-up examinations with nasal fiber optic endoscopy and regular administration of nasal steroids were analyzed. ResultsAdherence to periodic clinical examinations and regular treatment with nasal steroids was 25 %. CRSwNP recurrence was observed in 56.7 % of cases at the last follow-up examination. No statistically significant difference concerning nasal symptoms was observed between patients with and without current recurrence (p > 0.05). Subjects who underwent regular examinations and prompt treatment of small recurrences had a lower probability of relapse at their last examination (7.7 % versus 38.2 %, respectively; p < 0.001). Polyp grade > 2 in patients with or without adherence were seen in 15.4 % and 42.9 % of cases, respectively (p < 0.05). ConclusionsAdherence to follow-up examinations with nasal optic fiber endoscopy is crucial to early identify recurrence after surgery and promptly treat it with medical therapy.

Describing the Acoustic and Vocal Production Characteristics of the Irrintzi: Feasibility of Its Use for the Treatment of Voice Disorders.

The aims of this study were to analyze and characterize the irrintzi (a folkloric shout emitted in a single breath used by the Basque people) acoustically and to describe the mechanism by which it is emitted. Thirty-six sound samples of 12 female volunteers were analyzed. Acoustic analysis included primarily fundamental frequency (f o), spectral analysis in the time domain with a narrowband filter, and the use of linear predictive coding (LPC). Laryngeal and pharyngeal movements while emitting an irrintzi were studied by fiberoptic nasal endoscopy. Postural and mandible movements were observed and video recorded. Movements of the larynx and the vocal tract were also studied by lateral pharyngo-laryngeal radioscopy. The central part of an irrintzi spectrogram contains a peculiar, repeated M-shaped motif unseen in the spectrogram of any other human vocal emission, and intensity was over 90 dB SPL in all cases. f o was very high (1487 Hz) especially at the end of the irrintzi. Fiberoptic nasal endoscopy consistently revealed considerable elevation of the glottis, with the larynx swinging forward and retraction of the ventricular bands. Lateral radioscopy showed a very high larynx and a high tongue dorsum. The irrintzi is a sound emitted in a single breath and characterized by its shrillness and loudness, qualities that make it audible in noisy environments and over large distances and the vocal technique observed when it is produced can be explained by the Estill voice model (Steinhauer et al., 2017). The use of this technique may help in the treatment of voice disorders and improve efficiency in singers, teachers, actors, and people who use their voice at high volume or at high frequency. https://doi.org/10.23641/asha.20779405.

666 Rugby Tackle: A Cause of Delayed Onset Laryngeal Oedema

Abstract Case Presentation A 14-year-old boy presented to the emergency department with facial and neck swelling, hoarseness and dysphagia. The symptom onset was 24 hours after a rugby tackle to the neck and shoulder. Examination found significant bilateral lower facial and neck swelling. Blood results and observations were normal. Fibreoptic nasendoscopy (FNE) revealed diffuse oedema of arytenoids and soft tissue around the larynx. Computed Tomography (CT) neck with contrast demonstrated diffuse inflammatory changes in the submental and submandibular regions extending to the suprasternal notch, the aetiology for this was indeterminate. He responded to medical treatment with regular intravenous dexamethasone, intravenous antibiotics and as required, adrenaline nebulisers. He was discharged after two days and was able to return to school the following week. Discussion Laryngeal oedema is an ear, nose and throat emergency which can result in airway obstruction. It is commonly caused by bacterial infection. However, rarely other precipitants including blunt trauma are reported. This is the first case reported in the literature of delayed laryngeal oedema from a common sporting injury. It is important to recognise and consider trauma as a cause in patients with delayed laryngeal oedema, especially when no other obvious underlying cause is present. This case highlights the importance of thorough history taking to detect trauma. After ensuring a secure airway, systemic steroids are effective against trauma-induced laryngeal oedema and prophylactic antibiotics should be considered to avoid oropharyngeal contamination. FNE, CT and a minimum 24-hour observation period with specialist involvement are essential for neck trauma management.

662 Bilateral Vocal Cord Paralysis and Cranial Polyneuropathy: A Rare Presentation of Ramsay Hunt Syndrome

Abstract Case Presentation A 61-year-old gentleman with chronic lymphocytic leukaemia presented with right sided disseminated vesicles, otalgia, hearing loss, facial weakness, dysphagia, hoarseness, breathlessness, and stridor. In the preceding 48 hours he had two A&amp;E presentations with only right otalgia, facial weakness, throat tightness and mild breathlessness. Cranial nerve (CN) examination demonstrated right cheek numbness and absent jaw jerk reflex (CNV), right grade 6 lower motor neuron facial palsy (CNVII), impaired hearing (CNVIII), dysphonia, dysphagia, and asymmetric palate elevation (CNIX and X). Fibreoptic nasendoscopy (FNE) demonstrated bilateral vocal cord palsy. He was diagnosed with Ramsay Hunt syndrome (RHS) and disseminated herpes zoster (HZ) requiring intubation and ventilation, intravenous steroids, aciclovir, antibiotics and a prolonged intensive care admission. He was discharged after three months. Eight months later, he has a long-term tracheostomy, gastrostomy, and live-in carer. Discussion This is the only case found in the literature of RHS and associated bilateral vocal cord palsy with cranial polyneuropathy requiring a long-term tracheostomy. It highlights the significant morbidity attached with RHS complications, particularly in a patient with underlying malignancy. Awareness of these rare and potentially life-threatening complications should be raised to avoid investigation and treatment delay. HZ should be considered in patients with CNVII palsy and otalgia, with or without vesicles. Clinicians should perform full CN examination including FNE to assess for cranial polyneuropathy. RHS can present without vesicles, making it indistinguishable from Bell's Palsy. Therefore, we should consider treating Bell's Palsy with aciclovir. Furthermore, multidisciplinary management of disseminated HZ is essential.

Changes in Cough Reflex Sensitivity in Children After Removal of Hypertrophied Adenoid Tissue.

PurposeThe co-occurrence of adenoids and chronic cough is common in children. The goal of this research was to specify changes in cough reflex sensitivity as a result of adenoid tissue removal.Patients and MethodsThe sample group consisted of 17 children (six boys and 11 girls, aged 4–12 years, mean age 6.24 years), all of them possessing symptoms of chronic cough and adenoids, confirmed by nasal fiberoptic endoscopy. This sample group underwent cough reflex sensitivity assessment, which took place both prior to and after endoscopic adenoidectomy. The definition of the cough reflex sensitivity is the lowest capsaicin concentration that caused two (C2) or five (C5) coughs. Capsaicin aerosol in ascending concentrations (from 0.61 to 1250 µmol/L) was inhaled by a single-breath method (KoKo DigiDoser), with the addition of an inspiratory flow regulator valve (RIFR).ResultsConcentrations of capsaicin causing two (C2) and five coughs (C5) were reported. Cough sensitivity (geometric mean with 95% CI) for C2 was 31.86 (12.98–78.18) µmol/L preoperatively and 11.97 (6.16–23.26) µmol/L postoperatively (P=0.064). Cough sensitivity for C5 was 234.91 (97.19–567.77) µmol/L preoperatively and 69.13 (29.08–164.35) µmol/L postoperatively (P=0.022). The children’s pulmonary function was within the normal range.ConclusionIn our study, adenoidectomy significantly increased cough reflex sensitivity in non-atopic children suffering from chronic cough.

ADENOID SIZE IN CHILDREN WITH OTITIS MEDIA WITH EFFUSION.

SUMMARYOtitis media with effusion (OME) is amongst the most common pediatric diseases and the most common cause of hearing loss in children. It is accepted that adenoid hypertrophy (AH) is related to OME incidence. Better understanding of the correlation between the relative size of AH and the incidence of persistent OME may provide evidence to support a more standardized approach to the diagnosis and treatment of OME. A retrospective study carried out between April 2016 and April 2018 collected data on 65 children aged 2-12 years, diagnosed with chronic OME and symptoms of AH, where conservative therapy failed. Pre-diagnostic data were collected from patient history, otoscopy, rhinoscopy, and oropharyngoscopy findings. Diagnostic workup included tympanometry, audiometry, and flexible nasal fiberoptic endoscopy. Adenoid grading was performed according to Cassano method after endoscopic visualization. Of the 65 patients, 37 were male and 28 were female. There was no statistically significant difference according to gender or average age. The highest incidence of persistent OME with AH was recorded in the youngest age groups (2-5 and 6-9 years). The most frequent AH grades were grade II (35.38%) and grade III (50.77%), yielding a statistically significant result. The most common presenting symptoms were hearing impairment, snoring, and nasal obstruction (100%, 64.62% and 60%, respectively). Higher AH grades are critical for persistence of OME and may cause conservative therapy failure.

Implant loss and sinusitis after sinus lift ‐ an underestimated complication?

Background: Sinus lift is designed to enable the placement of maxillary implants in situations with vertically reduced alveolar bone. It has become a more frequently performed procedure. Possible complications comprise sinusitis, failing grafts and failing of the dental implant. More severe problems and chronic sinusitis have been reported. Aim/Hypothesis: To report on 76 patients with implant loss after sinuslift. To report the reasons, the possibilities for repair in routine cases and in more severe situations of sinusitis with multiple implant loss and damage to surrounding structures. To report the long‐term outcome. Materials and Methods: Between 2000 and 2020 76 patients with failing implants after sinuslift were referred to four Oral Surgery and ENT services in Switzerland. Of 169 implants originally placed 71 implants were already lost before the first consultation. 14 patients had no complaints other than implant loss. The other 62 patients complained about varying degrees of pain, swollen midface, pussy exudates, paresthesia etc. In 3 patients implants had been failing repeatedly. CBCT showed in 58 patients maxillary sinusitis, in 4 patients half‐sided pan‐sinusitis. In 11 patients, nasal fiberoptic endoscopy was carried out. Further investigations consisted of bacteriology, mycology and histology. Reasons for sinusitis were attributable to postoperative blowing of the nose, infection of the graft, antiresorptive drugs, peri‐implantitis reaching the floor of the sinus and allergic reaction to sinus grafting material mixed with collagen. Another reason for implant loss was a failing graft without signs of sinusitis. Results: 53 implants had to be removed under Local Anaesthesia (LA), 9 implants could be left in situ. 8 patients did not need surgical intervention for sinusitis but only antibiotic treatment. 41 patients needed surgical intervention under LA for cleaning the sinus of infected graft material and closing of fistula. 27 patients needed surgical intervention under General Anaesthesia (GA) because of more extensive disease, removal of debris, fungi, dislocated dental implants and nasal endoscopy. 51 patients became pain free. In 11 patients some chronic pain remained. In 18 patients the sinus did not heal to a degree that re‐sinuslift was deemed appropriate. Whilst 29 patients were subsequently treated with dentures, 47 patients underwent a second surgery for new grafting procedures with autologous bone, followed by implant insertion. This was possible in 28 patients under LA, whilst 19 patients needed GA for reconstruction of lost maxillary structures with large mandibular or with hip bone graft. Conclusions and Clinical Implications: Whilst many complications after sinus lift are not severe and can be treated locally, some patients exhibit more severe problems with e.g. pan‐sinusitis and chronic sinusitis. Multidisciplinary cooperation between dentists, oral surgeons, and ear, nose and throat specialists can be very helpful in diagnosing and treating these cases. To estimate the chance for success of redo of sinus lift is rather difficult, especially when bone substitutes were used beforehand which may not have integrated.

Clinicopathologic and radiologic features of pediatric unilateral nasal masses at a tertiary hospital

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Cases of unilateral nasal masses (UNM’s) are usually inflammatory but some are neoplastic in nature. We conducted this study to determine the clinic-pathologic features, radiological findings and patterns of UNM’s in our institution.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We conducted a retroactive chart review of all pediatric cases followed and treated for medically untreatable UNM from 2015 till 2018 at King Fahad Specialist Hospital (KFSH) in Dammam, Saudi Arabia. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Cases of 25 patients (16 males and 9 females) with a mean age of 10.81±4.53 years were studied. There were 12 patients (48.0%) who presented with a nasal obstruction, and nasal polyp was found by fiberoptic nasal endoscopy (FNE) in 12 patients (48.0%). Two patients (8.0%) had unremarkable FNE findings. The most common site of origin of the mass was the ethmoid sinus (24.0%). Twenty patients (80.0%) had FESS, 3 (12.0%) had endoscopic excision, 1 had FESS plus abscess drainage and 1 (4.0%) had marsupialization. Two patients (8.0%) had recurrence 12 months after surgery, and one patient (4.0%) had recurrence six months after surgery. Six patients (24.0%) had malignant tumor of which 3 patients (12.0%) expired from the disease.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Pediatric patients with a UNM may present with varied symptoms and may show unremarkable results with nasal endoscopy. However the risk of having an underlying malignant process is very high, thus a histopathologic diagnosis is warranted to confirm the diagnosis.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Efficacy of Pidotimod use in treating allergic rhinitis in a pediatric population

BackgroundAllergic rhinitis (AR) and adenoidal hypertrophy (AH) are the most frequent causative disorders of nasal obstruction in children, leading to recurrent respiratory infections. Both nasal cavities are colonized by a stable microbial community susceptible to environmental changes and Staphylococcus aureus seems to play the major role. Furthermore, nasal microbiota holds a large number and variety of viruses with upper respiratory tract infections. This local microbiota deserves attention because its modification could induce a virtuous cross-talking with the immune system, with a better clearance of pathogens. Although AR and AH present a different etiopathogenesis, they have in common a minimal chronic inflammation surrounding nasal obstruction; hence it would be challenging to evaluate the effect of an immunomodulator on this minimal chronic inflammation with possible clinical and microbiological effects. The aim of this study is therefore to evaluate the efficacy of an immunomoldulator (Pidotimod) on nasal obstruction in children with AR and/or AH and whether its action involves a variation of nasal microbiota.MethodsWe enrolled 76 children: those with allergic rhinitis (AR) sensitized to dust mites entered the AR group, those with adenoidal hypertrophy (AH) the AH group, those with both conditions the AR/AH group and those without AR ± AH as controls (CTRL). At the first visit they performed: skin prick tests, nasal fiberoptic endoscopy, anterior rhinomanometry, nasal swabs. Children with.AR ± AH started treatment with Pidotimod.After 1 month they were re-evaluated performing the same procedures.The primary outcome was the evaluation of nasal obstruction after treatment and the secondary outcome was the improvement of symptoms and the changes in nasal microflora.ResultsAll patients improved their mean nasal flow (mNF) in respect to the baseline. In AR children mNF reached that one of CTRL. In AH children±AR the mNF was lower in respect to CTRL and AR group. We did not find any differences among all the groups at the two different time points in nasal microflora.ConclusionsPidotimod is able to give an improvement in nasal obstruction, especially in AR children but this effect seems to be not mediated by changes in nasal microbiota.

Role and Adverse Effects of Premedication for Reducing Pain and Discomfort during Fiberoptic Nasal Pharyngoscopy and Laryngoscopy

INTRODUCTION: Fiberoptic nasal endoscopy is a common procedure. Pretreatment with many drugs has been tried to decrease discomfort and pain related to the procedure. It was our effort to study whether they are effective in reducing pain and discomfort of the procedure.&#x0D; MATERIAL AND METHODS: It was a four-armed triple blind randomized controlled trial. Block randomization was done. Four arms were pretreated with placebo, decongestant spray, local anesthetic spray, and combination of decongestant and local anesthetic spray. Discomfort of pretreatment, discomfort of the procedure, pain due to procedure, ease of procedure and adverse effects were recorded by visual analogue score and analyzed by non-parametric tests. P value less than 0.05 was considered statistically significant.&#x0D; RESULTS: There were 40 participants in each wing making a total of 160. There were 79 males and 89 females. Discomfort of pretreatment was significantly higher is groups treated with lidocaine spray alone or in combination (p&lt;0.001). Discomfort due to procedure was lowest in group pretreated with placebo (p=0.009) and pain was comparable throughout the groups (0.15).The procedure of nasal endoscopy was easiest in group pretreated with decongestant spray (p=0.02). Adverse effect was highest in form of burning sensation and pain in groups treated with lidocaine (p&lt;0.001).&#x0D; CONCLUSION: Lidocaine spray caused a lot of discomfort in form of pain and burning sensation and was not able to decrease pain or discomfort, alone or in combination with decongestant, related to fiberoptic nasal endoscopy. Decongestant, however, made the procedure easier.

Dislocation rates of postoperative airway exchange catheters - a prospective case series of 200 patients

BackgroundThe dislocation rate of oral versus nasal airway exchange catheters (AEC) in the postoperative care unit (PACU) are unknown. Our aim was to establish dislocation rates and to assess the usefulness of waveform capnography to detect dislocation.MethodsIn this non-randomized, prospective observational trial at the University Hospital Bern, Switzerland, we included 200 patients admitted to PACU after extubation via AEC, having provided written informed consent. The study was approved by the local ethical committee. AEC position was assessed by nasal fiberoptic endoscopy at beginning of PACU stay and before removal of the AEC. Capnography was continuously recorded via the AEC. Additional measurements included retching and coughing of the patient, and re-intubation, if necessary.ResultsData from 182 patients could be evaluated regarding dislocation. Overall dislocation rate was not different between oral and nasal catheters (7.2% vs. 2.7%, p = 0.16). Retching was more often noted in oral catheters (26% vs. 8%, p < 0.01). Waveform capnography was unreliable in predicting dislocation (negative predictive value 17%). Re-intubation was successful in all five of the nine re-intubations where an AEC was still in situ. In four patients, the AEC was already removed when re-intubation became necessary, and re-intubation failed once, with a front of neck access as a rescue maneuver.ConclusionsWe found no difference in dislocation rate between nasal and oral position of an airway exchange catheter. However, nasal catheters seemed to be tolerated better. In the future, catheters like the staged extubation catheter may further increase tolerance.Trial registrationThe study was registered in a clinical study registry (ISRCTN 96726807) on 10/06/2010.

Assessment of vocal cord movement by ultrasound in the ICU.

Ultrasound can be used to non-invasively and rapidly examine airway conditions, but vocal cord visualization with the traditional approaches is poor. Our aim was to compare the accuracies of front-side transverse-axis ultrasound (FTU), lateral-side longitudinal-axis ultrasound (LLU), and the combination of both approaches for vocal cord movement disorder diagnoses (e.g., vocal cord paralysis or arytenoid cartilage dislocation). We compared FTU, LLU, and the combination of both methods for patients in the intensive care unit (ICU). We used nasal fiber-optic endoscopy to confirm vocal cord injury. Among the 120 patients examined, 24 (20%) had vocal cord paralysis. The visualization rate of vocal cords for FTU was 71.7% (assessable, 86; non-assessable, 34), that for LLU was 88.3% (assessable, 106; non-assessable, 14), and that for the combined approach was 96.7% (assessable, 116; non-assessable, 4). The sensitivities and specificities were 58.3% (14/24) and 75% (72/96) for FTU, 91.7% (22/24) and 87.5% (84/96) for LLU, and 100% (24/24) and 95.8% (92/96) for the combined approach. Visualization rates for LLU were significantly higher than for FTU (P = 0.002); FTU + LLU rates were higher than those for FTU (P = 0.001). The difference between LLU and FTU + LLU was not statistically significant (P = 0.025). LLU can be used to evaluate arytenoid cartilage activity inICUs, and the results are highly correlated with the diagnosis of nasal fiber-optic endoscopy. The combination of FTU and LLU shows promise as a rapid primary screening method for vocal cord injury.

The effect of adenoidectomy on cough reflex sensitivity in atopic children

The aim of this study was to determine whether cough sensitivity is changed after adenoidectomy in atopic children with chronic cough.21 Children having symptoms of chronic cough and adenoid hypertrophy verified by nasal fiberoptic endoscopy were submitted to cough sensitivity measurement before and after adenoidectomy. Their pulmonary function was within normal range. Concentrations of capsaicin causing two (C2) and five coughs (C5) were reported. Children' (14 boys and 7 girls, mean age 6,52 yrs) cough sensitivity (geometric mean, with 95% CI) for C2 was preoperatively (before adenoidectomy) 19.95 (9.95–39.98) micromol/l vs. children' C2 postoperatively 14.04 (7.16–27.55) (P = .083 for Wilcoxon paired two sample test). Children' C5 was preoperatively 86.26 (39.25–189.57) micromol/l vs. C5 postoperatively 95.23 (46.33–195.75) micromol/l (P = .794 for Wilcoxon paired two sample test).We conclude that cough sensitivity for C2 and C5 was not significantly changed after adenoidectomy in atopic children with chronic cough.

Rhinofibroscopic and Rhinomanometric Evaluation of Patients with Maxillary Contraction Treated with Rapid Maxillary Expansion. A Prospective Pilot Study.

The aim of this study was to evaluate through nasal fiber optic endoscopy and rhinomanometry the patency of upper nasal airways in patients treated with rapid palatal expansion Study design: 30 patients (12 males and 18 females) aged 7-11 years with transverse maxillary constriction underwent rhinomanometric and fiberoptic examination before (T0) and after rapid palatal expansion (T1).The amount of nasopharynx obstruction was quantified with reference to the full choanal surface. Nasal resistance was recorded separately for right and left sides, and combined for both sides. The differences in nasopharynx obstruction and in nasal resistance between T0 and T1 were statistically evaluated. The amount of nasopharynx obstruction significantly decreased after palatal expansion (p<0.001). Total nasal inspiration and expiration resistance significantly decreased at T1 (p<0.001). The reduction ranged between 0. 23 and 0. 66 Pa/cm3/s for inspiration and between 0. 20 and 0,.58 Pa/cm3/s for expiration. A statistically significant positive correlation existed between the T1-T0 differences in the amount of nasopharynx obstruction and the T1-T0 differences in expiration nasal airway resistance (Spearman's correlation coefficient rho = 0.38; p = 0.03). Rapid maxillary expansion has an influence on nasal resistance and improves the patency of upper airways in patients with minor or moderate breathing problems.

The effect of adenoidectomy on transnasal airflow in children with hypertrophy of adenoid tissue.

Background:The aim of this study was to clarify changes of transnasal airflow resulting from adenoidectomy and to assess the effect of surgery depending on adenoid hypertrophy (AH) obstruction grade.Materials and Methods:Altogether fifty children having symptoms of nasal obstruction and adenoids were submitted to a rhinomanometric assessment before and after adenoidectomy. At the same time, using the nasal fiberoptic endoscopy, the grade of AH obstruction was determined, according to which the children were divided into four classes. We assessed the change of total transnasal inspiratory airflow and total nasal resistance due to adenoidectomy.Results:Values of transnasal airflow and nasal resistance measured in the study group of fifty children were preoperatively 262 mL/s and 0.565 kPa/L/s; postoperatively 288 mL/s and 0.52 kPa/ L/s. We have noticed statistically significant increase of the airflow (P = 0.015); however, decrease of the resistance (P = 0.054) was not significant. In the group of children suffering from the 1st to 2nd grade (29 children) preoperatively measured values presented 280 mL/s and 0.52 kPa/L/s; postoperatively, 276 mL/s and 0.54 kPa/L/s; change of the airflow (P = 0.634) and resistance (P = 0.829) was not significant. In the study group having the 3rd and 4th grade (21 children), the values indicated preoperatively 240 mL/s and 0.62 kPa/L/s; postoperatively, 340 mL/s and 0.44 kPa/L/s; there were significant airflow increase (P = 0.012) and resistance decrease (P = 0.033).Conclusions:Adenoidectomy significantly increased the airflow; however, we observed the different effect in the group of children with the 1st and 2nd grade compared to the group with the 3rd and 4th grade. A significant increase of the airflow and decrease of the resistance were present only in the group with the 3rd and 4th grade; therefore, the significant reduction of nasal obstruction symptoms might be expected only in this group of patients.

Nasopharyngeal carcinoma: United Kingdom National Multidisciplinary Guidelines.

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Although much commoner in the eastern hemisphere, with an age-standardised incidence rate of 0.39 per 100 000 population, cancers of the nasopharynx form one of the rarer subsites in the head and neck.1 This paper provides recommendations on the work up and management of nasopharyngeal cancer based on the existing evidence base for this condition. Recommendations • Patients with nasopharyngeal carcinoma (NPC) should be assessed with rigid and fibre-optic nasendoscopy. (R) • Nasopharyngeal biopsies should be preferably carried out endoscopically. (R) • Multislice computed tomographic (CT) scan of head, neck and chest should be carried out in all patients and magnetic resonance imaging (MRI) where appropriate to optimise staging. (R) • Radiotherapy (RT) is the mainstay for the radical treatment for NPC. (R) • Concurrent chemoradiotherapy offers significant improvement in overall survival in stage III and IV diseases. (R) • Surgery should only be used to obtain tissue for diagnosis and to deal with otitis media with effusion. (R) • Radiation therapy is the treatment of choice for stage I and II disease. (R) • Intensity modulated radiation therapy techniques should be employed. (R) • Concurrent chemotherapy with radiation therapy is the treatment of choice for stage III and IV disease. (R) • Patients with NPC should be followed-up and assessed with rigid and/or fibre-optic nasendoscopy. (G) • Positron emission tomography-computed tomography (PET-CT), CT or MRI scan should be carried out at three months from completion of treatment to assess response. (R) • Multislice CT scan of head, neck and chest should be carried out in all patients and MRI scan whenever possible and specially in advanced cases with suspected recurrence. (R) • Surgery in form of nasopharyngectomy should be considered as a first line treatment of residual or recurrent disease at the primary site. (R) • Neck dissection remains the treatment of choice for residual or metastatic neck disease whenever possible. (R) • Re-irradiation should be considered as a second line of treatment in recurrent disease. (R).

Endoscopic repair of bilateral choanal atresia, starting with vomer resection: Evaluation study.

Choanal atresia is the most common inborn nasal anomaly, and its definitive treatment is surgical to achieve proper bilateral nasal patency. Four main surgical approaches were used for repair: transantral, transpalatal, transseptal, and transnasal. The transnasal endoscopic approach is the most widely accepted nowadays. In this study, we aimed to evaluate the long-term results of a transnasal endoscopic repair of congenital choanal atresia started with resection of the posterior portion of the vomer and was completed without the use of stents in a large series of patients. Twenty-five patients (age range, 3-15 days) with bilateral congenital choanal atresia had surgery by using stentless endoscopic transnasal repair by starting with resection of the vomer bone. Postoperative control included office fiberoptic nasal endoscopy. During the follow-up period of 15-66 months (mean [standard deviation], 35.76 ± 16.8 months), 18 patients (72%) had a wide choana with adequate nasal breathing; Six patients (24%) had narrowing of the choana (<50%), still with adequate and satisfactory airway without feeding difficulties, and one patient (4%) developed restenosis (>50%) after 7 months, which necessitated repeated surgery. One patient (the fourth case) developed a palatal defect, which healed conservatively. No other complications were detected. The described technique proved to be effective and easier, with good long-term satisfactory results in a large series of patients. This technique allows early use of both nasal passages for simultaneous endoscope and instrument insertion to excise both atretic plates without the use of stents or flaps.

False Computed Tomography Findings in Bilateral Choanal Atresia.

Introduction Choanal atresia (CA) is a challenging surgical problem defined as a failure in the development of communication between the nasal cavity and nasopharynx. Objective The objective of this study is to describe computed tomography (CT) findings in cases with bilateral choanal atresia. Methods The study involved performing axial and coronal non-contrast CT scanning with 2–3 mm sections on14 neonates that had bilateral CA. We used fiberoptic nasal endoscopy to confirm the diagnosis. We evaluated coronal CT to study the skull base area in such neonates. Results This study included 14 neonates with bilateral CA; with mean age of 7 ± 3.5 days. Mixed atretic plates were found in 12 (85.7%) cases while two (14.3%) had pure bony atresia. Isolated CA was detected in 9 cases (64.3%) and 5 (35.7%) cases had associated anomalies. Coronal CT showed soft tissue density in the nasal cavity that appeared to extend through an apparent defect in the nasal roof (cribriform plate), falsely diagnosed by radiologists as associated encephalocele. At the time of surgical repair, all patients showed thick tenacious mucous secretions in both nasal cavities and revealed no encephalocele. Nasal roof remained intact in all cases. Conclusion The thick secretion of bilateral CA could give a false encephalocele appearance on the CT. It is highly recommended to perform proper suction of the nasal cavity of suspected CA cases just before CT scanning.