Nasopharyngeal Endoscopy Research Articles

An Observational Study to Evaluate Association Between Velopharyngeal Anatomy and Speech Outcomes in Adult Patients With Severe Velopharyngeal Insufficiency.

By measuring velopharyngeal structure and evaluating speech intelligibility, to explore and observe the association between velopharyngeal anatomy and speech outcomes in these patients. Thirty-one adult patients with velopharyngeal insufficiency after the primary palatoplasty aged 18 to 35 years (mean 22.03 years) were enrolled as the study group. The patients had significant hypernasality and audible nasal emission. The degree of velopharyngeal closure assessed by electronic nasopharyngeal fiberoptic endoscopy was grade III. Cephalometric analysis was performed on lateral cephalograms to measure velopharyngeal structure, including hard palate length (ANS-PNS), velar length (PNS-U), pharyngeal depth (PNS-PPW), and oropharyngeal airway space (U-MPW). Their speech intelligibility was evaluated through the Mandarin Chinese speech intelligibility test, and each speech sample was examined by 2 speech and language pathologists. The results were assessed with the SPSS 23.0 software package, and regression analysis was used to examine the relationship between velopharyngeal structure and speech outcomes. A significant negative correlation was confirmed between speech intelligibility and pharyngeal depth. Pharyngeal depth also showed a linear relationship with speech intelligibility, and there was no significant correlation between speech intelligibility and other measures (hard palate length, velar length, oropharyngeal airway space). In the velopharyngeal anatomy, only pharyngeal depth was associated with speech intelligibility in adult patients with severe velopharyngeal insufficiency, this is consistent with our clinical observation. It suggests that appropriate reduction of pharyngeal depth during palatopharyngoplasty may have a good effect on the speech recovery in patients with cleft palate and patients with velopharyngeal insufficiency after palatorrhaphy.

The efficacy of endoscopic plasty for children with bilateral congenital choanal atresia

Objective:To evaluate the clinical effect of endoscopic repair for the treatment of children with bilateral congenital choanal atresia. Methods:A retrospective analysis was conducted in our department that six children who were diagnosed as bilateral congenital choanal atresia by nasopharyngeal endoscopy and nasal CT scanning. All cases underwent endoscopic repair and placed the silicone stent to support the enlarged nostrils for six months, and these patients were followed up to observe re-atresia rate after taking out of the supporting tube. Results:Six cases' nasal ventilation were effectively improved after operation without serious complications, 5 cases showed a satisfactory curative effect after taking out of the supporting tube, only 1 case with bony atresia found choanal re-atresia during follow-up. Conclusion:The clinical effect of using endoscopic repair for children with bilateral congenital choanal atresia showed remarkable efficacy with a low re-atresia.

Результаты лечения ронхопатии и синдрома обструктивного апноэ сна у детей с гипертрофией аденоидных вегетаций

Introduction. There are various sleep disorders that are striking and depressing at the same time in their diversity. One of the urgent problems that modern medicine is working on is problems with breathing during sleep, including obstructive sleep apnea syndrome (OSAS). The prevalence of this disease in children ranges from 1.2 to 5.7%. Adenotomy is an absolute indication for children with OSAS and adenoid hypertrophy. Aim. To study the frequency of occurrence of the OSAS in patients admitted to their hospital otorhinolaryngological department of Rauhfus Children’s Municipal Multi-Specialty Clinical Center of High Medical Technology for the planned surgical treatment of adenoid hypertrophy; to assess the effect of adenotomy on the course of OSAS in children. Materials and methods. 42 children aged from 4 to 12 years were examined; all patients underwent computer-based pulse oximetry, rhinomanometry, and nasopharyngeal endoscopy. Results. After adenotomy, nasal patency in children improved significantly: from 289.26 ml/s to 467.00 ml/s; the mean night saturation and desaturation nadir values in children during treatment improved from 97.31 to 97.68% and from 87.58 to 91.52%, respectively; sleep apnea syndrome was detected in 88% of all patients; 1 month after adenotomy, in 66.67% of the examined children OSAS was not detected. Conclusion. Improvement of nasal breathing after adenotomy, confirmed by rhinomanometry data, contributes to improved sleep, as evidenced by the results of computer-based pulse oximetry.

Drinking a structured water product on markers of hydration, airway health and heart rate variability in Thoroughbred racehorses: a small-scale, clinical field trial

Racehorses in training are in situations of repeated stress that may have effects on hydration and health, including airway health. The main hypothesis of this descriptive study was that daily consumption of a structured water (SW) product for 4 weeks will result in improved hydration, reduced markers of upper airway health concerns and increased heart rate variability. Two groups of Thoroughbred racehorses matched for physiological, training and racing attributes were studied for 4 weeks. One group (n = 17) received 10 L (~15%) of their daily water as SW (followed by ad libitum filtered deep well water) and the control group (n = 15) only filtered deep well water. Duplicate (two separate days) blood samples and bioelectrical impedance analysis (BIA) measures were obtained at baseline, 2 and 4 weeks. Hydration was assessed using BIA. The upper airway was assessed by nasopharyngeal endoscopy at baseline within 60 minutes of breezing (weekly near-race gallop pace). On weekly breeze days heart rate was recorded at rest, during exercise and recovery and data were analysed for heart rate variability. Compared to controls, horses drinking SW showed: (a) increased hydration by 2 weeks that was sustained to 4 weeks; (b) upper airway health (less mucous and less trace bleeding) post-breezing; and (c) increased heart rate variability (more restorative autonomic response) at rest. There were no performance benefits, no adverse events occurred, and blood hematological and biochemistry parameters were normal throughout. It is concluded that drinking 10 L daily of SW increased hydration and may have conferred some wellness benefits.

Acute Adult Supraglottitis: An Impending Threat to Patency of Airway and Life.

IntroductionAcute adult supraglottitis (AAS) is one of the upper airway infections that can potentially cause upper airway obstruction and, if not treated promptly, can be life-threatening. The widespread use of vaccines against Hemophilus influenzae has decreased the incidence of epiglottitis in children, whereas the incidence of AAS is on the rise. We aim to highlight the presentation, diagnosis, and management in AAS with our study. Patients and MethodsA retrospective analysis was performed on all patients admitted to a tertiary health care facility surgical intensive care unit (SICU) where AAS was identified and the demographic data, duration of symptoms, imaging studies, management, and complications were recorded. In these patients, the diagnosis of AAS was confirmed by nasopharyngeal endoscopy. Data was entered in the IBM Statistical Package for Social Sciences (SPSS), version 23 (IBM SPSS Statistics, Armonk, NY), and groups were compared using student t-test and chi-square test. P values of ≤ 0.05 were considered statistically significant.ResultsA total of 118 patients were admitted to the SICU. The male: female ratio was 3.9: 1. Major risk factors were smoking and drinking cold liquids. The common presenting symptom was sore throat (89.8%). The thumb sign was positive in 65% of the patients. Common bacteria were the Streptococcus species (11.9%). Ceftriaxone was the most commonly prescribed inpatient antibiotic. All patients received steroids as adjuvant therapy. Adrenaline nebulization was used in 66% of the cases. Forty-six percent of patients required endotracheal intubation. In 10.2% of patients, intubation was not possible and in 12.7% of patients, a tracheostomy was done. Ludwig’s angina was the most frequent complication. Patients presenting with dysphagia and fever had a significantly higher incidence of Ludwig’s angina (P ≤ 0.02 and 0.005, respectively). AAS patients complicating into Ludwig’s angina (severe cellulitis of submandibular, submental, and sublingual spaces) had a significantly longer duration of symptoms, a higher incidence of streptococcal infection, airway interventions, and prolonged stay in an intensive care unit (p ≤ 0.05).ConclusionMale gender, smoking, and drinking cold liquids were the risk factors associated with AAS, and thumb sign on lateral neck soft tissue x-ray was suggestive of it. AAS caused by Streptococcus species was a relatively serious condition, leading to complications like Ludwig’s angina.

Using MRI and Nasopharyngeal Endoscopy for Assessment of Soft Palate Following Cleft Palate Surgical Repair Using Two Surgical Techniques

Purpose: to compare and assess the results obtained by using 2 different surgical techniques that utilize two stage palatoplasty to repair the palate, Furlow’s technique and intravelar veloplasty. Material and Methods: This study was performed on 14 patients suffering from cleft palate, patients were divided into 2 groups, in group I Furlow’s technique was used in palatal repair, in group II IVVP technique was used in palatal repair. All cases were selected from the Outpatient Clinic of the Faculty of Dental Medicine, Al-Azhar University for Girls. Results: Postoperative results of the MRI showed that the velum and the length of the muscle has become longer in each group, even though, there was no significant change between both techniques. The postoperative results of the nasopharyngeal endoscope proved that the increase in the levator muscle length increased the movement of the velum, in each group, however, between both group there was no significant difference. Conclusions: Both Furlow palatoplasty and intravelar veloplasty are efficient techniques that can be used in the repair of cleft soft palate. Both techniques can lengthen the soft palate together with palatal muscle reorientation; without the need to raise large mucoperiosteal flaps from the hard palate. Both techniques, with their modifications had shown success in the primary closure of different varieties and sizes of cleft gaps. The two stage palatoplasty can eliminate the need to raise large mucoperiosteal flaps from the hard palate.

Effects of simultaneous nasometer and nasopharyngeal fibroscopic examination on the value of nasalization rate in cleft palate patients

Objective: To evaluate the changes of nasalance when cleft palate patients examined using nasometer and nasopharyngeal fiberscopy simultaneously. Methods: A total of 33 cleft palate patients from August 2004 to August 2010 were examined by nasopharyngeal fiber endoscopy and nasometer simultaneously. The nasalance of 33 voice samples was compared under two situations only nasometer and nasometer with nasopharyngeal fiberscopy. Results: The statistics showed that the nasalance value of 33 voice samples of 33 participants under different situations were no significant difference through paired t-test (P>0.05). Conclusions: Nasopharyn fiber endoscopy had no influence to the results of the nasalance value under simultaneous condition. The nasometer and nasopharyn fiber endoscopy can be applied to evaluate the velopharyngeal function of cleft palate patients simultaneously.

An innovative method for manufacturing the Tuebingen palatal plate for infants with Robin sequence

BackgroundRobin sequence (RS) is characterized by mandibular micro- and retrognathia, glossoptosis, upper airway obstruction and optionally a cleft palate. With an incidence of 1:8000, it belongs to the so-called rare diseases; 30–50% of patients have RS as part of a syndrome. A comparatively well-studied treatment option is the Tuebingen Palatal Plate (TPP), which has proven effective in both, isolated and syndromic RS, but often requires multiple endoscopies for perfect fit and effectiveness. We report on a new method for fitting the TPP with only one session of nasopharyngeal endoscopy resulting in the plate being finished in one day.Methods and resultsFirst, a prototype is produced, consisting of a traditional acrylic palatal part and a velar extension made of thermoplastic resin, usually measuring 10x40mm. Using polymerization, a scale is added to the posterior part of the extension to help with determining its optimal length during endoscopic evaluation. The extension is pre-bent in the dental laboratory to achieve an approximate shape. During endoscopy, the prototype can be adjusted to the infant’s anatomy: first, the angulation is customized by controlled heating, bending and cooling of the thermoplastic spur. Second, the length of the spur is adapted by grinding its tip. Then the prototype is returned to the dental laboratory for completion; the final plate can be delivered to the patient on the same day. It acts by shifting the tongue into a more anterior position, thereby opening the airway and releasing upper airway obstruction, as well as by acting as a functional orthodontic appliance that stimulates mandibular growth through exerting pressure on the base of the tongue.ConclusionsWith the thermoplastic spur presented here, a TPP can be produced within one day, requiring only one endoscopy. This approach may facilitate fabricating the TPP.

A Preliminary Dynamic Investigation on Velopharyngeal Movements During Blowing: A New Approach for Evaluation

To explore an alternative approach to evaluate velopharyngeal function on those speakers with compensatory misarticulation. Nasopharyngeal endoscopy was used to observe the velopharyngeal movement on 26 adult Mandarin speakers during articulation and different nonverbal state, including SCPS, DCPS, and ABS. There were significant differences for the rate of velopharyngeal incompetence (RVPI) among the 4 different states. The RVPI was least for the Articulation State, followed by the Air Blowing and DCPS. The RVPI was largest for the SCPS. The result indicated that the ABS may be used as an alternative approach to evaluate the velopharyngeal function instead of the articulation samples while patients cannot make clear articulation due to compensatory misarticulation habits. It merits further study on nonverbal activities, which could lay a foundation for exploring more effective approach for evaluation of the velopharyngeal function.

Role of topical intranasal steroids in pediatric hearing loss due to otitis media with effusion: the experiences

<p class="abstract"><strong>Background:</strong> Otitis media with effusion (OME) is one of the commonest diseases causing hearing impairment in children. Hearing loss in early childhood may lead to risk of speech and language problems and psychosocial abnormalities. Aim of this study is to evaluate the role of topical intranasal steroids (Mometasone furoate) in pediatric hearing loss due to otitis media with adenoid hypertrophy.</p><p class="abstract"><strong>Methods:</strong> A prospective study carried out at a tertiary care teaching hospital of eastern India where 104 children participated with diagnosis of otitis media with effusion and hearing loss between 2017 to 2019. These participants were divided into study group and control group. The age group of the children was between 5 to 10 years. Detail otoscopic examination, pure tone audiometry, tympanometry and nasopharyngeal endoscopy were done for assessing the hearing loss, fluid in the middle ear and adenoid hypertrophy. </p><p class="abstract"><strong>Results:</strong> There is improvement of hearing in the study group as compared to control group. A significant improvement in hearing was seen in the study group (p=0.0001). In the study group, 37 (77.08%) out of the 48 children OME resolved over a period of 12 weeks after treatment in comparison to 18 (37.50%) in the control group (p=0.0004).</p><p class="abstract"><strong>Conclusions:</strong> Intranasal topical steroids can be a treatment option alternative to surgery in OME. As it is short term follow up in this study, long term follow up is required. Intranasal mometasone furoate treatment can be considered as a good treatment option for OME.</p>

Fiber-Optic Raman Spectroscopy with Nature-Inspired Genetic Algorithms Enhances Real-Time in Vivo Detection and Diagnosis of Nasopharyngeal Carcinoma.

Raman spectroscopy is an optical vibrational spectroscopic technique capable of probing specific biochemical structures and conformation of tissue and cells in biomedical systems. This work aims to assess the clinical utility of a fiber-optic Raman spectroscopy with nature-inspired genetic algorithms for enhancing in vivo detection and diagnosis of nasopharyngeal carcinoma (NPC) patients. The Raman diagnostic platform is developed based on simultaneous fingerprint (FP) and high-wavenumber (HW) fiber-optic Raman endoscopy associated with genetic algorithms-partial least-squares-linear discriminant analysis (GA-PLS-LDA). A total of 2126 in vivo FP/HW Raman spectra (598 NPC, 1528 normal) acquired from 113 tissue sites of 14 NPC patients and 48 healthy subjects during nasopharyngeal endoscopic examinations. Distinct Raman peaks have been identified (853 cm-1 - proteins, 1209 cm-1 - phenylalanine, 1265 cm-1 - proteins, 1335 cm-1 - proteins and nucleic acids, 1554 cm-1 - tryptophan, porphyrin, 2885 cm-1 - lipids, 2940 cm-1 - proteins, 3009 cm-1 - lipids, and 3250 cm-1 - water) that are related to the significant biochemical changes ( p < 1 × 10-5) in NPC compared to normal tissue. Raman diagnostic performance is evaluated through the leave-one-object (tissue site)-out cross-validation (LOOCV) method. A statistically significant GA-PLS-LDA model ( p < 1 × 10-5) on FP/HW Raman yields a CV diagnostic accuracy of 98.23% (111/113), sensitivity of 93.33% (28/30), and specificity of 100% (83/83) for NPC classification. This work demonstrates that the fiber-optic FP/HW Raman diagnostic platform developed has great promise for improving real-time in vivo detection and diagnosis of NPC at the molecular level during clinical nasopharyngeal endoscopy.

Effectiveness of Furlow palatoplasty in velopharyngeal insufficiency after cleft palate surgery

To explore the application value of Furlow palatoplasty in reconstruction of velopharyngeal insufficiency (VPI) after cleft palate surgery. Between August 2015 and January 2017, 48 patients with VPI after cleft palate surgery were treated with Furlow palatoplasty. There were 29 males and 19 females, aged from 4 to 17 years (mean, 6.1 years). There were 16 cases of incomplete cleft palate and 32 cases of complete cleft palate; and 16 cases of soft cleft palate and 32 cases of soft and hard cleft palate. The interval between first cleft palate surgery and Furlow palatoplasty was 3 to 13 years (mean, 5.9 years). The patients were accompanied by significant open rhinolalia and nasal leakage. The degree of velopharyngeal closure assessed by electronic nasopharyngeal fiberoptic endoscopy was grade Ⅲ. The operation time and intraoperative blood loss were recorded. The total length of palate, the length of soft palate, the depth of pharyngeal cavity, and the width of pharynx and palate arch were measured before operation and at immediate after operation, and the change of the above indexes before and after operation was calculated. According to the results of clinical assessment, the patients were allocated into three groups: velopharyngeal competence (VPC) group, marginal velopharyngeal inadequacy (MVPI) group, and VPI group. The relationship between the soft palate and the posterior pharyngeal wall was evaluated by lateral cephalometric radiographs at 3 months after operation, and the patients were allocated into complete contact group, point contact group, and non-contact group. The velopharyngeal closure was evaluated by electronic nasopharyngeal fiberoptic endoscopy (grade Ⅰ, Ⅱ, Ⅲ). Spearman analysis was used to analyze the correlation between the changes of the total length of palate, the length of soft palate, the depth of pharyngeal cavity, and the width of pharynx and palate arch before and after operation. The contact degree of soft palate and posterior pharyngeal wall and the closure degree of pharynx and palate were grouped separately, and the above indexes were analyzed statistically. The operation time was 35-64 minutes (mean, 41 minutes); the intraoperative blood loss was 3-10 mL (mean, 6 mL). All patients were followed up 3 months. After 3 months of operation, the clinical evaluation results were 34 cases of VPC, 7 cases of MVPI, and 7 cases of VPI. Lateral cephalometric radiographs showed that 30 cases had complete contact with the posterior pharyngeal wall, 11 cases had point contact, and 7 cases had no contact. Electronic nasopharyngeal fiberoptic endoscopy showed that the pharyngeal closure function was improved to varying degrees, 29 cases of grade Ⅰ, 12 cases of grade Ⅱ, and 7 cases of grade Ⅲ. There were significant differences in the total length of palate, the length of soft palate, the depth of pharyngeal cavity, and the width of pharynx and palate arch between pre- and post-operation ( P<0.05). Spearman correlation analysis showed a correlation between the change in the total length of palate before and after operation and the change in the length of soft palate ( r=0.448, P=0.001). There were significant differences in the changes of total length of palate, the length soft palate, and the depth of pharyngeal cavity before and after operation between VPC, MVPI, and VPI groups ( P<0.05); and there was no significant difference in the change of the width of pharynx and palate arch before and after operation between groups ( P>0.05). There were significant differences in the changes of total length of palate and the length soft palate before and after operation between complete contact, point contact, and non-contact groups ( P<0.05); and there was no significant difference in the change of the depth of pharyngeal cavity and the width of pharynx and palate arch before and after operation between groups ( P>0.05). Furlow palatoplasty can restore the VPI after cleft palate surgery, which can effectively prolong the soft palate and reduce the depth of the pharynx. It can cover the physiological and anatomical morphology of velopharyngeal closure significantly and improve the velopharyngeal function.

THE GIANT INVERTED PAPILLOMA SCHNEIDER WITH GERMINATION IN THE ACNE SINUSES AND NASOPHARYNX

Inverted transitional cell papilloma (Schneider papilloma), a rare benign tumor, accounts for about 0.5 % of all neoplasms of the nose. Usually unilateral, recurrences of the tumor can occur after 5-10 years. In about 5% of patients, an inverted transitional cell papilloma is able to turn into cancer after a long-term benign course. These tumors have a destructive growth, recur and malignize. The article presents a case from clinical practice. The patient was admitted with a diagnosis of right-sided chronic polypous sinusitis. On examination, the right half of the nose is filled with polypoid formations, and in the posterior rhinoscopy, formations similar to a giant choanal polyp are determined. The peculiarity of education in the nasopharynx was hilly, lobed surface, so it was decided to carry out nasopharyngeal endoscopy through the left half of the nose for better visualization and taking a biopsy. The result of histological examination is an inverted transitional cell papilloma. The patient underwent a CT scan of the paranasal sinuses: the right half of the nasal cavity is filled with a soft tissue density mass formation, which prolapses into the right maxillary sinus, and is accompanied by the destruction of bone trabeculae and protrusion of the labyrinth walls and fills the right frontal sinus. Under intravenous combined anesthesia with tracheal intubation, a sinus surgery was performed according to Denker. Tumor formation removed as a single unit. The right half of the nose, the cavity of the maxillary and ethmoid sinuses and nasopharynx form a single cavity. There were no complications during the operation. Remote tumor was sent for histopathological examination. The result of histopathological examination of a remote tumor is an inverted papilloma. The peculiarity of this clinical case is the rarity of the pathology, the gigantic size of the neoplasm, the germination of the inverted papilloma in the maxillary, ethmoid sinuses and nasopharynx, removal of the neoplasm as a single unit, minimal blood loss during the operation, the absence of complications.

Late presentation of nasopharyngeal carcinoma

Nasopharyngeal carcinoma has a tipically insidious presentation, with often neglected signs and symptoms, thus more than 99% of patients are symptomatic on diagnostic 1. There are 5 types of presentation models: the rhinologic type (nasal obstruction, epistaxis, rhinorrhea), the otologic type (otorrhea, conductive hearing loss), the lymphatic type (bulky cervical neck masses), the neurologic type (headache, cranial nerve palsy) and the opthalmic type (diplopia due to cranial nerve involvement - III, IV and VI). These presentation models are usually singular but will become associated as the disease progresses and the tumor extends, encompassing the skull base. &#x0D; We present the case of a 51 y.o. male with bilateral neck massess which appeared approximatively 6 months ago, recurrent epistaxis after sneezing, unilateral (right) hearing loss and otorrhea, right side hypogeusia (partial loss of taste sense) of the tongue and hypoesthesia of the right hemiface, involving the mandible and cheek. &#x0D; Naso-pharyngeal endoscopy showed a tumor involving the right lateral wall of the rhinopharynx as well as the posterior and superior walls and extending to the sphenoid sinuses and downward to the oropharynx. The tumor encompassed the Eustachian tube orifice - and the patient had otomastoiditis with persistent suppuration, consistent with otoscopy findings. Contrast CT scans showed skull base involvement, thus explaining cranial nerve involvement (mandibular branch of V).&#x0D; The diagnosis was locally advanced disease (stage IV) and a biopsy was performed, followed by a multi-modal radiation and chemotherapy protocol.&#x0D; Case particularity: late-onset presentation with rhinologic, neurologic, otic and lymphatic signs.

Eustachian Tube Function in Adults with Ventilation Tubes Inserted for Otitis Media with Effusion.

To investigate the eustachian tube (ET) function (ETF) in adults with ventilation tube (VT) inserted for the treatment of chronic otitis media with effusion (COME). A total of 17 subjects with at least one VT were enrolled. A detailed history was obtained, and risk factors were assessed with questionnaires. Examination including nasopharyngeal video endoscopy and ETF tests, the forced response test (FRT), inflation-deflation test (IDT), and nasal/nasopharyngeal maneuvers (such as sniffing and Valsalva, Toynbee, and the diver's maneuvers) were performed. Averages for FRT were 580±333 daPa, 382±251 daPa, and 138±192 daPa for opening pressure, steady-state pressure, and closing pressure, respectively. Most subjects demonstrated minimal or weak active function during the FRT and IDT. While nasopharyngeal maneuvers changed the nasal/nasopharyngeal pressures, they did not significantly change the middle-ear pressures. These results indicated that most subjects had severe obstructive ET dysfunction (ETD) with an ET lumen that required high pressure differences to open and poor active muscular function inadequate for luminal dilation. These results imply that while any treatment to widen the ET, such as balloon dilation of the ET, is not expected to change the voluntary active muscular function, it may reduce the tissue pressures and resistance, thus facilitating luminal opening both passively and actively. Most patients with VT inserted for the treatment of COME appear to have an abnormal ETF with difficulty in passively opening the ET and weak active muscular function. Management of such patients addressing only passive properties may not be sufficient for the resolution of ETD.

Fabrication and verification of three-dimensional prototyped models of nasal cavities and paranasal sinuses

Objective: To make three-dimensional prototyped models of nasal cavities and paranasal sinuses for endoscopic skills training and teaching and to verify and evaluate the fidelity of the models. Methods: Imaging data of a patient with nasal septum deviation was selected for prototyping the nasal cavities model, and the imaging data of a patient with chronic rhinosinusitis who underwent the endoscopic sinus surgery 4 months ago was selected for the paranasal sinuses model. Both patients came from the Department of Rhinology, the First Affiliated Hospital of Zhengzhou University. The models were printed by the desktop-level printer based on the fused deposition modeling (FDM). The evaluations of anatomical structures and prespecified tasks on the simulators were completed by 5 residents and 5 experts of Rhinology.The models were evaluated by survey ratings based on a 5-point Likert scale. The average time to complete each task was calculated.Mann-Whitney nonparametric test was used to assess the differences between experts and residents groups. The statistical significance level was set at P<0.05. Results: All the components of the two models were prototyped in 24 h. For the nasal cavities model, the scores of each anatomical structure were more than 4.0. As to the paranasal sinuses model, except for the frontal sinus (3.6), the scores of each anatomical structure were more than 4.0. All the participants who performed the prespecified tasks evaluated the models well (>4.0). With the nasal cavity simulator, the experts completed the tasks (nasal cavity and nasopharyngeal endoscopy, removal of nasal foreign body, nasal packing, pledget insertion), and the other tasks (the nasal cavity and nasopharyngeal endoscopy, identification of ostiums of paranasal sinuses, maxillary sinus debridement with 70° nasal endoscopy) were completed with paranasal sinus model. The average time to complete each task by experts group and residents group (M (P(25), P(75))) were 10.3 (10.0, 10.7) s vs 17.1 (14.6, 20.7) s, 2.1 (2.0, 2.2) s vs 3.4 (2.6, 4.7) s, 30.1 (27.8, 32.8) s vs 59.2 (52.0, 65.4) s, 54.8 (50.1, 63.2) s vs 92.2 (79.3, 106.9) s, 9.3 (8.7, 9.9) s vs 14.5 (13.3, 14.9) s, 20.1 (19.3, 21.2) s vs 41.9 (35.5, 45.1) s, 31.1 (28.8, 35.2) s vs 52.8 (47.7, 56.3) s, respectively, and the average time to complete each task was shorter for the experts group than for the residents (U value was 0, 1.000, 0, 0, 0, 0, 0, respectively, all P<0.05). Conclusion: The models of nasal cavities and paranasal sinuses made by our desktop-level FDM 3D-printer are useful for endoscopic training skills.

Osteoradionecrosis of the Skull Base in Nasopharyngeal Carcinoma: Incidence and Risk Factors

Nasopharyngeal carcinoma (NPC) is a type of malignancy with a high prevalence in southern China and Southeast Asia. The primary treatment modality is radiation therapy (RT). Osteoradionecrosis (ORN) of the skull base remains one of the most serious complications after RT, affecting survival time and quality of life. Thus far, skull base ORN has been seldom reported and can be difficult to distinguish and easy to misdiagnose. In this retrospective study, we report the incidence of skull base ORN and analyze its associated factors in an attempt to decrease the occurrence of ORN. From January 2001 to December 2012, a total of 1348 patients who received diagnoses of NPC received 1 course of RT. Complete medical records were reviewed, and the patients were examined by magnetic resonance imaging and nasopharyngeal endoscopy during follow-up after primary treatment. Patients with other tumors of the head and neck, a history of RT, failure to complete RT, and those lost to follow-up were excluded. Treatment was delivered with external beam RT using standard linear accelerators. A total of 1348 patients with NPC were enrolled in this study after 1 course of RT; among these patients, 14 received diagnoses of skull base ORN. The incidence of skull base ORN was 1.04%. The average latency interval from the completion of RT to the diagnosis of skull base ORN was 45.57months. Skull base ORN after 1 course of RT was associated with the T stage; total radiation dose to the nasopharynx, including the skull base in the radiation field; and anemia. The occurrence of skull base ORN was associated with primary tumors with advanced T stages, high doses of nasopharynx RT, and radiation fields that included the skull base. These factors may be used as predictors for the incidence of skull base ORN.

Efficacy of balloon Eustachian tuboplasty combined with grommet insertion in the treatment of chronic dilation Eustachian tube dysfunction

To evaluate the efficacy of balloon Eustachian tuboplasty (BET) combined with grommet insertion in the treatment of chronic dilation Eustachian tube dysfunction (CDETD). A retrospective study was performed in 19 patients with CDETD who underwent BET at the Department of Otolaryngology-Head and Neck Surgery, Xinhua Hospital Affiliated with Shanghai Jiaotong University School of Medicine, from October, 2014 to September, 2016. The ages of these patients ranged from 10 to 67 years. All the patients underwent the preoperative assessment of oto-endoscope, tympanometry, pure tone audiometry, fiber nasopharyngeal endoscopy, Eustachian tube pressure measurement (TMM), CT and MRI. These patients had failed to respond to medicine, multiple tympanic membrane puncture and at least 2 times grommet insertion before our study. BET was performed in 5 patients (5 ears), and BET+grommet insertionwas performed in other 14 patients (23 ears). The changes of Eustachian tube function in these patients was assessed using the Eustachian tube score (ETS) and Eustachian tube dysfunction questionnaire-7 (ETDQ-7) preoperatively and 1, 3, 6, 9 and 12 months after surgery, respectively. In addition, subjective symptoms including the difficulty level of valsalva, aural fullness and earache were assessed by visual rating scale (VAS score) preoperatively and at 1, 6, and 12 months after surgery. The mean scores before surgery were compared with that at 1, 3, 6, 9 and 12 months. Postoperative adverse reactions and complications were recorded, such as earache, nosebleeding and so on. Valsalva score and VAS score for aural fullness before surgery were 8.286±0.189 and 8.571±0.221, respectively. Valsalva score and VAS score for aural fullness were 3.714±0.317, 2.393±0.434, respectively, at one month after surgery, which were decreased significantly, as compared with the scores before surgery (P<0.05). VAS score at 6 months and 12 months after surgery were statistically significant compared with those before surgery (P<0.05). ETS score after surgery was significantly higher than that before surgery (P<0.05). ETDQ-7 score after surgery was significantly lower than that before surgery (P<0.05). The subjective satisfaction in these patients was 84.2%. BET is simple and safe, with fewer complications, and effective for the treatment of CDETD combined with grommet insertion.

Balloon dilation for the treatment of nasopharyngeal stenosis in seven cats.

ObjectivesThe objective of this study was to evaluate the effectiveness of balloon dilation for the treatment of nasopharyngeal stenosis in cats.MethodsThe medical records of seven cats with nasopharyngeal stenosis treated with balloon dilation were reviewed. The most common presenting clinical signs included upper airway noise, sneezing, nasal and/or ocular discharge. All seven cats were confirmed to have nasopharyngeal stenosis via nasopharyngeal endoscopy and were treated with balloon dilation under endoscopic guidance.ResultsAll seven cats had acceptable short-term control (median 14 days) of clinical signs after the procedure. Two of six cats had successful long-term control (median 34 days) of clinical signs after one balloon dilation and an additional 2/6 cats had acceptable long-term control of clinical signs after a second balloon dilation procedure. The most significant complication of balloon dilation was the recurrence of stenosis.Conclusions and relevanceThe findings of this study indicate that balloon dilation is a safe and effective treatment option for the relief of clinical signs associated with nasopharyngeal stenosis in cats. Multiple procedures may be necessary for the best chance of long-term success.

Velopharyngeal closure pattern and speech performance among submucous cleft palate patients

To characterize the velopharyngeal closure patterns and speech performance among submucous cleft palate patients. Patients with submucous cleft palate visiting the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University between 2008 and 2016 were reviewed. Outcomes of subjective speech evaluation including velopharyngeal function, consonant articulation, and objective nasopharyngeal endoscopy including the mobility of soft palate, pharyngeal walls were retrospectively analyzed. A total of 353 cases were retrieved in this study, among which 138 (39.09%) demonstrated velopharyngeal competence, 176 (49.86%) velopharyngeal incompetence, and 39 (11.05%) marginal velopharyngeal incompetence. A total of 268 cases were subjected to nasopharyngeal endoscopy examination, where 167 (62.31%) demonstrated circular closure pattern, 89 (33.21%) coronal pattern, and 12 (4.48%) sagittal pattern. Passavant's ridge existed in 45.51% (76/167) patients with circular closure and 13.48% (12/89) patients with coronal closure. Among the 353 patients included in this study, 137 (38.81%) presented normal articulation, 124 (35.13%) consonant elimination, 51 (14.45%) compensatory articulation, 36 (10.20%) consonant weakening, 25 (7.08%) consonant replacement, and 36 (10.20%) multiple articulation errors. Circular closure was the most prevalent velopharyngeal closure pattern among patients with submucous cleft palate, and high-pressure consonant deletion was the most common articulation abnormality. Articulation error occurred more frequently among patients with a low velopharyngeal closure rate.