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PubMed1998

[The role of acoustic rhinometry in the evaluation of the volume of nasopharynx before and after adenoidectomy].

OBJECTIVE: To determine the type of acoustic rhinometry curve in different kinds of nasal and nasopharyngeal diseases and the role of acoustic rhinometry in the evaluation of the changes of the volume of nasopharynx before and after adenoidectomy. METHODS: One hundred and fifty-one patients with nasal and nasopharyngeal diseases, including rhinitis, nasal polyps, obstructive sleep apnea syndrome, palatoschisis, atrophic rhinitis, adenoid vegetation, perforation of nasal septum, carcinoma of nasopharynx, and stricture of nasal limen, were measured with acoustic rhinometry. Meanwhile, 15 patients with adenoid vegetation were measured before and after adenoidectomy, the changes in volume recorded by acoustic rhinometry were compared with the adenoid volume obtained by the method of displacement. RESULTS: Acoustic rhinometry curve can be divided into normal and abnormal curves and the abnormal curves can be divided into four types according to the site of changes. Acoustic rhinometry curve altered with the changes in character, degree and site of nasal and nasopharyngeal diseases and could return to normal after surgery or medical treatment. The volume of nasopharynx of adenoid vegetation patients was significantly smaller than that of the normal control and it rose significantly and became closed to normal after adenoidectomy. The volume of adenoid and the calculated changes in volume of the nasopharynx was found to be interrelated and highly significant(r = 0.87, P < 0.001). CONCLUSION: The results indicate that acoustic rhinometry curve is a useful method in the assistant diagnosis and judgment of therapeutic effectiveness of many kinds of nasal and nasopharyngeal diseases and can provide reference for the evaluation of the volume of adenoids.

Adenoidectomy↗
PubMed2004

[Non-Hodgkin lymphomas of the nasopharynx in children--diagnostic and therapeutic difficulties].

UNLABELLED: About 7% of all childhood cancers comprise non-Hodgkin's lymphoma (NHL). NHL are heterogenous group of neoplasms deriving from lymphatic system (cell B and T). B-cell NHL characterize by high malignancy, but coincidentally good reaction for treatment. In about 20% primary tumour is localised within head and neck, and nasopharynx lymphomas comprise 10%. This location maintains the biggest diagnostic and therapeutic difficulties because of tumours of this site proliferate in the region of frequent infections postponing a proper diagnosis and the local control after complete treatment is difficult. AIM OF THE STUDY: The authors analyse clinical symptoms before diagnosis, the incidence of nasopharynx lymphomas, histopathological type of neoplasm, clinical stage, results of treatment. MATERIAL AND METHODS: The study includes 97 patients who were treated because of lymphomas between 1993-2002. The character of clinical symptoms and their duration, histopathological type of lymphomas, results of treatment were analysed. RESULTS: The primary nasopharynx location was assessed in 9 patients (9.3%). Sex: 7 boys, 2 girls, age: 2-17 years. The duration which elapsed from initial clinical symptoms to diagnosis was 2-10 weeks. The histopathological assessment in 6 children was Burkitt lymphoma and in 3 children--Burkitt-like lymphoma. Metastases: CNS--1 patient, bone marrow--1 patient, abdomen--1 patient. Treatment was performed according to LMB-89 protocol. RESULTS: First complete remission--7 patients; second complete remission--2 patients. CONCLUSIONS: Lymphomas of nasopharynx cause diagnostic problems because of their early stage pseudo-inflammatory manifestation. Special attention should be paid to perform imaging studies (MRI/CT), which are useful in the reaching the proper diagnosis. The radiologic evaluation of primary lesion is still difficult. In the doubtful cases, the surgery and histopathological examination are necessary.

Adolescent↗
PubMed1995

Prognostic factors for loco-regional control and outcome of re-irradiation for patients with poorly-differentiated squamous cell carcinoma of the nasopharynx.

Retrospective analysis was performed to evaluate the prognostic factors for loco-regional control and the results of re-irradiation for 28 patients with recurrent, poorly-differentiated squamous cell carcinoma (PDSCC) of the nasopharynx. Twenty-four of them received re-irradiation. Local, local plus regional and regional recurrences were observed in 19, five and four patients, respectively. Except for three patients, all had Stage IV disease at the initial diagnosis. The only parameters influencing loco-regional recurrence were T and N stage categories. The median latent period from initial treatment to recurrence was 18.5 (range, 2-100) months. There was no difference in latent period by first recurrence site, although recurrent tumors confined to the nasopharynx or those only regionally developed had a longer latent period. Only four patients developed secondary distant bone metastases with a median latency of three months from loco-regional relapse. The patients with local recurrent tumors confined to the nasopharynx, and those with regional recurrences only, could be salvaged by re-irradiation, with five-year survival rates of 44 and 100%, respectively. Five of 28 patients (18%) developed severe chronic radiation sequelae: cerebrospinal complications in four patients, bilateral neck fibrosis in one. We conclude that recurrent PDSCC of the nasopharynx can be controlled by re-irradiation with some success. Radiation therapy techniques must, however, be carefully planned in order to avoid the severe late post re-irradiation sequelae. For patients with advanced non-curable local recurrences, palliative care should be recommended instead of agressive re-irradiation.

Carcinoma, Squamous Cell↗
PubMed1997

[Solitary fibrous tumor of the nasopharynx. Apropos of a case].

Solitary fibrous tumor (SFT) is a rare neoplasm, arising in the adult and more commonly in the pleura. For many years it has been referred to the serous surfaces of the body, namely pleura, peritoneum and pericardium; recently cases arising in mesenchymal organs such as lung, mediastinum, liver and paranasal sinuses were reported. We present a SFT of the nasopharynx, observed in a 41 year-old patient complaining a 6 months history of aural fullness at the right ear. Clinical examination revealed the presence of secretory otitis media and swelling of the lateral wall of the nasopharynx. CT scan and MR showed the presence of a solid mass, with scarce vascularization, extending from the right side of the nasopharynx to the infratemporal and pterigoid fossae. The surgical approach consisted in a facial translocation by the rotation of a maxillary-check flap through different osteotomies; a firm whitish mass not invading the surrounding tissues was identified and enucleated. A definitive diagnosis cannot be made at frozen sections, requiring more accurate processing and immunohistochemical staining. Literature reports fourteen cases of SFT of the upper aero-digestive tracts (nasopharynx, paranasal sinuses, larynx) and some 8 more cases in the head and neck area (thyroid, salivary glands and parapharyngeal spaces). This case report adds a further contribution to support the mesenchymal origin of the SFT.

Adult↗
PubMedDate not supplied

EBER in situ hybridization differentiates carcinomas originating from the sinonasal region and the nasopharynx.

Epstein-Barr virus (EBV) has a well-established association with nasopharyngeal carcinoma (NPC), while its association with sinonasal carcinoma is still controversial. The role of EBV in sinonasal carcinoma and the potential value of EBER is situ hybridization in differentiating carcinomas originating from these anatomically neighboring regions were investigated. EBER in situ hybridization was applied to detect EBV in the specimens of surgically proved sinonasal carcinoma and the biopsies of carcinoma of the nasopharynx. EBER in situ hybridization was performed on paraffin embedded tissues by using PCR-derived, digoxigenin-labeled EBER-1 DNA probes. EBV was detected in 2 of 31 (6.5%) surgical specimens of sinonasal carcinoma, including 1 keratinizing squamous cell carcinoma and 1 adenocarcinoma. EBV was detected in all of 31 (100%) biopsies of carcinomas of the nasopharynx, including 1 keratining squamous cell carcinoma, 15 nonkeratinizing carcinomas, 14 undifferentiated carcinomas, and 1 adenocarcinoma. The present study does not support the role of EBV in the development of sinonasal carcinoma as does in carcinoma of the nasopharynx. EBER in situ hybridization is a useful adjunct for differentiating carcinomas originating from the sinonasal region and the nasopharynx.

Adenocarcinoma↗
PubMed2005

Recovery of potential pathogens and interfering bacteria in the nasopharynx of otitis media-prone children and their smoking and nonsmoking parents.

OBJECTIVE: To study the frequency of isolation of potential pathogens and interfering bacteria in the posterior nasopharynx of otitis media-prone (OMP) children and their smoking and nonsmoking parents to possibly explain why active and passive exposure to smoking is associated with carriage of potentially pathogenic bacteria and an increased risk of respiratory tract infection in both adults and children. SETTING: Outpatient clinic. PARTICIPANTS: Twenty OMP children and their smoking parents (smoking group) and 20 OMP children and their nonsmoking parents (nonsmoking group). INTERVENTIONS: Posterior nasopharynx cultures were taken from 20 OMP children and their smoking parents and 20 OMP children and their nonsmoking parents. MAIN OUTCOME MEASURE: Potential pathogens and aerobic and anaerobic bacteria with interfering capabilities against these organisms were identified. RESULTS: Fourteen potential pathogens were isolated from smoking parents, and 17 were recovered from their children. Concordance in isolation of a pathogen between a parent and child was noted in 11 instances. Three potential pathogens were isolated from nonsmoking parents (P<.001 compared with the parents and children in the smoking group and children in the nonsmoking group), and 16 were recovered from their children. Bacterial interference by normal flora isolates against potential pathogens was noted in 58 instances in smoking parents and in 55 instances in their children (P<.05). Bacterial interference was noted in 129 instances in nonsmoking parents (P<.05 compared with the parents and children in the smoking group and children in the nonsmoking group) and in 55 instances in their children. CONCLUSIONS: A high recovery rate of potential pathogens and a low number of interfering organisms were observed in OMP children. This was not related to their parents' smoking habits. The posterior nasopharynx flora of smoking parents contained more potential pathogens similar to the ones recovered from OMP children and fewer interfering organisms than nonsmoking parents.

Adult↗
PubMed1978

So-called hairy polyps or teratoid tumors of the nasopharynx.

Two new cases of hairy polyp of the nasopharynx, one with congenital atresia of the left carotid artery, are added to 111 cases that have already been reported. Unlike trigerminal neoplastic teratomas, the hairy polyps are derived from two germ cells, the ectoderm and mesoderm. They are composed of a conglomeration of disorganized and disorderly tissues that form a sessile to a pedunculated mass that is attached to the nasopharynx. They are strictly developmental anomalies in early embryogenesis with very limited growth potential. We discuss their clinical features, diagnosis, and development. In an evaluation of any nasopharyngeal mass in the newborn, consideration should be given as to whether the mass arises in the nasopharynx or is an extracranial extension of glioma or encephalocele.

Adolescent↗
PubMedDate not supplied

New approach to the nasopharynx: the maxillary swing approach.

A new approach to expose the nasopharynx and the paranasopharyngeal space is described. The maxilla, severed from its bony connections, is swung laterally to provide exposure of the nasopharynx. Tumors in the nasopharynx and the paranasopharyngeal space can be adequately resected and tubings for afterloading brachytherapy can be positioned accurately during surgery. The blood supply of the maxilla is from the attached cheek flap and masseter muscle. Three illustrative cases are presented. The wounds in all of them healed primarily with minimal morbidity. The only disadvantage is the development of mild trismus, which responded to conservative treatment.

Adult↗
PubMed1980

[Morphology and growth of the nasopharynx from three years to maturity (author's transl)].

The nasopharynges of 80 adults and children were examined by a specific technique. An impression was taken for a precision plaster model to allow measurement and analysis. In this manner it was possible for the first time to describe spatial relationship and growth of the nasopharynx. The vertical height increases steadily up to the age of 9 years when addition of the adenoids seems to interrupt the growth of the nasopharynx. From then on, the height continues to increase until old age. This increase in mature patients can be attributed to alterations resulting from loss of teeth or maxillary deformation caused by atrophia senilis. The depth shows wide variations, growth was observed with increasing age. The width, i.e., the distance between the eustachian tubes, does not increase. This is due to enlargement of the tubes and increase of the prominentia tubae. The cross-sectional area of the choanae available for air flow increases steadily up to 380 mm2. The volume of the nasopharynx increased in our sample from 2.4 to 6.8 mm3 which represents a factor of 2.8 over the initial size.

Adenoids↗
PubMed2004

Virtual endoscopy of the nasopharynx in the evaluation of its normal anatomy and alterations due to lymphoid hyperplasia: preliminary report.

The purpose of this study was to evaluate the diagnostic usefulness of virtual endoscopy in establishing the anatomic appearance of nasopharynx, both normal and affected by lymphoid hyperplasia. Thirty-seven patients affected by chronic rhinosinusal and otomastoid pathology, all studied by rhinoscopy, were examined with multislice computed tomography (CT) and virtual endoscopy of the nasopharynx. Rhinoscopy showed a completely normal nasopharynx in 15 cases and a variable grade of lymphoid hypertrophy in 22 patients. A general agreement was observed between traditional and virtual endoscopy findings in both subgroups. The tasca of Luschka was detected in 13/15 of normal subjects and only in 3/22 patients. The Rosenmuller fossae appeared deeper in normal subjects and their symmetry could be considered an important criterion of normality. In all cases, a good evaluation of the tubaric ostium was obtained. Differentiation between hyperplasic lymphoid tissue and neoplasms is possible only in lymphoid hyperplasia characterized by median crest-like swelling with a narrow base. In most cases, differential diagnosis cannot be based only on morphological criteria of virtual endoscopy, but it should be evaluated considering the overall CT findings and clinical presentation.

Diagnosis, Differential↗
PubMed1993

Cardiovascular responses to gustatory and mechanical stimulation of the nasopharynx in rats.

The effects of natural (mechanical and gustatory) stimulation of the nasopharynx or electrical stimulation of the pharyngeal branch of the glossopharyngeal (PH-IXth) nerve on the changes in heart rate (HR) and arterial blood pressure (BP) were investigated in paralyzed and anesthetized rats. Afferent responses in the PH-IXth nerve were also investigated. Electrical stimulation of the PH-IXth nerve elicited a tachycardia and an increase in BP. Among the gustatory (1.0 M NaCl, 0.03 M HCl, 0.03 M QHCl, 1.0 M sucrose, H2O, and 0.9% NaCl) and mechanical stimuli applied to the nasopharynx, 1.0 M sucrose and 0.9% NaCl were ineffective in changing HR and BP; the rest of the stimuli were strongly effective as was the case with electrical stimulation of the PH-IXth nerve. Responses were evoked in the PH-IXth nerve by nasopharyngeal stimulation with the stimuli which were effective in producing cardiovascular responses. On the other hand, 1.0 M sucrose and 0.9% NaCl, which were ineffective stimuli for cardiovascular responses, did not produce any response in the PH-IXth nerve. There was a high correlation between the magnitude of the responses in the PH-IXth nerve and those of the cardiovascular system. These results indicate that gustatory and mechanical information carried in the PH-IXth nerve innervating the nasopharynx plays an important role in cardiovascular regulation as well as the sense of taste.

Action Potentials↗
PubMed1991

The nasopharynx in oral and maxillofacial radiology. I. Benign lesions.

This is not a comprehensive review of all benign lesions that can be found in the nasopharynx, but merely a review of the relationship of the nasopharynx to its surroundings. It is also a reminder of the need for the oral and maxillofacial radiologist to be familiar with this area, because it often appears on radiographs made for other purposes, or to investigate problems that have extended to and from the nasopharynx and the oral and maxillofacial region.

Adenoids↗
PubMed2005

Investigation about the homogeneity of nasopharyngeal microflora at the different location of nasopharynx of children with acute otitis media.

OBJECTIVE: Nasopharynx is thought to be a very important site as becterial reservoir for acute otitis media (AOM). In this study, we investigated on the homogeneity of nasopharyngeal microflora at the different location of nasopharynx of children with AOM. METHODS: Thirty nasopharyngeal samples of 15 children with AOM, two samples harvested from both nostrils of each child, were cultured and analyzed by patterns of antibiotic susceptibility and pulsed-field gel electrophoresis analysis (PFGE). RESULTS: A total of 30 nasopharyngeal samples were cultured and 19 isolates of Streptococcus pneumoniae from 10 children (66.7%), 8 isolates of Haemophilus influenzae from 4 children (26.7%), and 12 isolates of Moraxella catarrhalis from 7 children (46.7%) were obtained. In all children except three, the nasopharyngeal microflora at right and left orifice of the eustachian tubes showed no obvious differences in the bacterial species and quantities. Furthermore, in children with the same species of were cultured from right and left orifice of the eustachian tubes at the same time, all nine couples of S. pneumoniae isolates, four couples of H. influenzae isolates, and five couples of M. catarrhalis isolates showed about the same susceptibility and PFGE patterns. CONCLUSION: These results suggest that the microflora at the different location of nasopharynx of children with AOM is almost homogeneous, irrespective of the clinical signs.

Acute Disease↗
PubMed1998

A cephalometric study by multivariate analysis of growth of the bony nasopharynx in patients with clefts and non-cleft controls.

To clarify the characteristics of growth of the nasopharynx, comparison of the cephalometric growth of bones surrounding nasopharynx between 61 patients with complete unilateral cleft lip and palate (UCLP group) and 82 non-cleft controls (NCC group) was carried out. All of the subjects were divided into four developmental stages (i.e. stage 1 at 4 years of age, stage 2 at 8 years of age, stage 3 at 12 years of age and stage 4 at 17 years of age). Measurements on the antero-posterior and the vertical dimensions were derived from a coordinate system and points on bones surrounding the nasopharynx on lateral X-ray cephalograms, and results were analyzed by multivariate analysis and t-test. The results showed that (a) the posterior maxillary point (PMP) in the UCLP group was located more postero-superiorly than that in the NCC group, and this was the main factor that allows discrimination between the two groups and (b) the cranial base, posterior maxilla and the cervical vertebrae were found to be in independent in growth, however, the nasopharyngeal triangle connecting three points on these three bones (Ho: cranial base; PMP: posterior maxillary point; At: atlas) showed harmonious growth in both the UCLP and NCC groups.

Adolescent↗
PubMed1994

Association of recurrent acute otitis media with nasopharynx dimensions in children.

The purpose of this study was to evaluate the hypothesis that the nasopharyngeal anatomy has influence in the risk of recurrent acute otitis media (AOM) attacks. We analysed the occurrence of acute otitis media in 238 healthy schoolchildren who were X-rayed for orthodontic purposes. Six measurements reflecting the size and shape of the bony nasopharynx were recorded from lateral cephalograms. The means for almost all the dimensions of the bony nasopharynx measured were smaller in the children with two or more attacks of AOM in their history than in those with no attack or only one attack. Logistic multivariate modelling showed the distance from the posterior nasal spine to the sella-basion line to be a significant risk factor for recurrent otitis media in girls (difference 1.0 mm; 95 per cent confidence interval 0.1-2.0 mm; p = 0.04) and the shape of the nasopharynx (roundness) in boys (difference 1.9 mm; 95 per cent confidence interval 0.1-4.0 mm; p = 0.01). Measuring the nasopharyngeal bony dimensions may help to identify those children with a risk of recurrent otitis media, at whom prophylactic therapies should be targeted.

Acute Disease↗
PubMed2000

Radiology of the nasopharynx: pictorial essay.

The nasopharynx, located just below the central skull base, is a difficult area to evaluate clinically. Endoscopic examination provides useful information but cannot delineate submucosal disease. Benign lesions of the nasopharynx are relatively uncommon. They include Thornwaldt cyst, juvenile angiofibroma, haemangioma, haemangiopericytoma, Kimura's disease, branchial cleft cyst, oncocytoma, amyloidoma, and non-ossifying fibromyxoid tumours. The most common malignant lesions are carcinomas and lymphomas. Other malignant neoplasms such as adenocystic carcinomas are rarely seen. The purpose of the present pictorial review is to highlight the salient normal anatomy of the nasopharynx and the spectrum of pathological anatomy.

Female↗
PubMed1999

[The nasopharynx and pharyngeal tonsil in the history of otology and rhinology. Pictures from the history of otorhinolaryngology, presented by instruments from the collection of the Ingolstadt Medical History Museum].

Anatomy, nomenclature, first clinical observations: In ancient Greece and Rome and in the Middle Ages the posterior opening of the nasal passage was known (Greek "choane" = funnel) as an atomical structure, and it was also known that chronic nasal catarrh is common in children, but it was not realized that this was associated with special pathological alterations. The anatomist H. von Luschka in Tübingen, Germany, was the first to describe the nasopharynx in detail, and he coined the term "pharyngeal tonsil." The otologists of the 19th century like Kramer and Toynbee had placed the Eustachian tube in the center of their investigations and carried out numerous dissections with demonstration of the tubal orifice. They also knew that middle ear infections usually originated in the nasopharynx, but they did not realize that the hypertrophic pharyngeal tonsil was the cause. Posterior rhinoscopy and the diagnosis of the hypertrophy of the pharyngeal tonsil: Czermak in Budapest in 1860 had invented posterior rhinoscopy, and he was the first to diagnose hypertrophic alterations around the tubal orifice and the first to realize that they were the cause of tubal malfunction. Wilhelm Meyer in Kopenhagen in 1868 and 1873-1874 described hypertrophy of the pharyngeal tonsil ("adenoid vegetations") in detail and associated this finding with a syndrome characterized by mouth-breathing, snoring, a typical facial expression, deafness, recurring middle-ear affections, and characteristic alterations of speech. He based his conclusions on 5 years' experience with 175 observations in his office and on examination of 2700 children in Denmark and England. Surgical therapy of adenoid vegetations: Voltolini in Breslau in 1865 had observed a few cases of hypertrophy of the pharyngeal tonsil, and he was the first to treat them by galvanic cauterization. Meyer developed various instruments for reducing the pharyngeal tonsil. They were introduced through the nose while the application of the instrument was assisted digitally via the mouth and pharynx. The operation of the pharyngeal tonsil was adopted very eagerly by a great number of nasal surgeons. Among the numerous special instruments that subsequently were invented the most promising was the ring knife invented by Gottstein in 1886. Anesthesia and positioning: The pioneers of this intervention, Voltolini, Meyer, Semon and others, all operated without any anesthesia, but they usually would need up to 12 sessions (Semon) until the pharyngeal tonsil had been sufficiently reduced. Beckmann in Berlin, who had invented a modification of Gottstein's ring knife, reported in 1897 on more than 5000 cases in which he had removed the adenoids in just one session, in each case without anesthesia. Besides these surgeons, others used cocaine for local anesthesia or chlorethyl or bromethyl for general anesthesia. The German surgeon Edmund Rose (Berlin and Zürich) in 1874 introduced the position with the head suspended for larger interventions like resection ot the maxilla. Rudloff in Wiesbaden, Germany, in 1900 adopted this position for adenoidectomy, but this was generally accepted only after the mouth gags developed by Davis-Boyle and Negus had been introduced. The diagnostic and surgical interventions in the nasopharynx were a powerful link in the process of fusion between otology and rhinolaryngology around the turn of the century. This historical development is described in great detail with many figures and quotations from the literature.

Adenoidectomy↗
PubMed1990

[Aerodynamics of respiratory flow in the nasopharynx].

The authors present a new technique for studying airflow patterns and particle deposition in the nasopharynx. The nasal cavities and the nasopharynx from the head of a human cadaver were filled with siliconrubber and a "positive" model was then produced by moulding with plastic. An apparatus was constructed to provide calibrated flow of propandiol in both directions. Flow characteristics were visualized by introducing small particles in suspension or by injecting methylene blue with a needle. In addition, test aerosol was drawn in through the model to demonstrate dust deposition sites in the nasopharynx. In the future, this method will enable us to examine the nasopharyngeal airflow patterns and deposition sites of inhaled particles.

Airway Resistance↗