ABSTRACT
El quiste de Thornwaldt es poco común en la nasofaringe, pueden causar síntomas clínicos significativos. Fue descrito por Tornwaldt en 1885. Es una patología poco frecuente, benigna, inducida por persistencia de remanente de notocorda. Los quistes de Thornwaldt son generalmente siempre asintomáticos. El diagnóstico de esta masa suele ser incidental, como parte de un examen endoscópico nasal, o se puede detectar en el examen radiológico. Reportamos este caso de un paciente adulto que presento sintomatología auditiva inicial, secundario a un quiste nasofaríngeo hallado en la rinofibrolaringocospia, requiriendo tratamiento quirúrgico para su resolución.
Thornwaldts cyst is uncommon in the nasopharynx, can cause significant clinical symptoms. It was described by Tornwaldt in 1885. It is a rare, benign pathology induced by persistence of notochord remnant. Thornwaldts cysts are usually always asymptomatic. The diagnosis of this mass is usually incidental as part of a nasal endoscopic examination or that can be detected in the radiological examination. We report the case of an adult patient who presented initial, secondary to nasopharyngeal cyst found in the rinofibrolaringocospia auditory symptoms, requiring surgical treatment for resolution.
Thornwaldt Cisto é raro na nasofaringe, pode fazer com que os sintomas clínicos significativos. Foi descrito por Tornwaldt em 1885. É uma doença rara, patologia benigna induzida restos persistentes de notocorda. Thornwaldt cistos são geralmente sempre assintomática. O diagnóstico desta massa é geralmente incidental como parte de um exame endoscópico nasal ou que pode ser detectado no exame radiológico Reportamos este caso de um paciente adulto que apresento sintomatología auditiva inicial, secundário a um quiste nasofaríngeo achado na rinofibrolaringocospia, requerendo tratamento quirúrgico para sua resolução.
Subject(s)
Male , Humans , Middle Aged , Cysts , Natural Orifice Endoscopic Surgery , Nasopharyngeal Diseases/diagnosis , Nasopharyngeal Diseases/pathologyABSTRACT
Haemophilus influenzae (Hi) é um microrganismo que faz parte da microbiota transitória da nasofaringe humana e, eventualmente, pode causar doenças em indivíduos suscetíveis. A vacina Hib conjugada além de proporcionar uma proteção direta contra a doença nos vacinados, também reduz a colonização da nasofaringe pelas cepas vacinais. Os estudos de portador de Hi na população permitem a caracterização das cepas circulantes, portanto a identificação correta do microrganismo é de fundamental importância para estimar com acurácia o efeito da vacina. A técnica padrão-ouro para detectar Hi em material clínico é a cultura, um método específico, de sensibilidade variável e que demanda maior tempo para a completa identificação do microrganismo. O uso de técnicas moleculares tem auxiliado na diferenciação de Hi de outras espécies do gênero Haemophilus, devido à alta sensibilidade e especificidade para detectar o agente etiológico. Diferentes ensaios de PCR-TR e PCR foram desenvolvidos para o diagnóstico de Hi utilizando diferentes genes alvo específicos como o gene hpd e o gene fucK. Estes genes são altamente conservados e permite a detecção de Hi capsulado e não capsulado. O principal objetivo deste estudo foi avaliar a acurácia da PCR-TR utilizando o marcador molecular hpd#3 para detectar o Hi na secreção de nasofaringe de crianças saudáveis comparando-a com a cultura. Um total de 410 amostras de secreção de nasofaringe estocadas a -70ºC em meio STGG foi selecionado aleatoriamente para esta avaliação. Pela PCR-TR, 161 (39,2%) amostras foram positivas para o gene hpd e 249 (60,8%) negativas. Pela cultura, 166 (40,5%) amostras foram positivas para Hi e 244 (59,5%) culturas negativas. Sendo assim, a PCR-TR apresentou uma sensibilidade de 90,9% (95% IC: 85,3-94,7) e especificidade de 95,9% (95% IC: 92,4-97,9) quando comparada à cultura para detectar Hi...
Haemophilus influenzae (Hi) colonizes the human nasopharynx and eventually can cause diseases in susceptible individuals. The Hib conjugate vaccine provides direct protection against the diseases and also reduces nasopharyngeal colonization by vaccine strain. Hi carriage studies allow the knowledge of circulating strains and the accurate identification of the microorganism is important to estimate the effect of the vaccine. Culture is the gold standard method to detect Hi in clinical samples, this is a specific method, with variable sensitivity and demand more time for the complete identification of the microorganism. The use of molecular techniques has helped in differentiating Hi from other species of the Haemophilus spp. due to the high sensitivity and specificity to detect the etiologic agent. Different RT-PCR and PCR assays were developed for the diagnosis of Hi using several biomarker genes such as hpd and fucK gene. These genes are highly conserved and are present in encapsulated and non-encapsulated Hi strains, allowing the detection of both variants. The aim of this study was to evaluate the accuracy of RT-PCR to detect Hi in nasopharyngeal samples of healthy children vaccinated against Hib comparing it with the culture. A total of 410 nasopharyngeal swabs stored at -70°C in STGG medium were randomly selected to evaluate RT-PCR assay targeting protein D (hpd#3). Considering the 410 nasopharyngeal swabs, 161 (39.2%) samples were positive for Hi and 249 (60.8%) had negative RT-PCR. By culture, 166 (40.5%) samples were positive for Hi and 244 (59.5%) were negative. Thus, the hpd#3 RT-PCR showed a sensitivity of 90.9% (95% CI: 85.3 - 94.7) and a specificity of 95.9% (95% CI: 92.4 - 97.9) when compared to culture to detect Hi in nasopharyngeal swabs. The results showed no significant difference (McNemar's chi-square = 0.64 p>0.5) between RT-PCR and culture and the Kappa coefficient showed an excellent agreement (0.873) between the two techniques...
Subject(s)
Humans , Child , Gene Amplification , Nasopharyngeal Diseases/diagnosis , Haemophilus influenzae , Carrier State , Polymerase Chain Reaction , Real-Time Polymerase Chain ReactionABSTRACT
Tuberculous infection of the upper respiratory tract is an uncommon clinical condition and in that nasopharyngeal involvement is struck with rarity per se. This condition is often prevalent in people of low socioeconomic strata living in endemic areas, especially in developing countries. It has a silent and indolent course and most commonly mimicks nasopharyngeal carcinoma in its clinical presentation. In absence of concurrent pulmonary involvement, it is often misdiagnosed or diagnosed only after the biopsy has been taken. Nevertheless, high index of suspicion is required on part of the clinician to diagnose this comparatively rare entity.
Subject(s)
Antitubercular Agents/therapeutic use , Adult , Bacillus , HIV , Humans , Male , Nasopharyngeal Diseases/diagnosis , Nasopharyngeal Diseases/drug therapy , Nasopharyngeal Diseases/microbiology , Nasopharynx/microbiology , Nasopharynx/pathology , Staining and Labeling , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Tuberculosis/microbiologyABSTRACT
Nasal diseases are very common in dogs and rhinoscopy is often required for a definitive diagnosis. Rhinoscopy, while superficial in nature, can guide the clinician to the final diagnosis. In this study, rhinoscopy was performed on 54 dogs with symptoms of chronic nasopharyngeal disease. The endoscopic diagnosis of neoplasia or chronic nasal inflammation was validated with histological examination of pathological samples, in order to evaluate the degree of concordance between endoscopic findings and histological diagnosis. The agreement between endoscopy and histology was tested by application of Cohen's kappa coefficient. We conclude that correlation between endoscopic results and histological diagnosis, expressed by a Cohen's kappa coefficient of 0.73, is only possible with a constant cooperation between the clinician and the pathologist.
Subject(s)
Animals , Dogs , Dog Diseases/diagnosis , Endoscopy/methods , Histological Techniques/veterinary , Italy , Nasopharyngeal Diseases/diagnosisABSTRACT
Rhinosporidiosis is a chronic granulomatous disease of the mucocutaneous tissue, which clinically presents as polypoidal growths. Cutaneous lesions are infrequent and are generally associated with mucosal lesions. We present a case of cutaneous rhinosporidiosis in association with recurrent nasopharyngeal rhinosporidiosis in a 65-year-old male patient. He presented with dysphagia for solid foods and skin growth on the left side of jaw of 2 years duration. Histopathology of cutaneous and nasopharyngeal lesions revealed numerous thick walled sporangia in a vascular connective tissue along with a granulomatous inflammation confirming the diagnosis of cutaneous and nasopharyngeal rhinosporidiosis. Endoscopic removal of nasopharyngeal polyp was done and he was started on dapsone therapy.
Subject(s)
Aged , Humans , Male , Nasopharyngeal Diseases/diagnosis , Rhinosporidiosis/diagnosis , Skin Diseases, Parasitic/diagnosisABSTRACT
Four cases of sinonasal and nasopharyngeal adenoidcystic carcinoma that came to the RIMS Hospital, Imphal during the period of July, 2002 to March, 2003 are reported in this article. The age incidence ranged from 30 to 80 years and the mean age was 47.5 years; with male to female ratio of 1:1. The average duration from first sympton in the patient to the date of his medical consultation was 17.8 months. Nasal obstruction was the first symptom two cases; lump sensation in the throat and headache in the third and fourth cases respectively. Despite the evidence of rapid and extensive local spread there were definitely delays from the patients' end to consult a clinician. Whereas the tumour itself is not common, the usual sites, if it occurs, are palate and minor salivary glands and rarely mucous and seromucinous glands elsewhere.
Subject(s)
Adult , Aged , Aged, 80 and over , Carcinoma, Adenoid Cystic/diagnosis , Female , Humans , Male , Nasal Obstruction/etiology , Nasopharyngeal Diseases/diagnosis , Nose Neoplasms/complicationsABSTRACT
Com o advento da tomografia computadorizada, a avaliação dos locais de acometimento e extensão do nasoangiofibroma juvenil tornou-se mais precisa, o que facilitou o correto estadiamento pré-operatório. O objetivo deste trabalho é avaliar a concordância interobservadores, por meio da análise por tomografia computadorizada, de 15 casos de nasoangiofibroma juvenil em relação à extensão para locais relacionados com altos índices de recidivas. Todos os pacientes eram do sexo masculino, com idade média de 15,8 anos. A análise da concordância entre os observadores quanto à extensão e envolvimento da fossa infratemporal, seios esfenóide e cavernoso e fossa craniana média foi excelente, em relação à fissura orbitária superior foi boa e em relação à base do processo pterigóide e fossa craniana anterior foi ruim. Concluiu-se que a análise apresenta alta concordância entre os observadores para os locais estabelecidos, com exceção da base do processo pterigóide e da fossa craniana anterior
The advent of computed tomography permitted a much more precise evaluation of tumor localization, thus facilitating presurgical staging. The objective of this study was to evaluate the interobserver agreement on the analysis of computed tomography scans of 15 patients with juvenile nasopharyngeal angiofibroma, regarding assessment of tumor extension to sites of high recurrence rate. All patients were male and had a mean age of 15.8 years. The results of the interobserver agreement analysis regarding tumor invasion and extension to the infratemporal fossa, cavernous sinus, sphenoid sinus and medium cranial fossa were excellent. Identification of involvement of the superior orbital fissure was considered good. Interobserver agreement regarding tumor extension to the base of pterigoid process and anterior cranial fossa was considered poor. We concluded that there is a very good interobserver agreement on the evaluation of the established localization of tumor invasion, except when evaluating the base of the pterigoid process and the anterior cranial fossa.
Subject(s)
Humans , Male , Child , Adolescent , Adult , Nasopharyngeal Diseases/diagnosis , Image Interpretation, Computer-Assisted , Nasopharyngeal Neoplasms/diagnosis , Pterygopalatine Fossa , Retrospective Studies , Sensitivity and Specificity , Tomography, X-Ray ComputedABSTRACT
Nasopharyngeal tuberculosis used to be a common disease in the upper aerodigestive system. Before 1920, 1.4 and 6.5 per cent of all adenoids and tonsils removed from asymptomatic patients were infected by tuberculosis. After the introduction of antituberculous chemotherapy and BCG vaccination, this disease was considered uncommon and sporadic cases were reported in the medical literature. Recently, tuberculosis has begun to increase again due to the high global HIV-infected rate and antituberculous drug resistance among these people. To describe and highlight the clinical features of this condition, fifteen Thai patients (7 males and 8 females) from the Department of Otolaryngology, Siriraj Hospital, Bangkok, Thailand were reviewed. Cervical lymphadenopathy was the most common presenting symptom in our series (93.34%), 11 of them were classified as primary nasopharyngeal tuberculosis and most had abnormal nasopharyngeal findings by mirror examination except 2 cases. Although all had histopathological confirmation of nasopharyngeal tuberculosis, sometimes problems occur in the diagnosis between this disease and nasopharyngeal carcinoma, which are also common among Oriental people in many of their clinical similarities. Therefore routine nasopharyngeal biopsy is considered justified and diagnostic.
Subject(s)
Adolescent , Adult , Aged , Antitubercular Agents/therapeutic use , Biopsy, Needle , Child , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Male , Middle Aged , Nasopharyngeal Diseases/diagnosis , Nasopharyngeal Neoplasms/diagnosis , Prognosis , Thailand , Tuberculosis/diagnosisABSTRACT
Existe una gran inquietud mundial por inicar el informe de los hallazgos obtenidos con la endoscopía con fibra óptica y con la fluoroscopía en el esfínter velofaríngeo. La evolución debe ser realizada por un médico especialista (foniatría). Nasofaringoscopía: el equipo necesario es el nasofaringoscopio con frente de luz. La videograbación es deseable, pero no indispensable. El reporte debe ser discriptivo y llegar a conclusiones precisas sobre 1) fosa nasal: 2) meatro; 3) orificio de la salida de la trompa de eustaquio; 4) orofaringeo; 5) esfinter velofaríngeo (paredes faríngeas posterior y laterales y velo de paladar), 6)patrón de cierre (forma y cada estructura por separado, en reposo y fonación); 7) laringe. Flouroscopía; útil para valorar las parederes faríngeas laterales y el nivel de cierre del esfínter velofaríngeo. No se requiere en todos los casos, pero es completamente para la nasofaringoscopía. La videograbación no es indispensable. Siempre se deben realizar las incidencias frontal, lateral y basal
Subject(s)
Endoscopy , Nasopharyngeal Diseases/diagnosis , Optical Fibers/methods , Fluoroscopy , Esophagogastric Junction/physiopathologyABSTRACT
A case of primary tuberculosis of the nasopharynx with cranial nerve 6 and 3 involvement is reported. The disease according to available statistics is very rare. The response to antituberculous therapy was very satisfactory.
Subject(s)
Adult , Humans , Male , Nasopharyngeal Diseases/diagnosis , Tuberculosis/diagnosisABSTRACT
177 patients with nasopharyngeal masses were studied. The neoplastic lesions constituted about 48% of the nasopharyngeal masses. 39% were malignant and 8.5% were benign. Nasopharyngeal carcinoma was the commonest malignant tumour of the nasopharynx [55.0%] with a peak age incidence between 40-70 years, and a male to female ratio of 2:1. Malignant lymphoma was the second in order of frequency [34.8%], mainly of the non-Hodghin's variety [87.5%]. The mean age was 42.2 years and the male to female ratio was 1.62:1. The rest of the malignant lesions were diagnosed as rhabdomyosarcoma [4.4%], adenoid cystic carcinoma [2.9%] and fibrosarcoma [2.9%]. In this study, angiofibroma constituted 8.5% of nasopharyngeal masses with a mean age of 14.5 years and was only in males. Adenoids or lymphoid hyperplasia formed about 11.3% with a mean age of 19 years and male to female ratio of 1.2:1. The inflammatory lesions of the nasopharynx constituted about 36.15 of nasopharyngeal masses with a male to female ratio of 3:1. Scleroma of the nasopharynx made 23.9% of the inflammatory lesions. One patient was diagnosed as tuberculous nasopharyngitis, the rest of the inflammatory lesions [70.1%] were diagnosed histologically as chronic non-specific inflammation. The differentiation between benign and malignant nasopharyngeal masses depends upon histological examination and therefore accurate biopsy techniques are essential. Transnasal biopsies using topical anaesthesia invite inadequate sampling of tissue with resultant delay in diagnosis. Early recognition and treatment favorable influence survival. Complaints of pain, epistaxis, trismus or cervical mass are uncommon in patients with benign lesions and should alert the clinician to the probability of malignancy. Clinical symptoms suggestive of malignancy demand prompt and conclusive evaluation
Subject(s)
Nasopharyngeal Diseases/diagnosis , Nasopharynx , NeoplasmsABSTRACT
Agumas áreas de difícil acesso ao exame otorrinolaringológico habitual, como o rinofaringe säo atualmente visualizadas diretamente através de endoscopia com fibra óptica. Neste estudo em que foram examinadas 50 pacientes com suspeitas clínicas de lesöes no rinofaringe e que apresentavam a rinoscopia posterior (visualizaçäo indireta com espelho) normal ou de difícil realizaçäo, foram obtidos achados endoscópicos normais em 36% doa casos e alterados em 64%, evidenciando-se aqui a grande percentagem de positividade nos exames com visualizaçäo endoscópica. A rinofaringoscopia com fibra óptica deve ser utilizada de rotina para a exploraçäo do rinofaringe pela sua facilidade de manuseio, visualizaçäo detalhada das estruturas e pela possibilidade de colheita de material para uma exata definiçäo da lesäo
Subject(s)
Humans , Infant , Child , Adolescent , Adult , Aged , Male , Female , Nasopharyngeal Diseases/diagnosis , Endoscopy , Optical FibersABSTRACT
A cyst in the nasopharynx of a 51 year old male causing nasal obstruction, snoring and nasal discharge is reported. It was excised under general anaesthesia