phenylephrine-hydrochloride and Hypertrophy

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of neonate nasal obstruction. Because newborns are natural nasal breathers, urgent treatment may be needed. CNPAS is diagnosed by clinical symptoms and signs, and CT. In severe cases, surgical approach is needed. The most often used approach is widening of pyriform aperture via sublabial incision with nasal tubing. We report a novel surgical approach as a curative treatment for CNPAS by immediate transverse enlargement of the maxilla. We also review current literature of the condition focusing on surgical management of the disease.

Topics: Constriction, Pathologic; Humans; Hypertrophy; Infant, Newborn; Maxilla; Nasal Cavity; Nasal Obstruction; Nose

Rhinophyma is a benign disease involving the skin of the nose, which is characterized by skin thickening and hypertrophy of the sebaceous glands and connective tissue. It occurs predominantly by Caucasians in their fifth to seventh life decades and is 12-30 times more likely to affect males. The etiology and pathogenesis of Rhinophyma remains unclear, however it is generally stated to be the final stage of rosacea. A causative relationship between rhinophyma and alcohol consumption has not yet been proven. This review highlights the treatment options of rhinophyma. Surgery is gold standard for management of advanced rhinophyma. Each technique has pros and cons, but using surgical instruments with monopolar energy as loop and ball electrode seem to combine several goals best - first of all simultaneous removal and hemostasis followed by nasal contour refinement. Due to possible coincidence of skin cancer such as a basal- or squamous cell carcinoma, histopathological examination of all removed tissue is recommended.. Als Rhinophym wird eine benigne Hautveränderung der äußeren Nase bezeichnet, die durch eine Hypertrophie der Talgdrüsen gekennzeichnet ist. Betroffen sind meistens männliche Kaukasier zwischen der 5. und 7. Lebensdekade. Die Ätiologie der Erkrankung ist bisher nicht vollständig geklärt, sie wird jedoch als Spätstadium der Acne rosacea betrachtet. Ein äthyltoxischer Zusammenhang, wie bisher vermutet wurde, ist bis dato nicht belegt worden. Der Artikel gibt einen Überblick über mögliche operative und konservative Therapieansätze. Die chirurgische Therapie stellt dabei den Goldstandard dar. Dabei erweist sich der Einsatz der Elektroschlinge zur subtilen Resektion und die Verwendung der monopolaren Kugel zur Feinmodulation als besonders vorteilhaft. Aufgrund einer möglichen Koinzidenz des Basalzell- oder Plattenepithelkarzinoms im Rhinophymgewebe, erscheint eine histopathologische Aufarbeitung des abgetragenen Gewebes sinnvoll.

Topics: Humans; Hypertrophy; Male; Nose; Rhinophyma; Rosacea; Skin Neoplasms

Topics: Humans; Hypertrophy; Nasal Obstruction; Nose; Treatment Outcome

Mucociliary clearance (MCC), which exists in many systems, is the first defensive mechanism of the human body. Nasal MCC has an important role in transporting the secretions of the nasal cavity and paranasal sinuses along with the trapped inhaled pathogens to the nasopharynx. Physiologic or pathologic situations that effect nasal MCC, such as temperature, humidity, nasal obstruction, allergic rhinitis, chronic infections, etc., lead to impaired MCC and related local or circumjacent system disorders. With this perspective, when a unified airway with a multiple disease principle is considered, investigating the relationship between adenoid hypertrophy (AH), otitis media with effusion (OME) and nasal MCC is logical. In this review, histological and physiologic properties of nasal MCC and its possible role involving pathologic situations such as AH and OME is discussed together with recent literature findings.

Topics: Adenoids; Animals; Humans; Hypertrophy; Mucociliary Clearance; Nose; Otitis Media; Otitis Media with Effusion

Topics: Adenoids; Child; Endoscopy; Humans; Hypertrophy; Nose; Tomography, X-Ray Computed

Pediatric sleep-disordered breathing is a continuum, with primary snoring at one end, and complete upper airway obstruction, hypoxemia, and obstructive hypoventilation at the other. The latter gives rise to obstructive sleep apnea. An important predisposing factor in the development and progression of pediatric sleep-disordered breathing might be craniofacial disharmony. The purpose of this systematic review and meta-analysis was to elucidate the association between craniofacial disharmony and pediatric sleep-disordered breathing.. Citations to potentially relevant published trials were located by searching PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials. The MetaRegister of controlled trials database was also searched to identify potentially relevant unpublished trials. Additionally, hand-searching, Google Scholar searches, and contact with experts in the area were undertaken to identify potentially relevant published and unpublished studies. Inclusion criteria were (1) randomized controlled trials, case-control trials, or cohort studies with controls; (2) studies in nonsyndromic children 0 to 18 years of age with a diagnosis of sleep-disordered breathing or obstructive sleep apnea by either a sleep disorders unit, screening questionnaire, or polysomnography; and (3) principal outcome measures of craniofacial or upper airway dimensions or proportions with various modalities of imaging for the craniofacial and neck regions. The quality of the studies selected was evaluated by assessing their methodologies. Treatment effects were combined by meta-analysis with the random-effects method.. Children with obstructive sleep apnea and primary snoring show increased weighted mean differences in the ANB angle of 1.64° (P <0.0001) and 1.54° (P <0.00001), respectively, compared with the controls. An increased ANB angle was primarily due to a decreased SNB angle in children with primary snoring by 1.4° (P = 0.02). Children with obstructive sleep apnea had a distance from the posterior nasal spine to the nearest adenoid tissue measured along the PNS-basion line reduced by 4.17 mm (weighted mean difference) (P <0.00001) and a distance from the posterior nasal spine to the nearest adenoid tissue measured along the line perpendicular to the sella-basion line reduced by 3.12 mm (weighted mean difference) (P <0.0001) compared with the controls.. There is statistical support for an association between craniofacial disharmony and pediatric sleep-disordered breathing. However, an increased ANB angle of less than 2° in children with obstructive sleep apnea and primary snoring, compared with the controls, could be regarded as having marginal clinical significance. Therefore, evidence for a direct causal relationship between craniofacial structure and pediatric sleep-disordered breathing is unsupported by this meta-analysis. There is strong support for reduced upper airway width in children with obstructive sleep apnea. Larger well-controlled trials are required to address the relationship of craniofacial and upper airway morphology to pediatric sleep-disordered breathing in all 3 dimensions.

Topics: Adenoids; Adolescent; Cephalometry; Child; Child, Preschool; Humans; Hypertrophy; Infant; Larynx; Likelihood Functions; Nose; Pharynx; Sleep Apnea Syndromes; Sleep Apnea, Obstructive

In the clinic, approximately 30% of children with adenoid hypertrophy (AH) concomitant with allergic rhinitis (AR) report poor responses to intranasal steroids. To determine whether the combination of mometasone furoate (MF) and oxymetazoline (OXY) is more effective than either agent alone, we performed a two-stage, parallel, randomized, double-blind, double-dummy, clinical trial with 240 AH children with concomitant perennial AR. During the first stage, all children were randomly assigned to the MF or control group for six weeks of treatment. During the second stage, the non-responders from stage one were randomly assigned to 4 groups for 8 weeks of treatment that involved receiving the following treatments: MF/OXY, MF/placebo, placebo/OXY, or placebo/placebo. During the first stage of treatment, 39% of the responders treated with MF achieved greater reductions in total and individual symptom scores than did those on placebo. During the second stage of treatment, the nasal congestion scores of the MF/OXY group significantly decreased. The adenoid/choana ratio of the MF/OXY-treated group decreased and the nasal volume increased significantly. Our results suggest that the combination of OXY and MF is effective and safe for the treatment of AH children with concomitant AR and has a rapid onset of action.

Topics: Adenoids; Case-Control Studies; Child; Demography; Female; Humans; Hypertrophy; Male; Mometasone Furoate; Nose; Oxymetazoline; Patient Compliance; Rhinitis, Allergic, Perennial

To determine the effect of topical intranasal oxymetazoline on nasal resistance and aerobic exercise performance in patients with nasal congestion caused by inferior turbinate hypertrophy.. Individual randomized controlled trial.. Eight patients with inferior turbinate hypertrophy performed a set of exercise tests to exhaustion 1 week apart. They were given oxymetazoline or a placebo before each of the two test sessions according to a random pattern. Changes in nasal airflow were measured as peak nasal flow and ventilatory efficiency parameters, ventilatory equivalents, end-expiratory pressure, oxygen consumption, cardiac efficiency, rate of perceived exertion, and maximal and submaximal mechanical power.. Ten minutes after use of the drug or placebo, improvements in maximum nasal airflow were seen in the oxymetazoline group (P < 0.05). However, exercise tests showed improvements in both groups (P < 0.05). After exertion, there was no difference between the two groups in maximum nasal airflow (P > 0.05). There were no differences between groups in oxygen consumption, rate of perceived exertion, respiratory exchange ratio, ventilation, or ventilatory equivalents for oxygen.. Oxymetazoline increased nasal airflow in patients with turbinate hypertrophy, but this change did not translate into gains in physical exercise parameters or perceived exertion.. 1b.

Topics: Administration, Intranasal; Cross-Over Studies; Double-Blind Method; Exercise; Female; Humans; Hypertrophy; Male; Nasal Decongestants; Nose; Oxymetazoline; Respiration; Turbinates; Young Adult

To demonstrate the technique and efficacy of powered assisted adenoidectomy using nasal endoscopy.. Between 2002 and 2003, forty children (age ranged from 3 to 17 years) with symptoms and signs suggestive of snoring and/or obstructive sleep apnea and choanal adenoids were randomly selected and distributed in two groups. Group A underwent transnasal endoscopic powered adenoidectomy (TEPA) and group B underwent curettage adenoidectomy (CA). Both groups underwent pre- and postoperative nasal endoscopy. Direct comparisons between the two groups were made with regards to operative time, amount of blood loss, postoperative morbidity, complications, and resolution of symptoms.. Male to female distribution was equal 1:1. The mean age of both groups was 8 years. In group A, the mean blood loss was 8.2 ml compared to 22.1 ml in group B (p<0.05). The operative time in group A was 6.1 min vs 12.3 min in group B (p<0.05). There were no operative or postoperative complications in both groups. Postoperative follow up and nasal endoscopy showed no recurrence of symptoms or adenoid remnants.. Using TEPA for removing choanal adenoids is an adequate and safe method. The TEPA technique can be added to the armamentarium of techniques used by pediatric otolaryngologists.

Topics: Adenoidectomy; Adenoids; Adolescent; Child; Child, Preschool; Choanal Atresia; Endoscopy; Female; Follow-Up Studies; Humans; Hypertrophy; Length of Stay; Male; Minimally Invasive Surgical Procedures; Nose; Pain, Postoperative; Postoperative Care; Preoperative Care; Prospective Studies; Risk Assessment; Treatment Outcome

Temperature-controlled and temperature-monitored radiofrequency tissue volume reduction (RFTVR) for the turbinate is a new treatment modality for nasal obstruction secondary to turbinate hypertrophy. We compared the nasal functions after the treatment ofRFTVR and laser vaporizing turbinoplasty (LVT) using subjective symptom scores and objective tests.. Prospective, randomized clinical trial.. Twenty-four patients with nasal obstruction secondary to inferior turbinate hypertrophy were prospectively evaluated from March 1999 to October 1999 at Seoul National University Hospital (Seoul, Korea). Sixteen patients were treated with RFTVR, and eight patients with LVT. The preoperative and postoperative nasal functions were investigated by visual analogue scale of symptoms, butanol threshold test, saccharine test, acoustic rhinometry, rhinomanometry, and ciliary beat frequency.. At 8 weeks postoperatively, the severity and the frequency of nasal obstruction improved subjectively in 81.3% and 93.8% of RFTVR group and in 87.5% and 87.5% of LVT group, respectively. Significant improvement of nasal symptoms began from 2 to 3 days after the operation in the RFTVR group, whereas there was significant improvement of nasal symptoms at 8 weeks after operation in the LVT group. However, objective nasal functions including nasal volume and total nasal resistance were significantly improved at 8 weeks after surgery in both groups. Among patients reporting symptoms of hyposmia, 55.6% of RFTVR group and 63.6% of LVT group showed improved olfaction. Saccharin transit time and ciliary beat frequency were preserved after RFTVR CONCLUSION: RFTVR for the turbinate may be useful as an alternative approach for the treatment of chronic turbinate hypertrophy.

Topics: Acoustics; Adult; Airway Resistance; Butanols; Catheter Ablation; Cilia; Female; Follow-Up Studies; Humans; Hypertrophy; Laser Therapy; Male; Manometry; Mucociliary Clearance; Nasal Cavity; Nasal Mucosa; Nasal Obstruction; Nose; Odorants; Olfaction Disorders; Patient Satisfaction; Prospective Studies; Reoperation; Saccharin; Sensory Thresholds; Smell; Statistics, Nonparametric; Temperature; Turbinates

We prospectively and randomly compared triangular and rotation-advancement unilateral cleft lip repairs in 35 patients. The most significant difference between the two repairs noted in this series was a greater frequency of hypertrophic scars following rotation-advancement repairs. The overall appearance of the lip and nose postoperatively was the same in both groups.

Topics: Child; Cicatrix; Cleft Lip; Female; Humans; Hypertrophy; Lip; Male; Methods; Nose; Prospective Studies; Random Allocation; Surgical Flaps

This study proposed an automatic diagnosis method based on deep learning for adenoid hypertrophy detection on cone-beam computed tomography.. The hierarchical masks self-attention U-net (HMSAU-Net) for segmentation of the upper airway and the 3-dimensional (3D)-ResNet for diagnosing adenoid hypertrophy were constructed on the basis of 87 cone-beam computed tomography samples. A self-attention encoder module was added to the SAU-Net to optimize upper airway segmentation precision. The hierarchical masks were introduced to ensure that the HMSAU-Net captured sufficient local semantic information.. We used Dice to evaluate the performance of HMSAU-Net and used diagnostic method indicators to test the performance of 3D-ResNet. The average Dice value of our proposed model was 0.960, which was superior to the 3DU-Net and SAU-Net models. In the diagnostic models, 3D-ResNet10 had an excellent ability to diagnose adenoid hypertrophy automatically with a mean accuracy of 0.912, a mean sensitivity of 0.976, a mean specificity of 0.867, a mean positive predictive value of 0.837, a mean negative predictive value of 0.981, and a F1 score of 0.901.. The value of this diagnostic system lies in that it provides a new method for the rapid and accurate early clinical diagnosis of adenoid hypertrophy in children, allows us to look at the upper airway obstruction in three-dimensional space and relieves the work pressure of imaging doctors.

Topics: Adenoids; Child; Cone-Beam Computed Tomography; Deep Learning; Humans; Hypertrophy; Image Processing, Computer-Assisted; Nose

To improve the diagnostic accuracy of adenoid hypertrophy (AH) in children and prevent further complications in time, it is important to study and quantify the effects of different degrees of AH on pediatric upper airway (UA) aerodynamics. In this study, based on computed tomography (CT) scans of a child with AH, UA models with different degrees of obstruction (adenoidal-nasopharyngeal (AN) ratio of 0.9, 0.8, 0.7, and 0.6) and no obstruction (AN ratio of 0.5) were constructed through virtual surgery to quantitatively analyze the aerodynamic characteristics of UA with different degrees of obstruction in terms of the peak velocity, pressure drop (△P), and maximum wall shear stress (WSS). We found that two obvious whirlpools are formed in the anterior upper part of the pediatric nasal cavity and in the oropharynx, which is caused by the sudden increase in the nasal cross-section area, resulting in local flow separation and counterflow. In addition, when the AN ratio was ≥ 0.7, the airflow velocity peaked at the protruding area in the nasopharynx, with an increase 1.1-2.7 times greater than that in the nasal valve area; the △P in the nasopharynx was significantly increased, with an increase 1.1-6.8 times greater than that in the nasal cavity; and the maximum WSS of the posterior wall of the nasopharynx was 1.1-4.4 times larger than that of the nasal cavity. The results showed that the size of the adenoid plays an important role in the patency of the pediatric UA.

Topics: Adenoids; Child; Humans; Hydrodynamics; Hypertrophy; Nasopharynx; Nose

Narrow maxilla occurring due to various congenital or acquired causes creates major orthodontic problems and complicates prosthetic dental rehabilitation. The etiologic factors are mostly related to upper airway pathologies that restrict breathing and cause negative pressure at the base of the nose and nasopharynx. The upper and lower airway is a whole unit. Regional anomalies or acquired problems affect the entire system. This can lead to developmental issues and permanent disorders in childhood, which will last their real life. This study was planned to investigate the incidence of nasopharyngeal obstruction originating from allergic rhinitis, turbinate hypertrophy, septum deviation, and adenoid vegetation in children scheduled for orthodontic treatment due to maxillary stenosis.. Our study group consists of one hundred children aged 12-16 years who applied to the orthodontist due to dental malalignment and were found to have a narrowing of the maxilla. After the orthodontic evaluation, the patients were referred for an ENT examination to evaluate the etiological factors originating from the upper respiratory tract. In the study group, nasal congestion and allergic rhinitis were first investigated. All symptoms were evaluated and scored. Then, an ENT physical examination was performed in all cases, and nasal cavities, nasopharynx, and oropharynx were assessed with a fiberoptic endoscope. Regarding etiological factors, allergic rhinitis, turbinate hypertrophy, nasal septum deviation, and adenoid vegetation that would prevent breathing were carefully investigated.. Firstly, deep palate, narrowed maxillary arch, V-shaped arch, adenoid face type, bilateral posterior crossbite, insufficient lip presence, maxillary incisor protrusion (upper forward thrust), skeletal class 2 division 1 malocclusion, and increased lower face height detected in patients primarily diagnoses were grouped according to their pathologies. Allergic rhinitis was found in 43 cases, turbinate hypertrophy in 30 instances, nasal septum deviation in 18 cases, and adenoid vegetation that prevented respiration in 61 patients.. It is known that increased nasal airway resistance due to allergic rhinitis, septal deviation, turbinate hypertrophy, or adenoid vegetation in the upper respiratory tract may lead to permanent orthodontic disorders in children and adolescents. A multidisciplinary approach, early diagnosis, and treatment should be the first step to prevent this situation. Secondly, it should be planned to correct the anatomical disorders that have occurred with appliances and, if necessary, surgical approaches. Taking precautions before permanent problems arise in childhood is also crucial in prosthetic dentistry.

Topics: Adolescent; Child; Humans; Hypertrophy; Maxilla; Nasopharynx; Nose; Rhinitis, Allergic

Medial crural (MC) overlay is reliable method used in tip deprojection. Most cases with lower lateral cartilage (LLC) hypertrophy present by variations of MC and dome shapes needing specific technical maneuvers.. Thirteen hundred fourteen primary rhinoplasties were performed between 2018 and 2021. Patients with LLC hypertrophy who underwent MC deprojection were analyzed. Three variations in LLC hypertrophy were recognized. In type I, tip-defining points (TDP) were localized at the median plane with no angulation deformities at the LLC, which was managed by horizontal cuts of the lobular segments 4 to 6 mm below the domes. The cut fragments overlapped for 2 to 5 mm. In type II, TDP was lateralized due to widened divergence angles at the columellalobular junctions, which were managed by horizontal cuts over columellalobular junctions. The cut fragments overlapped 4 to 6 mm. In type III, TDP was localized at the median plane, there were dense angulations at the medial genu, which was managed with symmetrical removal of 4 to 5 mm cartilage from lobular segments. The domes were sutured over the medial segments.. Nineteen patients with LLC hypertrophy were included in the study among 314 patients. Twelve patients were female and 7 patients were male. The mean age was 32 years (25-42). Type I, II, and III LLC hypertrophies were detected in 10, 3, and 6 patients, respectively. A harmonious relationship between dorsum and tip and satisfactory tip stability was reached in all patients.. By classification of variations of MC and domal shapes, LLC hypertrophies may be managed with proper technical maneuvers specific to each type.

Topics: Adult; Back; Cartilage; DNA-Binding Proteins; Female; Humans; Hypertrophy; Male; Nasal Cartilages; Nose; Rhinoplasty

Revealing the structural morphology and inner flow field of the upper airway is important for understanding obstructive sleep apnea-hypopnea syndrome (OSAHS) incidence phenomena and pathological diagnosis in children. However, prior work on this topic has been focused on adults and the findings cannot be directly extrapolated to children because of different inducing factors. Therefore, this paper employs a simulation method to investigate upper airway flow characteristics of childhood OSAHS. It is found that the Reynold number changes highly throughout the whole upper airway, and the laminar assumption is no longer suitable for low Reynold number flow, which is much unlike classic fluid mechanics. Turbulent models of Standard k-ω and Spalart-Allmaras were developed prior to suggestion. The simulation is validated by experiments with an error of approximately 20%. Additionally, carried out in this analysis is the influence of adenoidal hypertrophy with different narrow levels. The cross-sectional area, flow velocity, pressure drop and volume rate will change greatly when the narrow level is above 64% of the upper airway, which can be a quantitative explanation for medical intervention if adenoid hypertrophy blocks 2/3 of the upper airway in the common clinical judgment of otorhinolaryngology. It is expected that this paper can be a meaningful instruction on OSAHS surgery plan making as well as recovery evaluation postoperatively.

Topics: Adenoids; Adult; Child; Computer Simulation; Humans; Hypertrophy; Nose; Sleep Apnea, Obstructive; Syndrome

Although cases of empty nose syndrome (ENS) are not very common, the suffering that ENS causes patient is immense and could be very difficult to imagine. Nasal nitric oxide (nNO) is an airway disease biomarker, and its levels increase after endoscopic sinus surgery. The trend of nNO levels in ENS before and after surgical treatment remains unknown. This study aimed to evaluate the role of nNO in ENS.. Patients with ENS who received surgical implantation and with chronic hypertrophic rhinitis (CHR) who underwent turbinoplasty and completed at least 1 year of follow-up were prospectively enrolled. nNO measurements and subjective assessments [SinoNasal Outcome Test (SNOT)-22, Beck Depression Inventory (BDI)-II, and Beck Anxiety Inventory (BAI)] were performed preoperatively and at 3, 6, and 12 months postoperatively.. We enrolled 19 ENS and 12 CHR patients. nNO levels were significantly lower in the ENS than in the CHR patients before surgical treatment (p < 0.001). nNO levels in the ENS patients significantly increased 3 months after implantation and remained plateaued (p = 0.015). BDI-II and BAI scores significantly improved after surgical treatment for the ENS patients but not for the CHR patients; changes in nNO levels correlated well with improvements in BDI-II and BAI scores (p = 0.025 and 0.035, respectively).. nNO significantly increased at third month after surgical treatment and remained plateaued in ENS patients. This increase correlated with improvements in BDI-II and BAI scores. Therefore, nNO may be important in assessing the psychiatric status of empty nose syndrome.

Topics: Adult; Aged; Chronic Disease; Female; Humans; Hypertrophy; Male; Middle Aged; Nitric Oxide; Nose; Nose Diseases; Rhinitis; Syndrome; Young Adult

Valutazione dei sintomi nasali mediante SNOT-22 nei pazienti sottoposti a settoplastica.. Obiettivo del nostro studio è valutare i sintomi nasali dei pazienti con indicazione a settoplastica mediante il questionario SNOT-22 ed investigare gli effetti di alcune variabili, quali la chirurgia della conca, l’età, l’apnea ostruttiva del sonno (OSA), il fumo e l’asma, su questi sintomi. Un totale di 100 pazienti è stato incluso nello studio. Ai pazienti è stato sottoposto il questionario SNOT-22 (Sinus Nasal Conduct Test) preoperatoriamente e post-operatoriamente a distanza di 3 mesi. Gli interventi di settoplastica sono stati eseguiti in due centri e da due otorinolarinoiatri. I pazienti sono stati divisi in 2 gruppi a seconda della procedura chirurgica sul turbinato inferiore: shaving o outfracture. La differenza nel punteggio totale tra preoperatorio e post-operatorio è risultata signiticativa in entrambi i gruppi, con un valore di 17,85 (46%). Si è osservato un miglioramento dei sintomi da ostruzione nasale con valore medio di 0,81 punti (2,79 punti). Nel nostro studio non è stata riscontrata differenza significativa nei punteggi riguardanti i sintomi preoperatori e postoperatori dei pazienti sottoposti a resezione sottomucosa con outfracture (p = 0,861). Non abbiamo evidenziato differenza significativa tra i punteggi totali preoperatori e postoperatori per quanto riguarda asma, fumo, OSA e non-asmatici (p > 0,05). Non abbiamo evidenziato correlazione tra i punteggi e l’età in entrambi i gruppi (p > 0,05). Prima della settoplastica il sintomo principale era l’ostruzione nasale. L’intervento sul turbinato inferiore durante la chirurgia aumenta i benefici della settoplastica indipendentemente dalla tecnica chirurgica. Fattori quali asma, OSA, fumo sono significativamente correlati ai sintomi. Nei pazienti con asma e OSA, i punteggi sono risultati superiore sia prima sia dopo l’intervento.. The aim of our study is to evaluate the nasal symptoms of patients with indications for septoplasty using the SNOT-22 questionnaire and to investigate the effects of variables such as concha surgery, age, obstructive sleep apnoea (OSA), smoking and asthma on these symptoms. A total of 100 patients were included in the study. Pre-operative and at postoperative month 3, patients were administered the Sinus Nasal Conduct Test (SNOT-22). Septoplasty operations were performed by two centres and two otolaryngologists and head and neck surgeons. The patients were divided into two groups according to the surgical procedure of the lower concha, concha shaver group and concha out fractures. The difference in total score between preop and postop was significant in both the shaver and outfracture groups with a difference in total score of 17.85 (46%). Improvement in symptoms of nasal obstruction was observed with a mean improvement of 0.81 points (2.79 points). In our study, there was no significant difference in preop and postop symptom scores in patients who had subcuneal shaved submucous resection with outfracture (p = 0.861). There was no significant difference between preop and postop total scores between asthma, smoking, OSA and non-asthmatics (p > 0.05). There was no correlation between scores and age in either group (p > 0.05). Before septoplasty, the most important symptom was nasal obstruction. Intervention at the inferior turbinate during surgery increases the benefits of septoplasty independently of the surgical technique. Factors such as asthma, OSA, smoking are significantly relevant to symptoms. In those with asthma and OSA, the scores were found to be high both before and after intervention.

Topics: Adult; Endoscopy; Female; Humans; Hypertrophy; Male; Middle Aged; Nasal Obstruction; Nasal Septum; Nose; Postoperative Period; Quality of Life; Rhinoplasty; Surveys and Questionnaires; Tampons, Surgical; Treatment Outcome; Young Adult

We report a patient with hypertrophic pachymeningitis and symptomatic stenosis of the superior sagittal sinus. A 71-year-old man presented with right hemiparesis, sensory-dominant aphasia, and right hemispatial neglect that had been worsening over 2 weeks. Computed tomography showed isodense crescent-shaped lesions deforming the surface of the left cerebral hemisphere, mimicking a subdural hematoma with atypical perifocal edema in the left parietal lobe. Magnetic resonance imaging showed diffuse thickening of the dura mater with contrast enhancement of his left cerebral hemisphere. Histopathological examination of the dural specimen obtained by burr-hole surgery revealed mononuclear inflammatory cell infiltration, and he was diagnosed with hypertrophic pachymeningitis. Dynamic cerebral angiography showed superior sagittal sinus stenosis with reduced venous flow through the left parietal lobe. Administration of high-dose steroid therapy led to neurological improvement. In the case of a subdural mass with atypical parenchymal edema such as a chronic subdural hematoma, other etiology should be taken into consideration.

Topics: Aged; Humans; Hyperemia; Hypertrophy; Magnetic Resonance Imaging; Male; Meningitis; Multimodal Imaging; Nose; Tomography, X-Ray Computed

To establish how assessment of adenoid size is correlated between drug-induced sleep endoscopy (DISE) with indirect mirror nasopharyngoscopy (IMN).. Retrospective chart review.. Tertiary care academic hospital.. Over a 6-year period, 154 pediatric patients underwent DISE for obstructive sleep apnea and had IMN. DISE videos were assessed by one reviewer, blinded to results of mirror exams. IMN findings were taken from operative notes recorded by one attending physician. Demographic data, co-morbidities, and sleep study results were also recorded.. Ninety-three (58.5%) males and 66 (41.5%) females were included. Mean age at DISE was 7.34 ± 3.99 years, with an average of 29 days after DISE until nasopharyngeal mirror examination. The mean initial adenoid size based on DISE assessment was 2.62 + 0.99, and on nasopharyngeal mirror assessment was 2.56 + 0.97. DISE and IMN assessment of adenoid size correlated well (Spearman's Rho = 0.82, P < 0.00001; Kendal tau = 0.764, P < 0.00001).. DISE has proven to be an excellent tool to assess adenoid size prior to adenoidectomy in children with OSA.

Topics: Adenoidectomy; Adenoids; Adolescent; Child; Child, Preschool; Comorbidity; Diagnostic Techniques, Respiratory System; Endoscopy; Female; Humans; Hypertrophy; Hypnotics and Sedatives; Infant; Male; Nasopharynx; Nose; Organ Size; Pharynx; Physical Examination; Propofol; Retrospective Studies; Sleep; Sleep Apnea, Obstructive

In patients with primary ciliary dyskinesia (PCD), the release of nitric oxide (NO) is extremely low by epithelia of the nasopharynx and sinuses. Measurement of nasal NO (nNO) is recommended as a screening test for PCD. The study aimed to evaluate if adenoids affects nNO and may deteriorate the performance of the test.. In 48 nonallergic patients between 5 and 18 years of age with chronic symptoms of nasal obstruction and indications for adenoidectomy, the measurements of nNO by chemiluminescence analyser and nasal patency by active anterior rhinomanometry were performed both before and after adenoidectomy. Adenoidal tissue size was graded during surgery under general anaesthesia using transoral endoscopy.. Patients were stratified into groups with adenoids grades 1, 2 and 3 (<1/3, 1/3-2/3 and > 2/3 of the choana and post-nasal space covered by adenoids). Before adenoidectomy, the median of nNO decreased with the increasing grade of adenoids (920, 663, and 491 ppb, P < 0.05). The rhinomanometry results were comparable and showed no correlation with nNO. Seven patients (14.6%) were incorrectly classified to have PCD based on a subthreshold value of the volume flow of nNO (FnNO < 77 nL/min). Following adenoidectomy, nNO of the grade 3 patients increased by 107 ppb (P < 0.05) and no differences were found between groups (P = 0.40). All patients had the postadenoidectomy FnNO >77 nL/min.. nNO and FnNO are reduced in nonallergic children with obstructive adenoids. Adenoid hypertrophy can potentially cause a false positive result of the test for PCD.

Topics: Adenoidectomy; Adenoids; Adolescent; Breath Tests; Child; Child, Preschool; Ciliary Motility Disorders; Female; Humans; Hypertrophy; Male; Mass Screening; Nasal Obstruction; Nitric Oxide; Nose; Rhinomanometry

The aim of this study was to evaluate the diagnostic correlation and reliability of Dolphin Imaging fully automated segmentation (Dolphin Imaging and Management Solutions, Chatsworth, Calif) for assessing adenoid hypertrophy. This was investigated through 3 modes: (1) intraobserver and interobserver agreement of repeated airway auto-segmentation procedures, (2) correlation between auto-segmentation measures of volume and minimal cross-sectional airway against nasopharyngoscopy, and (3) optimum diagnostic cutoff thresholds for volume and minimal cross-sectional airway identified and tested with sensitivity and specificity analyses.. Cone-beam computed tomography scans of 38 patients with suspected upper airway obstruction were analyzed. Two calibrated evaluators applied a previously validated method to quantify nasopharyngeal minimal cross-sectional airway and volume using Dolphin Imaging. Assessments were compared against grades of obstruction provided by otolaryngologists' diagnoses.. The reliability between the 2 assessments by the same evaluator on the Dolphin automatic segmentation function for volume (ICC, 0.97; 95% CI, 0.95, 0.98) and minimal cross-sectional airway (ICC, 0.84; 95% CI, 0.69, 0.91) was excellent. The interoperator reliability for volume was also excellent (ICC, 0.97; 95% CI, 0.95, 0.98), but only good (ICC, 0.701; 95% CI, 0.44, 0.85) for minimal cross-sectional airway. In contrast, the Spearman rank correlation test demonstrated weak associations between the values of the automatic measurements for both volume (4.9%; ρ = -0.22) and minimal cross-sectional airway (3.7%; ρ = 0.19). Assessments of accuracy via Receiver Operating characteristic analysis, sensitivity, specificity, negative predictive values, positive predictive values, and likelihood ratios demonstrated the poor clinical applicability of volume and minimal cross-sectional airway numbers provided by Dolphin Imaging.. The evaluators were reliable at manipulating the selected software, achieving consistent volume and minimal cross-sectional airway measurements, However, Dolphin Imaging volumetric and minimal cross-sectional airway measurements did not correlate well with the nasopharyngoscopy-supported reference standard for adenoid hypertrophy assessment. Under these study conditions, volume and minimal cross-sectional airway used to assess localized adenoid hypertrophy with cone-beam computed tomography imaging based on automated measurements may not yield high-quality clinically relevant information about upper airway constriction related to adenoid hypertrophy.

Topics: Adenoids; Adolescent; Child; Cone-Beam Computed Tomography; Endoscopy; Female; Humans; Hypertrophy; Male; Nose; Pharynx; Reproducibility of Results; Software

Patients with unilateral complete cleft lip and palate (UCLP) have a characteristic bilateral septal deformity, and septal deviation can be associated with turbinate hyperplasia, leading to paradoxical nasal obstruction. The purpose of the present study was to measure and compare the bony and mucosal dimensions of the inferior turbinate on the cleft and non-cleft sides in patients with UCLP.. We implemented a retrospective cohort study of patients with UCLP who had undergone computed tomography (CT) scan between 2002 to 2013. Subjects who had undergone nasal revision, septoplasty, turbinectomy, or Le Fort I osteotomy before the imaging date were excluded. The primary predictor variable was the subject side (cleft vs noncleft side), and the primary outcome variable was the turbinate cross-sectional area. The secondary predictor variables included the site of measurement along the sagittal axis of the turbinate (anterior, middle, posterior) and tissue type (turbinate whole, bone, mucosa). The Wilcoxon signed rank test for paired samples compared the turbinate dimensions on the cleft and noncleft sides, with statistical significance set at P ≤ .05.. The sample included 53 patients (32 females and 21 males). The inferior turbinates were measured bilaterally on CT images obtained at a mean age of 12.2 ± 0.8 years. The inferior turbinate on the noncleft side was significantly larger in both bone and mucosa (P = .003). This relationship did not change when controlling for age and gender.. The results of the present study have confirmed bony and mucosal enlargement of the inferior turbinate on the noncleft side in patients with UCLP. This might contribute to bilateral nasal obstruction and should be considered during treatment planning for nasopharyngeal and orthognathic surgery.

Topics: Adolescent; Anatomy, Cross-Sectional; Cephalometry; Child; Cleft Lip; Cleft Palate; Cohort Studies; Female; Follow-Up Studies; Humans; Hyperplasia; Hypertrophy; Male; Nasal Bone; Nasal Mucosa; Nasal Septum; Nose; Retrospective Studies; Tomography, X-Ray Computed; Turbinates

Topics: Esthetics; Humans; Hypertrophy; Male; Middle Aged; Nose; Rhinoplasty; Wound Healing

The purposes of this study were to investigate the dental arch changes after adenotonsillectomies in prepubertal children and to compare the dental arch dimensions of mouth-breathing and nasal-breathing children.. The sample included 49 prepubertal severely obstructed mouth-breathing children and 46 prepubertal nasal-breathing children. Twenty-four of the 49 mouth-breathing children had an adenotonsillectomy and composed the adenotonsillectomy subgroup. The 25 children in whom the mouth-breathing pattern was unchanged during the 1-year study period composed the control subgroup.. The mouth-breathing children showed a deeper palatal vault, a larger mandibular width, and a larger mandibular arch length in comparison with the nasal-breathing children. After airway clearance, the adenotonsillectomy group showed a significant maxillary transverse width gain compared with the control subgroup. The control subgroup showed a significant deepening of the palatal height when compared with the adenotonsillectomy subgroup after 1 year.. The adenotonsillectomy subgroup had a significantly different pattern of arch development compared with the untreated controls. After adenotonsillectomy, the mouth-breathing children showed greater maxillary transverse development than did the controls. The palatal vault deepened in the untreated children. The mouth-breathing children showed a deeper palatal vault, a larger mandibular width, and a larger mandibular arch length in comparison with the nasal-breathing children.

Topics: Adenoidectomy; Airway Obstruction; Case-Control Studies; Cephalometry; Child; Child, Preschool; Cohort Studies; Cuspid; Dental Arch; Female; Follow-Up Studies; Humans; Hypertrophy; Male; Malocclusion, Angle Class II; Mandible; Maxilla; Molar; Mouth Breathing; Nasopharyngeal Diseases; Nose; Open Bite; Palate; Palatine Tonsil; Puberty; Respiration; Tonsillectomy

Simple snoring represents a social problem, not only because it could affect the patient's married life, but it often goes along with sleep-disordered breathing. Chronic nasal obstruction has many sequel including snoring and the inferior turbinate hypertrophy (ITH) is its most common cause. The aim of the study is to evaluate the efficacy of video-assisted endoscopic radiofrequency volumetric tissue reduction (RFVTR) to reduce snoring in patients affected by chronic nasal obstruction due to ITH.. This prospective study was conducted over 48 habitual snoring with persistent nasal obstruction due to bilateral ITH refractory to medical management received one time RFVTR of both it. Nasal symptoms were assessed both subjectively, by Visual Analog Scale (VAS) and NOSE Scale, and objectively by videorhinohygrometer. Snoring was measured by Snoring severity rated by the bed partner, in a longitudinal fashion, using VAS. All patients were evaluated pre-operatively, and after 45th day (range 35-50 days) post-operatively.. Thirty-two subjects completed study. All patients had significant symptomatic improvement in nasal breathing (5.53 ± 2.88 vs 1.87 ± 1.75; p < 0.05), confirmed by videorhinohygrometer values (p < 0.05). We had a significantly improvement of snoring in all patients (5.62 ± 2.80 vs 1.86 ± 1.43, p < 0.001) with a mean snoring Visual Analog Scale improvement of 77.4%.. Based on this study and literature review, it seems that RFVTR represents a safe, minimal invasive, easy performed, and time and cost effective surgery, which may decrease symptoms of snoring in patients with ITH, at least, in short-term follow-up.

Topics: Adult; Endoscopy; Female; Humans; Hypertrophy; Male; Middle Aged; Nasal Obstruction; Nose; Prospective Studies; Snoring; Turbinates; Young Adult

To classify the nasal tip hypertrophy according to the anatomic characters, so as to select the proper treatment methods.. From Jan. 2010 to Mar. 2012, 92 cases (aged 21-46 years,average 29 years old) with nasal tip hypertrophy were classified as soft tissue hypertrophy, the alar cartilage hypertrophy, separation of alar cartilage, secondary tip hypertrophy after operation, and compound hypertrophy. Treatment methods were selected according to the hypertrophy type, including soft tissue thinning hy medicine or operation, alar cartilage trimming and remodeling, autogenous ear and nasal septal cartilage grafts for elongation or remodeling of nasal tip or columella.. The follow-up period was 3 months to one year. The nasal tip hypertrophy was corrected obviously with a natural and harmonious appearance. The results were evaluated hy patients as perfect in 59 cases, good in 26 cases and medium in 7 cases.. Satisfactory results can he achieved for the nasal tip hypertrophy with appropriate methods according to the anatomic classification.

Topics: Adult; Female; Humans; Hypertrophy; Middle Aged; Nasal Cartilages; Nasal Septum; Nose; Rhinoplasty; Young Adult

To evaluate the intranasal complications in patients submitted to maxillary Le Fort osteotomy within the orthognathic evaluation through flexible fibroscope, method which is safety, reliable and minimally invasive.. A prospective, systematic non-randomized study is presented with a series of 47 patients who underwent a Le Fort I maxillary osteotomy due to dentofacial deformity between January 2008 and December 2008. The patients who were included underwent an evaluation of nasal respiratory function using a questionnaire designed for this objective, after which a fibroscopic examination was carried out.. With regards to the results of the NOSE questionnaire, 4/47 patients had Grade 2 nasal obstruction before the surgery. After the intervention, three improved to a 0-1 grade. 3/47 patients reported snoring during sleep without OSAS that was not modified as a result of the surgery. 2/47 patients presented with sequelae regarding the deviation of the septum, and 1/47 had a luxation of the anterior nasal spine that had not been recorded before the orthognathic surgery. The presence of synechiae was observed in 3/47 cases. A septal perforated mucosa was found in the IV area of the nasal septum. Hypertrophy of the lower turbinate was observed in 4/47 cases.. The fibroscope procedure is minimally invasive and it does not require local anesthesia or sedation, and it allows the surgeon to carry out an immediate and exhaustive evaluation, on an outpatient basis, of possible septal and nasal sequelae in patients undergoing orthognathic surgery.

Topics: Adult; Endoscopy; Female; Follow-Up Studies; Humans; Hypertrophy; Male; Maxilla; Middle Aged; Nasal Mucosa; Nasal Obstruction; Nasal Septum; Nose; Optical Fibers; Orthognathic Surgical Procedures; Osteotomy, Le Fort; Postoperative Complications; Prospective Studies; Pulmonary Ventilation; Respiration; Rhinitis; Tissue Adhesions; Turbinates; Young Adult

Topics: Adenoids; Adolescent; Child; Child, Preschool; Endoscopy; Female; Humans; Hypertrophy; Male; Nasopharyngeal Diseases; Nose; Radiography

To discuss the complication and the prevention of transnasal endoscopic adenoidectomy in children.. A total of 215 children patients with adenoid hypertrophy were treated with transnasal endoscopic adenoidectomy and were followed up for 1-6 months postoperatively. We summarized the complication and their management.. The children had a disappearance or relief of their clinical symptoms and manifestations after endoscopic adenoidectomy. Involved complication included 10 nose bleedings, 30 nasal synechia, 1 adenoidal regrowth.. Endoscopic adenoidectomy is performed under direct and clear view that allows surgeons to operate conveniently and shorten surgical time. Surgeons still have to be alert to these complications and try to avoid them.

Topics: Adenoidectomy; Adenoids; Child; Child, Preschool; Endoscopy; Female; Humans; Hypertrophy; Male; Nose; Postoperative Complications

Topics: Biopsy; Chronic Disease; Disease Progression; Eosinophilia; Fibrosis; Granuloma; Humans; Hypertrophy; Male; Middle Aged; Nose; Nose Diseases; Vasculitis

This is the first published report of the swimmer's nose deformity. This common athletic deformity has a characteristic, asymmetric dorsolateral nasal hump that progressively develops over years during a competitive swimming career and persists after cessation of the sport. The cause is thought to be bone and soft tissue remodeling in response to repetitive trauma chronically inflicted by a swimmer's goggles during the water reentry phase of breathing.

Topics: Adolescent; Adult; Child; Eye Protective Devices; Humans; Hypertrophy; Nose; Nose Deformities, Acquired; Swimming; Wounds, Nonpenetrating

To evaluate nasal flexible fiberoptic endoscopy as a diagnostic test of adenoid hypertrophy in children with nasal obstruction.. One hundred and thirty consecutive children aged 2-12 years were examined from May to October 2005. A questionnaire answered by parents or guardians was used to obtain a symptom score. Adenoid size was measured on radiographs of the nasal cavity using the Cohen and Konak method, and by nasal flexible fiberoptic endoscopy using the Wornald and Prescott classification. The criterion standard was the adenoid size demonstrated on radiograph.. The sensitivity of nasal flexible fiberoptic endoscopy was 92% (95% CI, 0.90-0.93), and specificity, 71% (95% CI, 0.70-0.72). The area under the ROC curve was 0.83 (95% CI, 0.76-0.90) at a p<0.001 level of significance. Kappa values were 0.94 (p<0.001) for interobserver agreement, 0.95 (p<0.001) for intraobserver agreement, and 0.54 (p<0.001) for agreement between tests.. Results suggest that nasal flexible fiberoptic endoscopy is a highly accurate diagnostic method. This examination can be performed easily in cooperative children; it is safe, objective and dynamic, and helps to establish diagnoses in difficult cases.

Topics: Adenoids; Child; Child, Preschool; Cross-Sectional Studies; Endoscopy; Female; Humans; Hypertrophy; Male; Nasal Obstruction; Nose; Observer Variation; Radiography; Sensitivity and Specificity; Surveys and Questionnaires

In mucopolysaccharidoses, upper airway obstruction has multiple causative factors and progressive respiratory disease may severely affect morbidity and mortality. In a cross-sectional study over 2 years we evaluated upper airway obstructive disease through overnight polysomnography, upper airway computed tomography and nasal endoscopy in 5 children and 6 adults with mucopolysaccharidoses of various types. Measurements of apnoea and apnoea-hypopnoea index, arousal index, and sleep efficiency were obtained through polysomnography. Retropalatal and retroglossal spaces were calculated through computed tomography, and the degree of adenoid hypertrophy was assessed through endoscopy. Apnoea index and apnoea-hypopnoea index were significantly higher in children than in adults with mucopolysaccharidoses (p = 0.03 and p = 0.03, respectively). Compared to healthy controls, retropalatal and retroglossal spaces were significantly smaller in children (p = 0.03 and p = 0.004, respectively) or adults with mucopolysaccharidoses (p = 0.004 and p = 0.004, respectively). All subjects had adenoid hypertrophy causing first-degree (36%) or second-degree (64%) obstruction at endoscopy. Overnight polysomnography, upper airway computed tomography and nasal endoscopy are useful tools for diagnosing obstructive sleep apnoea syndrome in mucopolysaccharidoses, and identifying the site and severity of airway obstruction.

Topics: Adenoids; Adolescent; Adult; Case-Control Studies; Child; Child, Preschool; Cross-Sectional Studies; Endoscopy; Female; Fiber Optic Technology; Humans; Hypertrophy; Lung Diseases, Obstructive; Male; Mucopolysaccharidoses; Nose; Patient Care Team; Polysomnography; Predictive Value of Tests; Severity of Illness Index; Sleep; Sleep Apnea, Obstructive; Tomography, X-Ray Computed; Wakefulness

The nasal septal deviation is a common cause of nasal obstruction. On the other hand, many septal deviations are asymptomatic. It seems a physiological adaptation occurs on both sides. Septal deviation leads to internal nasal asymmetry, which in turn causes compensatory change in turbinate morphology (e.g. turbinate hypertrophy respectively hypotrophy). This mechanism is investigated with the help of fluid dynamic experiments and functional rhinologic diagnostics.. Functional models of the nose (modified Mink's boxes) were used and assessment was made by acoustic rhinometry and rhinoresistometry, followed by flow dynamic investigations. Septal deviations of varying position, together with turbinates of differing grades of hypertrophy, were simulated and assessed.. We observed in models of septal deviation an increase in flow resistance on the ipsilateral side as a result of friction of flow particles in the narrowing. Furthermore, on the opposite side of the deviation, the enlargement of the stream channel did not generally lead to a reduction in flow resistance, but rather to a 'dead space', where only a slow-circling eddy was observed. This eddy causes an increase in turbulence. In vivo turbinate hypertrophy occurs to fill this dead space, thereby reducing turbulent flow without a significant increase in resistance. In cases of moderate septal deviation, compensatory mechanisms of the turbinates can lead to a normalization of nasal airflow and surgical therapy would not be indicated. Deviations in the anterior part of the septum seem to be more symptomatic, because the mechanism is missing and due to the physiological narrowing of the nasal isthmus. To differ between physiologic and pathologic deviation, functional diagnostics are needed.

Topics: Computer Simulation; Humans; Hypertrophy; Models, Biological; Nasal Septum; Nose; Pulmonary Disease, Chronic Obstructive; Rhinomanometry; Rhinometry, Acoustic; Tomography, X-Ray Computed; Turbinates

Rhinophyma is an uncommon disease of the nose characterized by irregular skin thickening and nodular deformation. The extensive growth causing 'whisky nose' is due to hyperplasia of the sebaceous glands and the surrounding connective tissue. Other facial regions may concomitantly be affected. We present a case of extensive gnathophyma accompanying minor lesions of the nose. Surgical treatment led to an excellent cosmetic result.

Topics: Aged; Chin; Humans; Hypertrophy; Male; Nose; Rhinophyma; Rhinoplasty; Rosacea; Sebaceous Glands; Surgery, Plastic

Topics: Child; Facial Muscles; Humans; Hypertrophy; Male; Nose

Retinoids have the capacity to accelerate the involution of multiple keratoacanthomas, including unusual variants such as keratoacanthoma marginatum centrifugum and keratoacanthoma en plaque that may persist and be associated with progressive growth and provide difficulties in diagnosis and management.. We describe 3 patients who had unusual infiltrated and keratotic plaques affecting the lower legs or nasolabial area that persisted or recurred that may be related to this group of unusual keratoacanthomas. The 3 patients had differing clinical lesions that did not resemble classic keratoacanthomas, but were linked by their biopsy findings of hypertrophic lichen planus-like reaction and pseudoepitheliomatous hyperplasia with a prominent infundibulocystic component that progressed to multiple keratoacanthomas or infundibulocystic squamous cell carcinoma. Polymerase chain reaction analysis of biopsy material from 2 patients failed to detect human papillomavirus. All 3 presentations provided a therapeutic dilemma, but responded rapidly to acitretin treatment at a dosage of 10 to 25 mg daily, which was continued for 15 to 24 months.. These cases illustrate an unusual reaction pattern that is hypertrophic lichen planus-like but, instead of evolving to classic lichen planus, progresses to infundibulocystic hyperplasia and the development of multiple keratoacanthomas or infundibulocystic squamous cell carcinomas. Retinoids represent a therapeutic option for this difficult clinical problem and may obviate repeated and extensive surgery.

Topics: Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Diagnosis, Differential; Female; Humans; Hypertrophy; Keratoacanthoma; Lichen Planus; Lower Extremity; Male; Nose; Skin Neoplasms

the efficacy of adenoidectomy in relieving nasal symptoms has been questioned. Although enlarged adenoids are often blamed for nasal obstruction, other causes can be missed if examination is not thorough. We suggest that endoscopy at the time of adenoidectomy may be useful to confirm large adenoids and exclude other causes, and the findings may help predict residual symptoms 2 years after adenoidectomy.. a prospective study of a consecutive series of children undergoing adenoidectomy for nasal obstruction was performed. All underwent endoscopy with a 4-mm rigid endoscope without decongestants under GA immediately prior to adenoidectomy. Two years later a postal symptom questionnaire was sent, with telephone follow up for non-responders. The findings on endoscopy were compared with residual symptoms at 2 years.. Forty-eight children aged 2-9 (mean 4) years were enrolled, 26 of them female. At 2 years follow up, data were available for 34 children (71%). Complete obstruction of the posterior choanae of the nose by adenoids was seen in 21 (62%). Additional findings (e.g. septal deviation, hypertrophic mucosa on the turbinates) were present in 22 (65%). Of them 9 (26%) had residual nasal symptoms. Of the children with less than occlusive adenoids, six (50%) out of 12 had residual symptoms, compared with three (14%) out of 21 with occlusive adenoids (chi(2)=4.91, P<0.05). Although residual symptoms were more common in those with additional findings on the original endoscopy (32 vs. 17%), this did not reach statistical significance.. residual nasal symptoms are common when children are followed up in the medium term. The findings on endoscopy may predict the success of adenoidectomy in relieving the symptoms, and may help to guide further treatment.

Topics: Adenoidectomy; Adenoids; Child; Child, Preschool; Endoscopy; Female; Follow-Up Studies; Humans; Hypertrophy; Male; Nasal Obstruction; Nose; Prospective Studies

Adenoidal hypertrophy is the commonest cause of nasal obstruction in the pediatric population. It may cause marked morbidity as regards respiratory physiology, facial growth and middle ear function. Determination of adenoidal presence and size is not easy. Nasal endoscopy and radiology are the most accepted modes of diagnosis and each has its disadvantages. We have used acoustic rhinometry to determine the size of adenoids. Changes in nasal volume and resistance were recorded and an easy formula was devised to determined adenoid size. This technique is easy, non-invasive and reproducible with a 93.5% predictive value.

Topics: Acoustics; Adenoidectomy; Adenoids; Airway Resistance; Cephalometry; Child; Child, Preschool; Ear, Middle; Endoscopy; Female; Humans; Hypertrophy; Male; Manometry; Maxillofacial Development; Mouth Breathing; Nasal Obstruction; Nose; Otitis Media with Effusion; Otitis Media, Suppurative; Predictive Value of Tests; Radiography; Reproducibility of Results; Respiration; Sleep Apnea Syndromes; Snoring

The objective of this study was to investigate an instrumental assessment technique for acquiring reproducible, metric data on the nasal airway in cleft-palate associated nasal dysplasia. A consecutive sample of 23 unilateral, 17 bilateral CLP patients and 15 controls with subjective normal nasal patency from a cleft-palate rehabilitation centre were studied. A series of transnasal acoustic measurements (pressure wave: 55 dB for 2 ms) of nasal volume were performed before and after topical decongestion with 2 x 0.3 mg of xylometazoline. A standardized regimen of acoustic parameters of the nasal valve and the adjacent segment of the nasal cavity were calculated. The cleft side yielded a significantly (40%) lower nasal volume than the non-cleft side. Considerably lower values were recorded for the isthmus of the cleft side (0.31 cm2) compared with the non-cleft side (0.52 cm2). Decongestion capacity was higher in the posterior segment, indicating cleft-side massive mucosal hypertrophy. In bilateral CLP, the isthmus measured 0.46 cm2. By decongestion, individual side differences were reduced in unilateral CLP patients but enhanced in bilateral clefts. The prevailing pattern of the cleft-side airway profile can be described as a 'descending W'. Acoustic rhinometry is a non-invasive, instrumental assessment technique for acquiring reproducible metric data of nasal dysplasia in cleft-palate patients. By identification of the location and amount of nasal obstruction, it provides topographic information about the individual airway profile. It is suitable for the longitudinal investigation of nasal-airway development, as well as the preparation and follow-up of corrective rhinosurgery.

Topics: Acoustics; Adolescent; Adult; Child; Cleft Lip; Cleft Palate; Follow-Up Studies; Humans; Hypertrophy; Imidazoles; Longitudinal Studies; Nasal Cavity; Nasal Decongestants; Nasal Mucosa; Nasal Obstruction; Nose; Nose Deformities, Acquired; Reproducibility of Results; Rhinoplasty; Sound

The long-term benefit of trimming of the inferior turbinates for nasal obstruction is unclear and our aim was to assess this. Fourteen patients who had had pre-operative nasal symptom scores and anterior rhinomanometry prior to inferior turbinate resection were reassessed at least 7 years post-operatively. Both nasal symptom scores for obstruction and nasal resistance had increased significantly in the intervening time period. Nasal crusting and hypertrophy of the cut inferior turbinate are considered to be responsible for this. Patients should be warned some degree of nasal obstruction may recur postoperatively.

Topics: Adult; Aged; Airway Resistance; Follow-Up Studies; Humans; Hypertrophy; Longitudinal Studies; Manometry; Middle Aged; Nasal Mucosa; Nasal Obstruction; Nose; Postoperative Complications; Pressure; Turbinates

Topics: Humans; Hypertrophy; Nose; Patient Care Planning; Rhinoplasty

The value of pernasal swabs and direct adenoid swabs in chronic adenoid and adenotonsillar disease was assessed in 175 patients. Prior to adenoidectomy (53 patients) or adenotonsillectomy (122 patients), pernasal and direct adenoid swabs were taken. Adenoid currettings and tonsil tissue were cultured. Haemophilus influenzae was the bacterium most frequently isolated from adenoid currettings and from the centre (core) of the resected tonsil. There was a close relationship between the bacteriology of the pernasal swab and the adenoid tissue and tonsil core in 72 and 71% of patients, respectively. There was an identical profile of pathogens in 52 and 49%, respectively. We suggest that in children with adenoiditis or adenotonsillitis and hypertrophy of the adenoid, a pernasal swab should be used in preference to a throat swab in selecting appropriate antimicrobial therapy. Penicillin and ampicillin are not appropriate blind therapy in chronic adenoid and adenotonsillar infections because of the prevalence of beta-lactamase-producing aerobes (40%) in adenoid and tonsil core in these conditions.

Topics: Adenoidectomy; Adenoids; Adolescent; Ampicillin; Bacteriological Techniques; beta-Lactamases; Child; Child, Preschool; Chronic Disease; Contraindications; Culture Techniques; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Hypertrophy; Male; Nose; Palatine Tonsil; Penicillins; Pharynx; Pneumococcal Infections; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Tonsillectomy; Tonsillitis

The external nose is a structure that provides prominence to the face. The internal nose is a paired nasal cavity that extends from the face to the pharynx. Turbinates are major structures within the lateral walls of the nose. They perform the major functions of the nose that include respiration, humidification, temperature regulation, and filtration of the inspired air. Conditions that obstruct the nose interfere with its optimal function. These range from acute or chronic infection to enlarged tonsils and adenoid tissue to nasal septal deviation. Surgeons caring for patients with clefts must have familiarity with nasal anatomy and function and conditions that alter them. Correction of these conditions may require medical and/or surgical treatment.

Topics: Adenoids; Bacterial Infections; Child; Cleft Palate; Humans; Hypertrophy; Infant; Nasal Cavity; Nasal Obstruction; Nasal Septum; Nasopharynx; Nose; Palatine Tonsil; Paranasal Sinuses; Pulmonary Ventilation; Respiration; Respiratory Tract Infections; Rhinitis; Smell; Turbinates

Topics: Adenoidectomy; Adenoids; Adolescent; Adult; Child; Endoscopy; Eustachian Tube; Humans; Hypertrophy; Middle Aged; Middle Ear Ventilation; Nasopharynx; Nose; Otitis Media with Effusion; Prospective Studies; Recurrence; Treatment Outcome; Tympanic Membrane

Topics: Animals; Antioxidants; Cytochrome P-450 Enzyme System; Epithelium; Hypertrophy; Male; Mitochondria; Nasal Mucosa; Nose; Oxygen; Oxygenases; Rats; Rats, Inbred F344

The purpose of this investigation was to analyse whether there were any differences between children with and without enlarged tonsils with regard to the posture of the head, the hyoid bone, and the tongue. Twenty-two children with enlarged tonsils were compared with a matched normal control group. Of the children in the tonsil group, 59 per cent were mouth-breathers during the day and 82 per cent during the night. None of the control children was a mouth-breather. The results showed that, compared with the control children, children with enlarged tonsils had an extended posture of the head, a lowered position of the hyoid bone, and an antero-inferior posture of the tongue. The vertical position of the hyoid bone also reflected the vertical position of the tongue. The antero-posterior position of the tongue was closely related to the oro-pharyngeal depth. The postural pattern in children with enlarged tonsils appears to be associated with the need for maintenance of free oro-pharyngeal airway capacity.

Topics: Adolescent; Analysis of Variance; Cephalometry; Cervical Vertebrae; Child; Female; Head; Humans; Hyoid Bone; Hypertrophy; Male; Mandible; Mouth Breathing; Nasopharynx; Nose; Oropharynx; Palatine Tonsil; Posture; Regression Analysis; Skull; Tongue

Forty-seven patients with irreversible nasal obstruction due to inferior turbinate hypertrophy were treated by cryosurgery, the short and medium term results having been clinically evaluated. Permanent good results in nasal breathing were achieved in 83% of the patients. Failures are mostly related to turbinates hypertrophy due to nasal allergy. The combination of cryosurgery and nasal septoplasty, in cases of hypertrophy associated with deformities of nasal septum, gives an excellent result. Cryosurgery of hypertrophic nasal turbinates is a simple, safe, and reliable procedure to improve nasal breathing in cases of nasal turbinate hypertrophy.

Topics: Adolescent; Adult; Aged; Child; Cryosurgery; Female; Follow-Up Studies; Humans; Hypersensitivity; Hypertrophy; Male; Middle Aged; Nasal Obstruction; Nasal Septum; Nose; Nose Diseases; Turbinates

Total inferior turbinectomy was carried out in 38 patients who complained of nasal obstruction following rhinoplasty or rhinoseptoplasty and in whom hypertrophied inferior turbinates were found to be the cause of obstruction. Postoperatively, relief of nasal obstruction was reported by 84 percent of patients, while rhinoscopy showed wide, clean nasal airways in 92 percent. Nasal airflow measurements in 32 tested patients showed increased patency in all of them, including 3 who still complained of nasal obstruction postoperatively. The follow-up period ranged from 1 to 7 years (mean 2.8 years). Atrophic changes of the nasal mucosa or chronic purulent infection was not observed in any of the patients. Because the results of partial procedures on the inferior turbinates are often unsatisfactory, I suggest performing total inferior turbinectomy in patients with obstructing inferior turbinates following rhinoplasty.

Topics: Adolescent; Adult; Airway Obstruction; Female; Follow-Up Studies; Humans; Hypertrophy; Male; Nasal Septum; Nose; Nose Diseases; Postoperative Complications; Pulmonary Ventilation; Rhinoplasty; Tissue Adhesions; Turbinates

Thirty-four children with clinically and radiologically confirmed adenoid hypertrophy underwent otoscopy, impedance tests, active anterior rhinomanometry and nasal mucociliary clearance evaluation before and 6 months after adenoidectomy. Mucociliary clearance velocity increased significantly while binasal resistances decreased after surgery. The authors conclude that mucociliary evaluation and objective measurements of nasal resistances should be added to impedance tests as indicators to adenoidectomy.

Topics: Adenoidectomy; Adenoids; Airway Resistance; Child; Child, Preschool; Cilia; Female; Humans; Hypertrophy; Male; Nasal Mucosa; Nose

Topics: Adolescent; Adult; Airway Obstruction; Child; Cryosurgery; Ethmoid Bone; Female; Humans; Hypertrophy; Male; Middle Aged; Nose

Topics: Adenoidectomy; Adenoids; Airway Obstruction; Child; Cost-Benefit Analysis; Humans; Hypertrophy; Nose; Pharyngitis; Recurrence; Tonsillectomy

We report a series of 88 patients in whom 119 obstructing inferior nasal turbinates were resected for airway obstruction, and who have been followed for 3 months to 3 years. The airways were consistently improved and, to date, there have been no undesirable sequelae.

Topics: Airway Obstruction; Anesthesia, General; Anesthesia, Local; Follow-Up Studies; Humans; Hypertrophy; Methods; Nasal Mucosa; Nose; Postoperative Complications; Pulmonary Ventilation; Turbinates

Topics: Adult; Asian People; Cicatrix; Cleft Lip; Dermoid Cyst; Female; Glioma; Head; Humans; Hypertrophy; Japan; Male; Middle Aged; Nevus, Pigmented; Nose; Nose Deformities, Acquired; Nose Neoplasms; Pigmentation Disorders; Postoperative Care; Postoperative Complications; Rhinoplasty; Skin Neoplasms; Skin Transplantation; Transplantation, Autologous

Topics: Adenoids; Adrenal Cortex Hormones; Airway Obstruction; Anti-Bacterial Agents; Child, Preschool; Foreign Bodies; Histamine H1 Antagonists; Humans; Hypersensitivity; Hypertrophy; Nasopharyngeal Diseases; Nose; Nose Deformities, Acquired; Nose Diseases; Otitis; Rhinitis; Sympathomimetics

Topics: Adenoids; Airway Obstruction; Ephedrine; Foreign Bodies; Hematoma; Histamine H1 Antagonists; Humans; Hypersensitivity; Hypertrophy; Mucus; Nasal Polyps; Nasal Septum; Nose; Nose Diseases; Nose Neoplasms; Rhinitis

Topics: Diagnosis, Differential; Endoscopy; Humans; Hypertrophy; Methods; Nasal Mucosa; Nose; Nose Diseases; Sinusitis

Topics: Acne Vulgaris; Adolescent; Adult; Female; History, 19th Century; Humans; Hyperemia; Hypertrophy; Male; Nasal Septum; Nose; Nose Deformities, Acquired; Nose Diseases; Rhinoplasty; United States

Topics: Adenoidectomy; Adolescent; Child; Child, Preschool; Humans; Hypertrophy; Manometry; Nose; Palatine Tonsil; Respiratory Function Tests; Tonsillectomy

Topics: Adenoidectomy; Adenoids; Audiometry; British Columbia; Child; Deafness; Eosinophilia; Health Surveys; Humans; Hypertrophy; Nose; Otitis Media; Respiratory Hypersensitivity; Respiratory Tract Infections; Sampling Studies; Tonsillitis

Topics: Adolescent; Black People; Child; Congenital Abnormalities; Ear, External; Fibroma; Fibromatosis, Gingival; Genetics, Medical; Gingiva; Humans; Hyperplasia; Hypertrophy; Nose; Pathology; Radiography; Skeleton; Splenomegaly; West Indies

Topics: Adenoids; Child; Diagnosis, Differential; Endoscopy; Humans; Hyperplasia; Hypertrophy; Infant; Nasal Mucosa; Nasal Obstruction; Nasal Polyps; Nasopharynx; Nose; Nose Neoplasms; Respiratory Insufficiency; Rhinitis; Rhinitis, Atrophic

Topics: Humans; Hypertrophy; Nasal Cavity; Nasal Surgical Procedures; Nose; Plastics; Surgery, Plastic

It is doubtful that the tonsils or adenoids contribute sufficiently to immunity or to hematopoiesis to warrant withholding adenotonsillectomy when there is need for the operation. Focal infection, rheumatic fever and allergic disease must be evaluated in the individual case. A seldom discussed reason for operation is the prophylaxis or treatment of malformation of the nose, sinuses, mouth and jaw. Well defined indications for adenotonsillectomy include frequent occurrence of infection, peritonsillar abscess, cervical lymph node disease believed caused by tonsillar infection, otitis media, and hypertrophy sufficient to embarrass swallowing or breathing. The operation may also be indicated in certain cases of impaired hearing, halitosis, or anorexia, and sometimes for carriers of diphtheria. Psychic trauma can be obviated by proper preparation of a child for the operation he is to undergo. There is a good evidence of evidence of relationship between recent adenotonsillectomy and infection with poliomyelitis-and a good deal of evidence to the contrary. Nationwide rules cannot be established on the basis of the evidence presented thus far. Since in many cases it is unwise to put off adenotonsillectomy, each case in each community in each season must be evaluated separately.

Topics: Adenoidectomy; Adenoids; Child; Diphtheria; Focal Infection; Halitosis; Humans; Hypersensitivity; Hypertrophy; Lymph Nodes; Male; Mouth; Nasal Surgical Procedures; Nose; Palatine Tonsil; Peritonsillar Abscess; Poliomyelitis; Rheumatic Fever; Tonsillectomy

Topics: Atrophy; Humans; Hypertrophy; Nasal Surgical Procedures; Nose

Topics: Adenoids; Animals; Hypertrophy; Nose; Perciformes; Pharynx; Radium

Topics: Hypertrophy; Mucous Membrane; Nasal Mucosa; Nose