33. Diseases occurring in the nasopharynx. Adenoid hyperplasia and its consequences. Tumors of the nasopharynx..

What are the diseases of the nasopharynx

• Adenoid hyperplasia

• Acute and chronic nasopharyngitis

• Tornwaldt’s disease: pharyngeal bursitis

• tumours

  • benign- Juvenile angiofibroma

  • malignant- SCC, lymphoepithelial carcinoma

What is adenoid hyperplasia

• enlargement of the adenoid

• located in posterior wall of pharynx

• size peaks at age 5 and resolves by age 12

• increases in size with repeated URTI and allergies

What are the clinical signs of adenoid hyperplasia

• nasal obstruction

• choanal obstruction

• eustachian tube obstruction

• chronic inflammation

Describe the nasal obstruction in adenoid hyperplasia

• adenoid facies

  • open mouth, high arched palate, narrow midface

• hypernasal voice, snoring, mouth breathing

Describe choanal obstruction in adenoid hyperplasia

• chronic rhinosinusitis/ rhinitis

• OSA

Describe eustachian tube obstruction in adenoid hyperplasia

• recurrent OM, serous OM, chronic suppurative OM

• CHL → delayed speech development

describe the chronic inflammation in adenoid hyperplasia

• nasal discharge, post nasal drip, cough

• cervical lymphadenopathy

What are the complications of adenoid hyperplasia

• postoperative bleeding

• airway obstruction

• nasopharyngeal stenosis

• eustachian orifice injury

• injury to sodt palate/ uvula

• adenoid regrowth

how do you diagnose adenoid hyperplasia

• history + imaging

• posterior rhinoscopy or endoscopy- enlarged adenoids

• otoscopy, hearing test- PTA, tympanometry

What is the treatment of adenoid hyperplasia

• only treated in case of complications

• adenoidectomy

• intranasal CS, antibiotics

What is nasopharyngitis

• upper airway infection → “common cold”

• can be acute or chronic

• chronic- commonly in heavy smokers, drinkers + those exposed to dust + fumes

What is the etiology of nasopharyngitis

• Viruses: influenza, parainfluenza, rhinovirus, adenovirus

• Bacteria: streptococci, pneumococcus, H. influenzae

what are the clinical signs of nasopharyngitis

• Dryness, burning at throat over soft palate

• Nasal discharge

• Pain, discomfort at back of nose + dysphagia

• Severe → fever, enlarged LN

How do you diagnose nasopharyngitis

• congested and swollen mucosa with white exudate

How do you treat nasopharyngitis

• mild- spontaneous recovery, analgesics

• severe- systemic antibiotics

What is Tornwaldt’s disease; pharyngeal bursitis

• infection of pharyngeal bursa at thte back of the nasopharynx

• median recess representing the attachment of the notochord to the endoderm of primitive pharynx

What is the cause of pharyngeal bursitis

bacteria

What are the clinical signs of pharyngeal bursitis

• Persistent post-nasal discharge with crusting on nasopharynx

• Nasal, tubal obstruction

• Dull occipital headache

• Recurrent sore throat

• Low grade fever

How do you diagnose pharyngeal bursitis

• history

• endoscopy, imaging- CT, MRI

How do you treat pharyngeal bursitis

• antibiotics

• marsupialization of cystic swelling and adequate removal of lining membrane

  • → surgical technique to treat a cyst or abscess

  • site remains open and can drain freely

What is Juvenile angiofibroma

• excusively in boys of age 10-18

what are the symptoms of Juvenile angiofibroma

• Obstructed nasal breathing

• Recurrent epistaxis, headache

• Impaired eustachian tube ventilation with middle ear effusion

• CHL due to obstruction of the eustachian tube orifice

how do you diagnose Juvenile angiofibroma

• history

• endoscopy

• imaging- MRI, CT, DSA

• biopsy should NOT be done- risk of heavy bleeding

what is seen with endoscopy in Juvenile angiofibroma

• well-circumscribed

• vascularized mass with superficial vascular markings in the nasopharynx or posterior part of nasal cavity

how do you treat Juvenile angiofibroma

• surgical excision

  • preoperative embolization of the feeding vessels- maxillary artery

  • should be performed to decrease the intensity of intraoperative bleeding

what is etiology of SCC

• EBV

• salted fish

• poor oral hygiene

what are the symptoms of SCC

• Unilateral CHL with middle ear effusion

• Cervical LN metastasis, usually involving the nodes at mandibular angle

• Nasal airway obstruction, recurrent epistaxis, headaches, cranial nerve palsies

how do you diagnose SCC

• History, endoscopy, biopsy, otoscopy

• EBV antibody titer → elevated IgA, contrasting with elevated IgM/IgG that is found in infectious mononucleosis

• Imaging (MRI, CT)

how do you treat SCC

• radiotherapy

  • most tumours are very radiosensitive and unfavourable tumour location + rapid invasion of the skull base preclude curative surgery in many cases