Retrospective analysis of 31 cases of nasopalatine duct cyst

OBJECTIVE

To perform a retrospective analysis of patients with nasopalatine duct cysts (NPDC) in Brazil and compare with previous analyses.

MATERIALS AND METHODS

The files of the Laboratory of Oral Pathology (Minas Gerais Federal University) from 1966 to 1997 were reviewed. Demographic, clinical and histologic data of patients with nasopalatine duct cysts were collected.

RESULTS

The mean age of patients with nasopalatine duct cysts at the time of diagnosis was 37.4 years and with a predilection for males. The majority of cases were asymptomatic. Histologically, non-keratinized stratified squamous epithelium alone or in combination with other epithelia was observed in 93% of the cases. Recurrence was not recorded.

CONCLUSION

The demographic, histopathological, radiographic, and clinical data of the NPDC in our series are similar to previous studies in other populations.

[A clinical treatise upon the nasal septal perforation]

Thirty nine cases of septal perforation of various origins were presented using clinical such as backgrounds age, gender, possible causes, and size of septal perforation evaluated by diameter. The cases included 26 males and 13 females with a mean age of 35 years range: 8 to 85 years. Possible causative factors were as follows: septal surgeries (9), other nasal and paranasal surgeries (17), nasal cautery or tamponade (2), occupational (2), collagen disease (2), inflammatory (1) and idiopathic (5). Signs and symptoms related to perforations were minor, such as stuffy nose (3), running nose (3), nosebleed (5), dry sensation (4), nasal pain (1), and asymptomatic (23). Sizes of perforations by largest diameter were small (less than 10 mm) in 7, moderate (11-20 mm) in 13, and large (more than 21 mm) in 6. The size of perforations tended to be variable, but two cases with collagen disease showed large perforations 35 mm. Although iatrogenic and idiopathic cases comprised the majority of cases (80%), such a few cases of grave significases as collagen and hematological diseases showed unusually large perforations.

An analysis of the factors affecting the average length of stay in the otolaryngology unit

Specific factors which have an influence on the average length of stay in the otolaryngology unit of a University Hospital are studied; the patients are covered by some type of insurance and have no out-of-pocket expenses. The effect of the following variables on the average length of stay is evaluated: age, sex and type of pathology. The periods of hospitalisation are significantly longer (Mann-Whitney test) in males (p < 0.0001), in older patients (p < 0.008) and in the case of tumours, which prolong the period of stay especially of males (p < 0.0001). It is suggested that the shorter stay in the case of females may be conditioned by social and family factors.

[An epidemiologic study of sleep-disordered breathing in the male population of Lorraine: preliminary results]

The prevalence of sleep-disordered breathing (SDB) was evaluated in a male population sample of Lorraine (university staff), with a protocol including a self-completed standardized questionnaire, anthropometry (including neck, waist and hip circumferences) and non-invasive ear, nose, and throat examination. Among 357 subjects present in the institution at the moment of the survey, 334 (93.6%) accepted to participate, and 300 (84%) returned the questionnaires. The anthropometric results corresponded to the French normative values according to gender and age. We chose a value of 32 as limit of the body mass index (BMI) between weight excess and obesity; this limit was exceeded by 7.2% of the subjects. The mean age of the sample was 44.8 (SD 10.1) years; the waist-to-hip ratio was of 0.907 +/- 0.053. The ENT examination found a high prevalence of nasal septum deviations (52.6%), of soft palate (25.2%), and uvula (42%) abnormalities; 32.1% of the subjects had experienced amygdalectomy. The non-responses to the questionnaire were infrequent (less than 2%), except for the questions regarding a history of hypertension (2.6%), weight fluctuations the last 5 years (7.6%), and the number of years in school (12%). The questionnaire included, for each question, the optional answer "don't know"; this answer was chosen for the questions concerning the duration of snoring (37.1%), stopping breathing during sleep (12.7%) and the parental history of narcolepsy (18.7 and 20.7%) and sleep apnoea (33.7 and 36.4%). 5.7% of the subjects declared sleep apnoeas at least once per week: 16.1% had unrefreshing sleep; 10.6% admitted to excessive daytime sleepiness; 41.9% were habitual snorers. These results indicate a prevalence of SDB in our sample which is comparable to the figures obtained in other European studies. Further analysis of our data will indicate if, besides weight excess and its troncular distribution, cigarette smoking and respiratory symptoms, the "minor" ENT abnormalities play a role in the pathogenesis of SDB.

The prevalence of nasal mite (Pneumonyssoides caninum) infection in Norwegian dogs

In a prospective study, the skulls of 250 dogs submitted for necropsy during 1993 at the Norwegian College of Veterinary Medicine were examined for the presence of parasites. All skulls were cleaved sagitally, and the frontal sinuses and nasal cavities were visually inspected. Eighteen dogs (7%) had Pneumonyssoides caninum infection at necropsy. No other parasites were observed. Sixteen dogs had heavy or moderate infection scores and 60% of these had concurrent sinusitis. The infected dogs belonged to 14 different breeds, 10 were male and eight were female and they varied in age from four months to 10 years old. Breed distribution, sex and age of the infected dogs did not differ significantly from the total study population. This study indicates that nasal mite infection occurs commonly in Norwegian dogs.

Respiratory symptoms and bronchial responsiveness in lifeguards exposed to nitrogen trichloride in indoor swimming pools

OBJECTIVES

To measure the levels of exposure to nitrogen trichloride (NCl3) in the atmosphere of indoor swimming pools and to examine how they relate to irritant and chronic respiratory symptoms, indices of pulmonary function, and bronchial hyperresponsiveness to methacholine in lifeguards working in the pools.

METHOD

334 lifeguards (256 men; 78 women) recruited from 46 public swimming pools (n = 228) and 17 leisure centre swimming pools (n = 106) were examined. Concentrations of NCl3 were measured with area samplers. Symptoms were assessed by questionnaire and methacholine bronchial challenge (MBC) test by an abbreviated method. Subjects were labelled MBC+ if forced expiratory volume in one second (FEV1) fell by > or = 20%. The linear dose-response slope was calculated as the percentage fall in FEV1 at the last dose divided by the total dose given.

RESULTS

1262 samples were taken in the 63 pools. Mean NCl3 concentrations were greater in leisure than in public pools. A significant concentration-response relation was found between irritant eye, nasal, and throat symptoms-but not chronic respiratory symptoms-and exposure concentrations. Among women, the prevalence of MBC+ was twice as great as in men. Overall, no relation was found between bronchial hyperresponsiveness and exposure.

CONCLUSIONS

The data show that lifeguards exposed to NCl3 in indoor swimming pools are at risk of developing irritant eye, nasal, and throat symptoms. Exposure to NCl3 does not seem to carry the risk of developing permanent bronchial hyperresponsiveness, but this association might have been influenced by self selection. The possibility that subjects exposed to NCl3 are at risk of developing transient bronchial hyperresponsiveness cannot be confidently ruled out.

Respiratory findings in synthetic textile workers

We studied 308 female and 92 male textile workers employed in a factory that produced synthetic fiber hosiery. The mean age of the women was 38 years, their mean duration of employment 16 years. The mean age of the men was 39 years with a mean duration of employment of 16 years. A control group of 160 female and 78 male nonexposed workers was also studied. Chronic and acute work related symptoms were recorded for all workers. Ventilatory capacity was measured by recording maximum expiratory flow-volume (MEFV) curves from which the forced vital capacity (FVC), the 1-sec forced expiratory volume (FEV1) and maximum expiratory flow rates at 50% and the last 25% (FEF50, FEF75) were read. There was a higher prevalence of all chronic respiratory symptoms in exposed than in control workers, although the differences were statistically significant only for dyspnea, sinusitis, and nasal catarrh (P < 0.01) in female synthetic textile workers, and for nasal catarrh (P < 0.01) in male synthetic textile workers. Occupational asthma was recorded in 3 (0.9%) of the women textile workers, and in 1 (1.1%) of male textile workers. There was a high prevalence of acute symptoms during the work shift, which was greatest for cough (female: 46%; male: 59%), dryness of the throat (female: 49%; male: 40%), dryness of the nose (female: 53%; male: 43%) and eye irritation (female: 46%; male: 36%). Ventilatory capacity data among the synthetic textile workers demonstrated significantly decreased FEF75 compared to predicted (P < 0.05). Our data suggest that inhalation of dust in synthetic textile plants causes the respiratory impairment.

[Emergencies in nasal and paranasal sinus diseases]

The paper provides statistical data obtained on 1126 patients with urgent nasal and paranasal sinus pathology of a total of 2054 patients urgently hospitalized to the ENT clinic of the Moscow Medical University in 1995. A detailed analysis is given of the incidence, diagnostic and therapeutic policy, complications in all kinds of nasal bleeding, acute and chronic sinusitis, trauma of the nose and paranasal sinuses, nasal furuncle.

A prediction model for strike in the sheep nasal fly, Oestrus ovis, in Namibia

A model was developed for predicting outbreaks of Oestrus ovis throughout the main sheep farming areas of Namibia. Pupal developmental periods were studied, concomitant air and soil temperatures enabling degree-day calculations to be made for prediction of adult fly strike. Monitoring of larval infection established seasonal incidence of O. ovis infestation and acted as verification of predictions. The establishment of relevant isothermal maps for Namibia made possible extrapolation from the several study sites to the entire sheep farming area. Retrospective and actual predictions of the important first peak after winter were considered accurate enough to recommend timing of control measures. No evidence of overwintering of first stage instars was found, the strategy used instead being extended pupation. Adult fly energy reserves were determined.

Paracoccidioidomycosis: an uncommon localization in the scrotum

Paracoccidioidomycosis is a systemic fungal infection caused by the thermally dimorphic fungus Paracoccidioides brasiliensis. The authors present a case of a 49-year-old man who developed verrucous lesions on nasal mucosa and on genital localization (inguinal and scrotal), without signs of systemic disease. Direct mycological examination, culture on Sabouraud glucose medium, and biopsy were positive for P. brasiliensis. The interest of this case is the genital localization which is uncommon in this infection. Moreover, there are few cases described in the literature.

Nasal tuberculosis in the 20th century

During the last decade, tuberculosis has reemerged as a major health problem in the United States. Much of the blame for this resurgence has been attributed to human immunodeficiency virus infection, although homelessness and deterioration of the social infrastructure have also been implicated. Extrapulmonary tuberculosis is uncommon, and nasal tuberculosis is rare. The latter usually manifests as nasal obstruction or discharge. Only 35 cases of nasal tuberculosis were identified in a search of the English-language medical literature from the last 95 years. They are reviewed here. In addition, we describe a new manifestation of nasal tuberculosis, exemplifying the variety of ways in which this may occur.

Computed tomography in lacrimal outflow obstruction

BACKGROUND

Acquired nasolacrimal duct obstruction is a common ophthalmologic problem. Despite widespread understanding of treatments available for nasolacrimal duct obstruction, few authors have commented on its etiology. Because the nasolacrimal system is anatomically related to important nasal and sinus structures, the authors postulated that acquired nasolacrimal duct obstruction and its complications might occur simultaneous to, and possibly as a consequence of, rhinologic or sinus disease.

MATERIALS AND METHODS

Twenty-three patients with acquired nasolacrimal duct obstruction and 100 control patients were evaluated by coronal computed tomography for evidence of sinus disease or nasal abnormalities. Specifically, five findings were noted: ostiomeatal complex disease, ethmoidal opacification, agger nasi cell opacification, concha bullosa, and nasal septal deviation.

RESULTS

Overall, 20 (87%) patients with acquired nasolacrimal duct obstruction demonstrated one or more radiologic finding of sinus disease or rhinologic abnormality whereas 63 (63%) control subjects exhibited these findings. This difference was determined to be statistically significant (P < 0.05). A statistically significant higher incidence of ethmoidal opacification, agger nasi cell opacification, and nasal septal deviation was observed in patients with nasolacrimal outflow obstruction than in controls. Differences in the incidence of ostiomeatal complex disease and concha bullosa were not found to be statistically significant.

CONCLUSION

These data demonstrate a correlation between computed tomography findings of sinus disease or nasal abnormality and the presence of acquired nasolacrimal outflow obstruction. This association between radiologic evidence of sinorhinologic disorders and lacrimal outflow obstruction may imply that dacryocystitis, like sinus disease, may be produced by disease of the lateral nasal wall. When evaluating a patient with acquired nasolacrimal duct obstruction, the physician should consider evaluation for concomitant nasal and sinus disease.

A survey of respiratory and dermatological disease in the chrome plating industry in the West Midlands, UK

Between 1993-1995 a cross-sectional survey of 20 chrome plating companies in the West Midlands was undertaken to assess the prevalence of respiratory and dermatological disease in platers. By means of a questionnaire and clinical examination 71 platers were examined of whom 23% were found to have dermatitis at the time of the visit and 45% of companies had at least one case of dermatitis in their plating workforce. Twenty-three per cent of platers had evidence of old chrome ulceration and 13% had evidence of new and healing chrome ulcers. When the nasal passages of platers were examined 17% had inflammation and 14% had septal perforation. Those with perforations were aged less than 35 years at the time of perforation which had usually occurred in the first 10 years of exposure. Lower respiratory symptoms were rare. Guidance on the prevention of disease in this occupational group which does not always have ready recourse to experienced occupational medical advice will be discussed.

A population-based case-control study of the relationship between cigarette smoking and nasopharyngeal cancer (United States)

This case-control investigation, based on the Selected Cancers Study, assesses the association between cigarette smoking and nasopharyngeal cancer, a relatively rare neoplasm in the United States. Men who were diagnosed pathologically with nasopharyngeal cancer during 1984-88 were included as cases in the analysis if they were 15 to 39 years old in 1968, and lived in the areas covered by eight cancer registries in the US (n = 113). Control men were selected by random-digit telephone dialing (n = 1,910). Using logistic regression analysis with adjustment for potential confounding factors, it was found that relative to nonsmokers, the risks of nasopharyngeal cancer were 2.3 (95 percent confidence interval [CI] = 1.3-4.0) and 1.4 (CI = 0.8-2.6) for former and current smokers, respectively. Using pack-years as a measure, adjusted odds ratio (OR) estimates were 1.3, 1.8, 2.5, and 3.9 for smoking for less than 15, 15-29, 30-44, and 45 or more pack-years, respectively. When squamous cell carcinoma was used as an outcome, the smoking/nasopharyngeal-cancer association became stronger. The analysis did not show interactions between smoking and alcohol consumption, or prior nasal diseases. The results of this study suggest that cigarette smoking may be related to the occurrence of nasopharyngeal cancer (especially squamous cell carcinoma) among US men.

Ocular and nasal irritation in operatives in Lancashire cotton and synthetic fibre mills

OBJECTIVES

To document the prevalence of work related ocular (eyeWRI) and nasal (noseWRI) irritation in workers in spinning mills of cotton and synthetic textile fibres and to relate the prevalence of symptoms to atopy, byssinotic symptoms, work history, and measured dust concentrations in the personal breathing zone and work area.

METHODS

A cross sectional study of 1048 cotton workers and 404 synthetic fibre workers was performed. A respiratory questionnaire was given to 1452 workers (95% of the total available population). Atopy was judged by skin prick tests to three common allergens. Work area cotton dust sampling (WAdust) was carried out according to EH25 guidelines in nine of the 11 spinning mills included in the study. Personal breathing zone dust concentrations were assessed with the IOM sampler to derive total dust exposure (PTdust) and a concentration calculated after the removal of fly (Pless).

RESULTS

3.7% of all operatives complained of symptoms of byssinosis, 253 (17.5%) complained of eyeWRI and 165 (11%) of noseWRI. These symptoms did not relate to atopy or byssinosis, or correlate univariately with any measure of cotton dust exposure (noseWRI v WAdust r = 0.153, PTdust r = 0.118, eyeWRI v WAdust r = 0.029, PTdust r = 0.052). Both of these symptoms on logistic regression analysis were related to being of white origin (P < 0.001), female sex (P < 0.001), and younger age (P < 0.001). With regression analysis, there was a negative relation between dust concentration and prevalence of symptoms.

CONCLUSION

Work related ocular and nasal irritation are the most common symptoms complained of by cotton textile workers. There was no relation between these symptoms and atopy, byssinosis, or dust concentration. It is likely that they relate to as yet unidentified agents unrelated to concentration of cotton dust.

Complications of endoscopic sinus surgery: analysis of 2108 patients--incidence and prevention

The incidence of complications of endoscopic sinus surgery (ESS) in a combined experience with 2108 total patients is compared to complications in 11 other series of patients (2583 total) who underwent ESS and 6 series of patients (2110 total) who underwent traditional endonasal sinus surgery. The incidence of major perioperative complications was 0.85%, with cerebrospinal fluid (CSF) leak being the most common. The most common minor complications of ESS were those related to orbital penetration and middle turbinate adhesions; minor complications occurred in 6.9% of the 2108 patients. There were no statistically significant differences in the overall incidences of major complications between this series and the other two groups. Recommendations are made for the prevention of complications during ESS.

Nasal septal abscess--retrospective analysis of 14 cases from University Hospital, Kuala Lumpur

Fourteen patients who presented to the University Hospital of Kuala Lumpur between June 1981 and June 1991 were reviewed retrospectively. Nasal septal abscesses are uncommon and therefore there are limited reports in the medical literature. Early diagnosis and immediate therapy is mandatory to avoid cosmetic nasal deformity or intracranial infection. Two out of the fourteen patients developed saddle nose deformity and septal perforation because of delay in treatment, the cases were misdiagnosed by non-otolaryngologist as turbinates swelling. The leading cause of nasal septal abscess was non-surgical trauma which accounted for about 85.7%. The commonest pathogenic organism isolated from the pus of nasal septal abscess was Staphylococcus aureus.

[Evaluation of the carriage of Staphylococcus aureus in patients and the personnel of a hemodialysis center for the prevention of infections]

With the aim of improving the prevention of Staphylococcus aureus infections in hemodialysis patients, an evaluation of S. aureus nasal carriage was carried out at the hemodialysis center of CHU-Rouen between the 1st of January, 1991 and the 30th of June, 1991. The S. aureus strains were classified according to their antibiotypes, serotypes and lysotypes. The carriage rate appears to be similar to that of the general population but inferior to what has been previously reported in hemodialysis centers. We report our findings on nasal carriage strains. The risk of infection is low. The standards of hygiene, adopted by hospital personnel, seem to be effective although cross colonization may have possibly occurred. Taking into account the different epidemiologic circumstances encountered in each hemodialysis center it is, therefore, necessary to determine the rate of carriage and identify the personnel at risk (persistent carriers, patients with a previous history of S. aureus septicemia, meti-R strains) in order to implement prophylaxis accordingly to epidemic characteristics of each center.

Myiasis in children: the Indian perspective

A retrospective analysis of 94 cases of childhood myiasis admitted over a 6-year period is presented. Children formed 37.9% of all cases of myiasis. More than 50% of the children were less than 5 years of age and most (96.8%) belonged to a rural background. Of the 94 cases, 81 (86.16%) were of aural, 11 (11.7%) of nasal and 2 (2.12%) of ocular myiasis. The peak incidence was seen from September to October. The main symptoms in aural myiasis were passage of worms (81.48%), discharge (44.44%) and pain (41.97%). In nasal myiasis epistaxis (100%), foul smell (100%) passage of worms (90.9%) and pain (72.72%) were the prime presenting symptoms. All patients were treated with chloroform and turpentine oil in the ratio 1:4 which was followed by manual removal of the maggots and were made maggot-free in 2-3 days. No complications were seen.

Nasal and paranasal disease in adult cystic fibrosis patients

Children with cystic fibrosis frequently have nasal polyps and sinusitis. This study addresses (para-) nasal disease in 39 adult cystic fibrosis patients. Fifteen patients (39%) had recently had serious nasal symptoms and 26% sinusitis. Seventeen (44%) had nasal polyposis. Almost all sinus radiographs taken showed opacification, which was unrelated to symptoms. Polypectomies and antral irrigations were usually ineffective, whilst more extensive surgery generally gave better results. It is concluded that a substantial number of adult cystic fibrosis patients frequently have upper airway symptoms. Sinus radiographs have little or no diagnostic value. Treatment of (para-) nasal disease in cystic fibrosis patients can be difficult; a guideline for treatment is suggested, calling for simple interventions coupled with intranasal steroids and nasal irrigation in early disease and for endoscopic to radical sinus surgery in recurrent advanced disease.

Nasal mucosal involvement in lupus erythematosus

The involvement of oral, conjunctival and genital mucosa in lupus erythematosus (LE) has recently been described. Reports of nasal involvement have been sporadic. A prospective study was performed to assess the prevalence of nasal symptoms and signs in LE and to identify the incidence of deposition of immunoreactants in the nasal mucosa of patients with LE. Thirty-six patients with LE were studied; 21 had non-specific nasal symptoms and 12 had evidence of chronic inflammatory changes in the mucosa of the nasal cavity or in the vestibule (septal perforation, inflamed mucosa, vestibulitis). Immunoreactants were found in only 4 patients and did not correlate well with clinical evidence of disease. Nasal mucosal involvement in LE is underestimated and often overlooked in the assessment of such patients.