Abstract Objective This study aimed to analyze the characteristics of laryngopharyngeal reflux (LPR) by using narrow band imaging (NBI) endoscopy. Study Design A prospective study. Setting A large‐volume practice with tertiary care providers. Methods A total of 67 patients with suspected LPR who underwent 24‐hour multichannel intraluminal impedance–pH monitoring were included from June 2020 to March 2022. Manifestations of NBI endoscopy included submucosal clustered brownish microvessels (CBMs), spotted brownish microvessels, and no special microvessels; the latter 2 formed the non‐CBM group. The manifestations of all patients and their changes were observed after 8 weeks of proton pump inhibitor and symptomatic treatment for patients with LPR, and symptomatic treatment for patients without LPR. Results According to the results of 24‐hour multichannel intraluminal impedance–pH monitoring, the incidence of submucosal CBMs was significantly higher in patients with LPR (30 cases) than in those without LPR (37 cases, P < .001), particularly in the posterior cricoid area ( P < .001). Besides Reflux Finding Score, the incidence of signs such as subglottic edema and vocal fold edema was significantly higher in the CBM group than the non‐CBM group ( P < .05). Finally, 22 patients with LPR (91.7%) and only 2 patients without LPR (28.6%) underwent a transformation from CBMs to spotted brownish microvessels after continuous medication for 8 weeks in the CBM group (χ 2 = 15.916, P < .001), while no significant change was observed in patients with or without LPR in the non‐CBM group ( P > .05). Conclusion Submucosal CBMs in the posterior cricoid area under NBI endoscopy may be a characteristic of LPR. Level of Evidence: 4.
Objective:The aim of this study is to analyze the application value of NBI endoscopy in finding the concealed primary lesions of misdiagnosis of oropharyngeal cancer. Methods:The clinical data of patients with missed oropharyngeal cancer treated in the Department of Otolaryngology Head and neck surgery, the Second Affiliated Hospital of Xi'an Jiaotong University from May 2018 to June 2021, were retrospectively studied, and the missed diagnosis was also analyzed combined with results of NBI endoscopy. Results:In 31 cases of misdiagnosis of oropharyngeal cancer patients, including 25 males and 6 females, there was no significant difference in age, BMI index, course of disease and TNM stage （P> 0.05）, and the pharyngeal or cervical symptoms were the first clinical manifestations of them, containing pharyngeal pain in 17 cases（54.8%） , pharyngeal foreign body sensation in 4 cases（12.9%） and unilateral cervical mass in 10 cases （32.3%）. No laryngoscopy was performed （21 cases） or no primary lesion was found by laryngoscopy （10 cases） at initial diagnosis. Among them, "inflammatory lesions" were given anti-inflammatory treatment with ineffective results or surgical resection was explored for suspicious lesions （17 cases）, or imaging examination （9 cases, including 6 cases with CT and MRI, 3 cases with PET-CT） and cervical lymph node biopsy （5 cases） were carried out for further diagnosis. According to these results, they were given ordinary laryngoscope （2 cases） or NBI endoscopy （29 cases） subsequently, finally they were confirmed as oropharyngeal squamous cellcarcinoma after localized biopsy at the suspicious lesions, indicating that the accuracy of NBI endoscopy in finding the concealed primary lesions of oropharyngeal cancer （93.55%） is significantly higher than that of ordinary electronic laryngoscope （6.45%）（χ²=43.613, P<0.01）. Conclusion:NBI endoscopy has unique advantages in finding oropharyngeal cancer in concealed parts such as tonsil, root of tongue, soft palate and lateral wall of oropharynx, which could reduce misdiagnosis of oropharyngeal cancer.目的：探讨窄带成像技术（NBI）内镜在寻找漏诊的口咽癌隐匿原发病灶中的应用价值。 方法：回顾性研究自2018年5月-2021年6月就诊于西安交通大学第二附属医院耳鼻咽喉头颈外科的漏诊口咽癌患者的临床资料，结合NBI内镜检查结果，分析漏诊原因。 结果：漏诊的31例患者临床诊断均为口咽恶性肿瘤，其中男25例，女6例，两者在年龄、BMI、病程及TNM分期方面比较差异均无统计学意义（P>0.05）。临床首发症状主要为咽痛（17例）、咽部异物感（4例）和单侧颈部局部肿物（10例）。初诊时21例未行喉镜检查，10例行喉镜检查未发现病灶。17例给予抗炎对症治疗无效或手术切除可疑病变部位，9例行CT、MRI及PET-CT，5例行颈部淋巴结穿刺活检。根据结果提示，2例再行普通喉镜，29例再行NBI内镜检查，在可疑病变处定位活检后证实为口咽部鳞状细胞癌，结果提示NBI内镜筛查漏诊的口咽癌隐匿原发病灶的准确率（93.55%）显著高于普通电子喉镜（6.45%），两者比较差异有统计学意义（χ²=43.613，P<0.01）。 结论：NBI内镜在寻找扁桃体、舌根、软腭及口咽侧壁等隐匿部位的口咽癌具有独特优势，可减少口咽癌的漏诊。.
Objective:To investigate the clinical features of diffuse large B-cell lymphoma （DLBCL） of head and neck. Methods:A retrospective study was conducted among patients with DLBCL in the Department of otolaryngology and head and neck surgery of the Second Affiliated Hospital of Xi'an Jiaotong University from July 2011 to September 2021. The disease location, clinical manifestations, diagnosis, treatment and prognosis of DLBCL patients in head and neck were analyzed retrospectively. Results:Oropharynx（27 cases, including 25 cases in tonsil）, neck（29 cases）, nasopharynx and nasal cavity （7 cases）were included in 63 cases of DLBCL in head and neck. Pharyngalgia, pharyngeal foreign body sensation and dysphagia were the most common manifestations of oropharyngeal DLBCL, while nasal obstruction, runny nose and hyposmia were the initial manifestations of nasal and nasopharyngeal DLBCL.Under the NBI endoscopy, locally uplifted neoplasm with rough surface mucosa was observed in 34 cases DLBCL patients of oropharynx, nasopharynx and nasal cavity. Among them, 16 cases were covered with yellow-white and patchy pseudomembrane on the surface of the neoplasm, and 5 cases were detected with abnormal new vessels, including 3 cases of tonsils, 1 case of root of tongue, and 1 case of nasopharynx. Painless progressive lymphadenectasis was the common manifestation of DLBCL in head and neck, and the maximum diameter（[21.3±6.7]mm） of neck lymph nodes in the same side of DLBCL was significantly larger than that in the opposite side（[16.0±7.2]mm, P=0.009）. Sixty-three cases of DLBCL in head and neck, including 27 cases of germinal center type（GCB）, 33 cases of nongerminal center type（non-GCB）, and 3 cases of non-specific DLBCL, were confirmed the diagnosis by needle biopsy（33 cases, 52.4%） and surgical resection（30 cases, 47.6%）. The imaging features of DLBCL in head and neck were mostly showed as local soft tissue masses with uniform density and uneven enhancement, and the surrounding structures were often compressed and displaced. All the patients were treated with standard R-CHOP chemotherapy regimens, and overall survival was longer in normal LDH, and overall survival of the patients at low risk of IPI was longer than those at medium-high or high risk of IPI（PLDH=0.011, PIPI=0.022, P<0.05）. Conclusion:DLBCL mainly occurs in oropharynx, especially the unilateral tonsil. When flake yellow-white pseudomembrane adhesion and abnormal neovessels on the surface of the mass are detected under endoscopy, and the ultrasound suggested multiple enlarged lymph nodes in the neck with large iplateral lymph nodes, the possibility of DLBCL should be considered. Surgical resection could be performed for diagnosis if necessary, and early diagnosis would have a better prognosis.目的：分析头颈部弥漫大B细胞淋巴瘤（DLBCL）的临床特征。 方法：选取2011年7月—2021年9月在西安交通大学第二附属医院住院的头颈部DLBCL患者为研究对象，进行回顾性研究，分析患者的发病部位及临床表现、诊断、治疗及预后。 结果：63例头颈部DLBCL的累及部位包括口咽部（27例，其中扁桃体25例）、颈部（29例）、鼻腔鼻咽（7例）等，发生于口咽部者多表现为咽痛、咽部异物感及吞咽不利，而鼻腔鼻咽部发病者以鼻塞、流涕、嗅觉减退为初始表现。34例发生于鼻腔鼻咽、口咽的DLBCL患者其电子喉镜检查可见局部隆起新生物，表面黏膜粗糙，其中16例（47.1%）患者肿物表面有黄白色、片状分布的假膜覆盖，5例患者（14.7%）NBI内镜下于假膜边缘检见异常新生血管，包括扁桃体3例，舌根部1例，鼻咽部1例。29例颈部DLBCL多表现为局部肿物渐进性增大，其电子喉镜和NBI内镜检查均未见明显异常。无痛性进行性淋巴结肿大是头颈部DLBCL的共同表现，且DLBCL患者病灶同侧颈部淋巴结最大直径[（21.3±6.7） mm]显著大于对侧淋巴结最大直径[（16.0±7.2） mm]（P=0.009）。63例DLBCL患者中，生发中心型（GCB）27例，非生发中心型（non-GCB）33例，未分型3例，确诊方式包括穿刺活检（33例，52.4%）和手术切除（30例，47.6%）。头颈部DLBCL的影像学表现多为局部软组织肿块，均匀等密度，并呈不均匀强化，周围结构常受压移位。在采用标准R-CHOP化疗方案的基础上，LDH正常患者总生存期长，IPI评分低危者较中高危、高危患者总生存期长（PLDH=0.011，PIPI=0.022，P<0.05）。 结论：头颈部DLBCL多好发于口咽部，尤其是单侧扁桃体。当内镜下检见肿物表面片状黄白色假膜附着或异常新生血管，超声提示颈部多发肿大淋巴结且病灶同侧淋巴结较大时，应考虑DLBCL的可能，必要时可行手术切除活检，及早诊断预后较优。.
Abstract Objective To assess the extent of recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) damage in patients with idiopathic vocal cord paralysis (IVCP) exhibiting different paralytic sides. Methods A total of 84 IVCP cases were evaluated using stroboscopic laryngoscopy, voice analysis, and laryngeal electromyography (LEMG). The results were compared between patients with left‐sided paralysis and right‐sided paralysis based on different disease courses (less than or more than 3 months). Results Initially, the average age and disease progression of IVCP patients were found to be similar regardless of the side of paralysis ( p > .05). Additionally, there were no significant variations in voice indicators, such as MPT, DSI, and VHI, between IVCP patients with left and right vocal cord paralysis ( p > .05). Furthermore, no disparities were detected in the latencies and amplitudes of the paralyzed RLN and SLN, as well as the durations and amplitudes of the action potentials in the paralyzed TM and PCM, among IVCP patients with left and right vocal cord paralysis ( p > .05). Notably, the amplitudes of the left paralytic CM were significantly lower than those of the right paralytic CM (0.45 vs. 0.53, Z = −2.013, p = .044). In addition, no disparities were observed in APDs and amplitudes between the ipsilateral PCM and TM, either for patients with left or right vocal fold paralysis ( p > .05). Finally, all the IVCP patients were subdivided into two subgroups according to different disease course (less than or more than 3 months), and in each subgroup, the comparison of voice indicators and LEMG results in IVCP patients with left or right vocal fold paralysis were similar with the above findings ( p > .05). Conclusion Overall, the degree of RLN and SLN damage appeared to be similar in IVCP patients with left and right vocal cord paralysis, provided that the disease course was comparable. Level of Evidence 4.
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