Chronic Rhinosinusitis
Chronic Hypertrophic Rhinitis
Chronic Otitis Media
Laryngocarcinoma
Nasopharyngeal Carcinoma
Adenoid Hypertrophy
Chronic rhinosinusitis is a chronic inflammatory disease to the mucous membrane of the nasal sinuses with a course of over 12 weeks. As a common disease in ENT, head and neck surgery, its main symptoms are nasal congestion, running nose and face swelling.
Chronic hypertrophic rhinitis developes mostly from chronic simple rhinitis, characterized by localized or diffuse hyperplasia and hypertrophy of the nasal mucosa, submucosa, and even bones.
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Two types of chronic otitis media: chronic non suppurative otitis media (chronic secretory otitis media) and chronic suppurative otitis media.
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Malignant tumors occurring in the larynx are commonly seen in the middle-age and elderly male, with manifestation of hoarseness, foreign body sensation, cough, etc.
As the main treatment method for laryngeal cancer, different surgical methods are selected based on comprehensive factors such as the scope of the lesion, the patient's overall condition, and the presence or absence of lymph node metastasis, in order to achieve radical resection of the tumor.
Plasma surgery for early vocal cord cancer is suitable for patients with glottic cancer and no cervical lymph node metastasis. Due to the advantages of operating under low temperature, it can better protect the laryngeal mucosa, shorten the postoperative recovery time, reduce postoperative pain, and achieve better voice recovery.
The adenoid is located in the posterior wall of the top of the nasopharynx and resembles a half peeled orange with a uneven surface. Pathological hypertrophy due to various reasons, which can cause symptoms such as nasal congestion, open mouth breathing, sleep snoring, and sleep apnea, is called adenoidal hypertrophy, and is a common disease in children.
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Etiology and Epidemiology

Sinusitis that has not been immediately treated or has not been completely cured, as well as by anatomical variations, bacterial and fungal infections, allergies, ciliary movement disorders, and iatrogenic factors. In addition, its onset is also closely related to genetic, environmental, and other factors.

Chronic rhinosinusitis is a common in ENT, head and neck surgery. According to a epidemiological survey, around 8 out of every 100 Chinese suffer from chronic rhinosinusitis.
Symptoms
The main manifestations are nasal congestion, purulent nasal discharge, facial distension and pain, and olfactory dysfunction. Some may also experience symptoms such as dizziness, loss of appetite, fatigue, and insomnia.
Surgical Treatment Options
FESS (Functional Endoscopic Sinus Surgery)
Upon failure of conservative treatment such as medication, patients may choose surgical treatment to achieve the goal of clearing the diseased tissue, correcting anatomical variations, reconstructing nasal and sinus ventilation and drainage, and restoring nasal function. Doctors may open the nasal sinuses under nasal endoscope to remove diseased tissues such as nasal polyps. They can also correct deviation of the nasal septum, correct anatomical variations, and help reconstruct ventilation and drainage of the nasal cavity and sinuses.
Balloon Sinuplasty
With the nasal endoscope, a small and soft balloon is placed into the nasal sinus passage, and the expansion of the balloon may restore the narrowed or blocked passage due to inflammation to its original size, allowing air to smoothly enter the nasal sinus. Then, saline is used to flush the sinus cavity to complete the ventilation and drainage of the nasal sinus. The advantages of sinus balloon dilation include minimal trauma, minimal mucosal destruction, and minimal bleeding. It reduces postoperative adhesion and restenosis of the opening, and significantly reduces the number of debridements required after surgery, thereby improving the cure rate of chronic sinusitis. Moreover, it does not cause any damage to the bone of the skull base and orbit, and has high safety.
Etiology


Chronic hypertrophic rhinitis refers to hyperplasia and hypertrophy of the nasal mucosa, even the periosteum, and the turbinate bones, which mostly develops from chronic simple rhinitis.
Symptoms
Hypertrophic rhinitis transfers from simple rhinitis, thus sharing the same general but more severe symptoms of hypertrophic rhinitis as simple rhinitis. Outstanding symptom would be nasal congestion, which changes from intermittent or alternating episodes of simple rhinitis to persistent nasal congestion. Due to nasal obstruction, various odors in the air won’t reach the olfactory zone, and the sense of smell is significantly impaired. Chronic hypertrophic rhinitis can affect the eustachian tube leading to the middle ear, causing patients to experience tinnitus and hearing loss. In severe cases, the posterior end of the inferior turbinate blocks the pharyngeal opening of the eustachian tube, which can lead to tinnitus and hearing loss. Nasal congestion often causes people to breathe through the mouth. Due to long-term oral breathing and the stimulation of backflow of nasal mucus, the throat is often tired and inflamed, causing dry throat, sore throat, foreign body sensation or itching in the throat, causing bursts of dry cough and hoarseness. Swelling of the nasal mucosa inevitably impedes the drainage of the nasal sinus openings, which often leads to sinus inflammation. This type of patient often has symptoms such as headache, dizziness, insomnia, and memory loss. Especially when the hypertrophy of the middle turbinate presses the nasal septum, trigeminal neuralgia can occur, which is even more painful and annoying.
Treatments
Various treatments for chronic hypertrophic rhinitis: medication, surgical treatment, laser therapy, microwave therapy, plasma radiofrequency ablation, etc. Ultilizing low-temperature plasma radiofrequency ablation to the inferior turbinate may reduce the volume of the inferior turbinate and improve nasal ventilation.
Etiology and Epidemiology

Chronic secretory otitis media is mainly caused by eustachian tube dysfunction, infection, immune response, and pressure damage.

Chronic suppurative otitis media is closely related to the persistence of acute suppurative otitis media, adjacent organ lesions, low immunity, and dysplasia of the mastoid process.

Secretory otitis media has a high incidence rate in children, which is one of the common causes of hearing loss in children.

According to foreign statistics, more than 50% of infants suffer from secretory otitis media, most of which recover within 3 months. According to statistics, in developing countries, the incidence rate of chronic suppurative otitis media in children is 1.3%~10.6%.

Surgical Treatment Options
Chronic Secretory Otitis Media
1. Tympanocentesis
Puncture the tympanic membrane and extract the effusion.
2. Tympanotomy or tympanotomy + tube insertion
For patients with thick fluid, inability to absorb it completely by tympanic membrane puncture, and rapid formation and accumulation of fluid after repeated puncture, tympanotomy + tube insertion should be performed. The retention time of the ventilation pipe varies, generally not exceeding 3 years.
When adults are found to have granulation or adhesions in the tympanum or mastoid process after various treatments described above are ineffective, tympanic exploration or simple mastoidectomy should be performed. After thorough removal of the diseased tissue, tympanoplasty should be performed according to different conditions.
Chronic Suppurative Otitis Media
Surgical treatment may be considered for patients with chronic suppurative otitis media:
If there are granulation or polyps in the middle ear, or there are no obvious granulation or polyps under the electrootoscope, but the treatment is not effective after regular medication, and CT shows lesions in the mastoid process, upper tympanum, etc., tympanic exploration should be performed to remove the lesions, improve drainage, and then perform tympanoplasty.
If otitis media has been completely absorbed and left with central perforation of the tympanic membrane tension, simple tympanoplasty is feasible.
Other treatments
For chronic secretory otitis media caused by eustachian tube obstruction, a balloon catheter can be inserted through the patient's nose or oropharynx under endoscope to expand the cartilage of the eustachian tube. This method is simple, safe, and effective. After surgery, eustachian tube ventilation training should be carried out, with both nostrils pinched, the mouth tightly closed, and puffing movements performed (please consult a doctor for specific training time and frequency). Balloon dilation can restore normal eustachian tube function, restore ear pressure balance, and remove the feeling of “ear tightness”.
Etiology and Epidemiology
It may be related to viral infection, genetics, tobacco and alcohol addiction, etc.
Laryngeal cancer is more common in the head and neck cancer family, ranking third. The incidence rate is 2.1/100,000, accounting for 1%~5% of the total malignant diseases. The case fatality rate of laryngeal cancer is 1.1/100,000.
Clinical Symptoms
Early Symptoms
Hoarseness is a possible early symptom in patients with laryngeal cancer, but this symptom is not specific and is often ignored. The typical symptoms of different laryngeal cancers are those that grow on the vocal cords, often causing changes in pronunciation and sound, such as hoarseness; Laryngeal cancers that do not directly grow on the vocal cords often have no sound changes, and hoarseness occurs only after the tumor invades the vocal cords. The early symptoms of laryngeal cancer that grows on the glottis are not obvious, and there may be throat discomfort, throat pain, and foreign body sensations that persist.
There may be other manifestations like:
·Persistent cough;
·Painful swallowing;
·Dysphagia;
·Pains on the neck or behind the ear;
·Dyspnea.
Sometimes patients have no symptoms of the throat and seek medical attention only because of a neck mass.
Surgical Treatment Options
As the main treatment method for laryngeal cancer, different surgical methods are selected based on comprehensive factors such as the scope of the lesion, the patient's overall condition, and the presence or absence of lymph node metastasis, in order to achieve radical resection of the tumor.
Plasma surgery for early vocal cord cancer is suitable for patients with glottic cancer and no cervical lymph node metastasis. Due to the advantages of operating under low temperature, it can better protect the laryngeal mucosa, shorten the postoperative recovery time, reduce postoperative pain, and achieve better voice recovery.
Etiology and Epidemiology
Basic causes:
EB virus infection: EB virus infects mainly human oral epithelial cells and B cells, integrating into the host cell DNA, preventing the apoptosis of infected cells, while activating their growth, causing nasopharyngeal carcinoma.
Precipitating factors:
Individual factors
It is most common in adults aged 40 to 50 years, and the incidence rate of men is higher than that of women.
Environmental factors
Nickel content in food and water is higher in areas with high incidence of nasopharyngeal carcinoma.
Dietary factors
Salted fish, cured meats, and other pickled foods are high-risk factors for nasopharyngeal carcinoma. During the pickling process, these foods can produce Class 2A carcinogens, nitrite, which can induce nasopharyngeal carcinoma.

The incidence rate is the highest in South China, while it is rare in North China. In 2018, there were more than 60,000 newly diagnosed cases of nasopharyngeal carcinoma in China. The prevelance in men is about 2.5 times in women, and it is more common at the age of 40~50.
Clinical Symptoms
In the early stage, nasopharyngeal carcinoma may not cause any symptoms, and when the symptoms are obvious, most patients have entered the advanced stage or advanced stage. Most patients have a lump in the neck as the first symptom. Patients with symptoms such as nasal discharge with blood, tinnitus, and nasal congestion in daily life are recommended to seek medical attention for a detailed examination of the nasopharynx.
Treatment Options
Radiotherapy
Nasopharyngeal carcinoma is very sensitive to radiotherapy, and radiotherapy is the first choice for its radical treatment. Early stage nasopharyngeal carcinoma can be cured by radiotherapy alone, while intermediate and advanced stage nasopharyngeal carcinoma usually requires a comprehensive treatment mode of radiotherapy combined with chemotherapy to achieve better efficacy. With the addition of comprehensive treatment modes such as chemotherapy and targeted therapy, the overall efficacy of nasopharyngeal carcinoma, especially in terms of local control rate, has been greatly improved, with a 5-year overall survival rate of up to 80%. However, some patients still face the risk of recurrence or metastasis, which is also an urgent need to be addressed in the current treatment of nasopharyngeal carcinoma.
Surgical Treatment
Surgical treatment can be used as a choice for the treatment of local radiotherapy failure or local recurrence of nasopharyngeal carcinoma. Currently, the commonly used endoscopic resection of nasopharyngeal carcinoma has the characteristics of direct surgical path, clear surgical field illumination, flexible visual angle, and minimally invasive. The curative effect is the same as that of traditional surgery, but the survival rate and quality of life of patients treated with this surgery are higher, with significantly fewer complications, especially reducing the mortality associated with late complications in patients.
Etiology and Epidemiology
Adenoid hypertrophy can be caused by a variety of reasons, such as tonsils or adjacent nasal cavities, sinusitis, chronic irritation of nasal purulent secretions, allergic reactions, excess nutrition, eating disorders, etc. It can also be caused by the enlargement of the pharyngeal tonsils at birth, ultimately leading to pharyngeal tonsil hypertrophy.
Epidemiological survey shows that the incidence rate of children under 10 years old is between 5% and 10%.
Clinical Symptoms
When hypertrophy of the pharyngeal tonsils occurs, there may be early symptoms of open mouth breathing, which may lead to dry mouth and bad breath, dry lips, runny nose, etc. There are also mid to late stage symptoms such as rough breathing, snoring during sleep, restlessness in sleep, ear and nose infections, and may even lead to severe facial deformities and systemic symptoms. Delayed or inappropriate treatment can seriously harm children's physical and mental health.
Surgical Treatment Options
Traditional surgery involves the removal or scraping of adenoids through a scalpel and adenoidectomy. Currently, low-temperature plasma radiofrequency ablation has become the main surgical method due to its advantages of simple operation, less intraoperative bleeding, less mucosal damage, rapid postoperative recovery, and low recurrence rate. Generally, children with adenoid hypertrophy may be accompanied by varying degrees of tonsillar hypertrophy. If adenoid and tonsillar hypertrophy are most prominent, they can generally be considered for resection together.