Treatment of chronic nasopharyngitis with monopolar suction diathermy

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Introduction

Chronic nasopharyngeal infection is rare. In clinical practice, patients present complaining of crusts and/or discoloured mucus streaming down the back of the throat, which they cough up. Endoscopically, a central area of crusting in the midline of the nasopharynx can be visualised. Infection of Tornwaldt's bursa has been implicated.¹ This condition has also been described as chronic adenoiditis.¹

To our knowledge, no effective medical or surgical treatment for chronic nasopharyngitis has previously been described. This report documents our experience of using suction ablation diathermy in this clinical setting.

Patients and methods

We performed a prospective review of four patients aged 23-65 years (two men and two women) who presented with chronic nasopharyngitis. Patients typically presented complaining of post-nasal mucus, and reported coughing up infected mucus and/or small crusts. Symptoms generally improved with antibiotics, only to relapse soon after treatment was ceased.

Nasopharyngeal bacteriology culture swabs grew Staphylococcus aureus (two patients), Klebsiella oxtoca and a heavy growth of mixed bacterial species. All four patients had normal sinus computed tomography scans and normal sinus nasendoscopy appearances. None had undergone previous radiotherapy. Two patients had undergone previous, unsuccessful endoscopic sinus surgery for their condition.

Initial medical management consisted of regular saline irrigation plus a 14-day course of doxycycline 100 mg daily combined with rifampicin 200 mg twice daily. When this proved unsuccessful, patients subsequently received a four-week course of omeprazole 40 mg daily, also unsuccessfully. Given these treatments' lack of success, surgery was undertaken.

Surgical technique

As the technique described below...