Introduction: The purpose of this study was to investigate whether patient, tumor and radiation therapy factors are associated with development of middle ear effusion (MEE) in nasopharyngeal carcinoma (NPC) patients. Methods: A retrospective review of NPC patients treated between January 2000 and June 2018 at Rabin Medical Center. Patient factors, tumor factors, radiation doses and radiation fields were collected and outlined if needed (middle ear, eustachian tube (ET), tensor veli palatini (TVP) and levator palatini (LVP) muscles), then analyzed and compared between patients with MEE and those without and between sides in patients with unilateral MEE. Results: 73 patients were enrolled. Most were males (71.2%) with advanced stage diseases (78%). At the time of diagnosis 14 patients (19.2%) presented with MEE and in 18 (24.6%) patients post radiation MEE was observed (15 ipsilateral to the tumor and 3 bilateral). Tumor stage, histology and laterality were not associated with development of MEE. Comparison of mean radiation field dosages including - gross target volume (GTV), clinical target volume (CTV) and patient target volume (PTV) showed no association with post radiation MEE. In addition, no difference was found in the radiation doses to the middle ear, ET or the LVP nor the TVP between ears with and without MEE. Conclusions: Postirradiation MEE remains a common adverse effect in NPC patients. Surprisingly, tumor stage, tumor laterality and histology were not associated with MEE. Similar findings were observed for total radiation doses and specific doses to the middle ear, ET and ET muscles.

Objective: To describe the occurrence, clinical presentation and management, of pediatric nasal foreign bodies, and to assess various risk factors for complications. Methods: A retrospective analysis of a computerized patient directory of 562 children admitted to the emergency department (ED) in a tertiary pediatric hospital during a 10-year period (Jan 2010-Dec 2019), with a witnessed NFB upon physical examination. Results: Upon admittance to the ED, most of the children (82%) were asymptomatic. Among the symptomatic children (18%), the primary symptoms were nasal discharge (10%), epistaxis (8%) and pain (4%). Younger children (under age 4 years) were more likely to insert organic materials, compared to older children. Younger children were also admitted sooner to the ED and were more likely to present with nasal discharge. The overall complication rate was 5%. None of the children had aspirated the NFB. Complications included infection (2%), necrosis (0.7%), septal perforation (0.5%), deep mucosal laceration (1.5%) and loss of NFB (1.9%). Significantly higher rates of symptoms and complications were associated with button batteries. Increased risk for complications were observed according to NFB-type, multiple attempts to remove NFB, posterior insertion of NFB and left-side insertion. Conclusions: NFB in children are common. Mostly, patients are asymptomatic, therefore a high index of suspicion is required, for quick diagnosis and safe removal, without complications.