Background and Clinical Significance: Intranasal foreign bodies are common pediatric otolaryngologic emergencies and are usually diagnosed and removed without difficulty. However, delayed or occult retention may mimic chronic unilateral sinonasal disease and occasionally result in severe inflammatory or infectious complications. This study presents three illustrative pediatric cases of delayed intranasal foreign bodies supported by a seven-year institutional experience. Case Presentation: A retrospective review was conducted of all pediatric patients (≤16 years) presenting with intranasal foreign bodies at a secondary referral hospital between January 2019 and May 2026. Demographic characteristics, clinical presentation, management, and outcomes were reviewed to provide institutional context. Among 82 identified patients, three children with delayed diagnosis and severe complications were selected for detailed presentation because they represented distinct clinical manifestations of prolonged foreign body retention. These included chronic unilateral rhinosinusitis caused by a retained peanut fragment, a medial orbital subperiosteal abscess secondary to a retained plastic nasal piercing component, and a foreign-body granuloma associated with retained nasal packing material. The remaining patients underwent uncomplicated removal, predominantly in the emergency department. Conclusions: The presented cases illustrate the diverse spectrum of complications that may occur following delayed intranasal foreign body retention in children. Persistent unilateral foul-smelling rhinorrhea, nasal obstruction, recurrent unilateral epistaxis, or refractory unilateral sinonasal symptoms should prompt careful evaluation for a retained foreign body. By combining detailed case descriptions with institutional experience, this report highlights the importance of maintaining a high index of suspicion and timely endoscopic management in children with persistent unilateral sinonasal symptoms.

We describe a case of sinonasal glomangiopericytoma (GPC), a rare perivascular tumour accounting for less than 0.5% of sinonasal neoplasms, presenting with refractory unilateral epistaxis. An anticoagulated male in his 60s required admission, nasal packing and unilateral left internal maxillary artery embolisation to achieve haemostasis.Following stabilisation, nasoendoscopy identified a vascular polypoid lesion arising high in the left nasal cavity near the olfactory cleft. MRI demonstrated a contrast-enhancing mass abutting the cribriform plate without orbital or skull-base invasion, which had not been recognised on prior imaging. Endoscopic biopsy confirmed GPC, followed by endoscopic resection at a tertiary skull-base centre.Postoperative recovery was uncomplicated, with early resolution of epistaxis and safe recommencement of anticoagulation. However, the tumour was transected at the surgical margin, indicating incomplete or margin-uncertain excision and requiring close surveillance for residual or recurrent disease. This case highlights a rare cause of refractory unilateral epistaxis and illustrates the importance of diagnostic vigilance, multidisciplinary management and the potential role of embolisation in selected high-risk patients.

Schneiderian inverted papilloma is a benign, locally aggressive tumor that typically arises in the respiratory mucosa of the nasal cavity and paranasal sinuses. These tumors are often asymptomatic but can cause unilateral nasal obstruction, discharge, hyposmia and epistaxis. They warrant attention particularly due to the potential for malignant transformation. They are treated most often with surgical excision. This case report describes a patient with Schneiderian inverted papilloma arising outside its usual location and managed with definitive radiation therapy instead of surgical excision due to concerns for functional impairment. Remission was obtained with radiation therapy, although the patient experienced treatment-related side effects.

DEK::AFF2 fusion‑positive sinonasal tract and skull base nonkeratinizing squamous cell carcinoma (DEK::AFF2 SCC) is a rare and recently recognized entity; however, its clinicopathologic and demographic features remain incompletely defined. We aimed to further refine and supplement the characterization of this entity. We retrieved institutional pathology records and identified 50 DEK::AFF2 SCCs at a single institution (2009-2025). The cohort included 20 males and 30 females aged 18-74 years (median, 50.5 y). The most common presenting symptoms were nasal obstruction and epistaxis. The predominant primary site was the paranasal sinus, followed by the nasal cavity and nasopharynx. Histologically, most tumors exhibit mixed exophytic and endophytic growth patterns, complex anastomosing trabeculae, monotonous cytomorphology, acantholytic changes, and tumor-infiltrating neutrophils. High-grade histologic features and infiltration were observed in 24% of the cases; 6% presented features resembling mucoepidermoid carcinoma, and 4% presented an ameloblastoma-like appearance. Immunohistochemically, more than 70% of the cases coexpressed squamous and glandular markers. The recurrence rate was 59.2%, the lymph node metastasis rate was 24.5%, the distant metastasis rate was 20.4%, and the disease‑related mortality rate was 24.5%, with a median follow-up period of 71 months (range, 5-235 mo). This study expanded the histologic spectrum of DEK::AFF2 SCC and demonstrated its aggressive behavior, highlighting the need for accurate differentiation from mimics and long‑term surveillance.

The common causes of epistaxis in children are mostly local mucosal dryness, trauma, or inflammation, while epistaxis caused by leech infestation is clinically rare and easily overlooked. This article reports a case of epistaxis in a child due to leeches and, combined with a literature review, analyzes its clinical characteristics and key points of diagnosis and treatment. Children often present with recurrent unilateral epistaxis, nasal obstruction, and a feeling of insect crawling, and most have a history of exposure to natural water. The diagnosis of epistaxis due to nasal hirudiniasis mainly relies on the detection of leeches through anterior rhinoscopy or endoscopic examination, and it is necessary to differentiate it from the common causes of epistaxis. The primary treatment is the thorough removal of leeches, supplemented by nasal irrigation or anti-infective measures. This study emphasizes that in endemic areas or in the context of relevant exposure history, leech infestation should be included in the differential diagnosis of intractable epistaxis in children to improve clinical vigilance and avoid misdiagnosis or missed diagnosis.

The meta-analysis and systematic review evaluated the efficacy and safety of balloon dilatation of the eustachian tube (BDET) in children with eustachian tube dysfunction. The PubMed, Cochrane Library, and ScienceDirect databases were searched in depth to identify relevant studies, and eight retrospective cohort studies were selected. A total of 652 patients were included in these studies. There were no serious complications, and only minor, self-limiting adverse events were seen, the most common of which were epistaxis and a patulous eustachian tube. The primary result was an improvement in the type of tympanogram, and the secondary results were the risk of failure and complications. The pooled analysis of seven studies showed that 64% (95%CI: 50-78%) of cases demonstrated improvement in tympanogram following BDET. However, heterogeneity was high (I² = 90.7%). The pooled failure rate, based on four studies, was 13% (95%CI: 1-17%). Although the evidence on the efficacy and safety of BDET in pediatric patients is encouraging, the overall quality of evidence is limited by the retrospective nature of the included studies, the absence of control groups, and inconsistent outcome measures. These results indicate that BDET may be a useful, minimally invasive procedure for treating eustachian tube dysfunction in children. However, more specific randomized controlled trials with standardized outcome measures are needed to clarify the treatment's long-term effectiveness and its role in clinical practice.

ObjectivesTo report a diagnostically challenging case of refractory epistaxis in a 16-year-old male that mimicked juvenile nasopharyngeal angiofibroma (JNA), and to highlight critical perioperative lessons regarding coagulation disorders and postoperative wound healing.MethodsDetailed clinical, radiologic, surgical, pathologic, and hematologic data were reviewed.ResultsAn adolescent male presented with recurrent unilateral epistaxis and nasal obstruction. Imaging demonstrated a mildly enhancing posterior nasal mass, and laboratory testing revealed a persistently prolonged activated partial thromboplastin time (APTT). Based on a presumptive diagnosis of JNA, preoperative embolization followed by endoscopic resection was performed. Histopathology revealed an angiomatous nasal polyp. Despite adequate intraoperative hemostasis, the patient developed recurrent postoperative epistaxis refractory to repeated surgical exploration and nasal packing. Comprehensive coagulation studies ultimately demonstrated markedly reduced factor VIII activity, confirming moderate hemophilia A. Sustained hemostasis was achieved only after recombinant factor VIII replacement combined with prolonged, atraumatic nasal compression. No recurrent bleeding occurred during follow-up.ConclusionAngiomatous nasal polyp in adolescent males may closely mimic JNA, particularly when compounded by an unrecognized coagulation disorder. In patients with persistent APTT prolongation, postoperative epistaxis may reflect impaired wound healing rather than inadequate surgical hemostasis. Early hematologic evaluation and appropriate factor replacement are essential to prevent repeated unnecessary surgical interventions.

Olfactory neuroblastoma is a rare neuroendocrine tumor typically arising from the superior nasal cavity, and primary occurrence in the maxillary sinus is exceptionally uncommon, often leading to diagnostic confusion with other sinonasal malignancies. A 34-year-old man presented with bilateral nasal obstruction, recurrent epistaxis, and frontal headache, and imaging revealed a right maxillary sinus mass. Initial endoscopic biopsy suggested a differentiated neuroendocrine tumor, but whole-body octreotide scintigraphy was negative. The patient underwent endoscopic endonasal medial maxillectomy with complete tumor resection. Final histopathology demonstrated small round blue cells in lobular architecture, strong chromogranin and synaptophysin positivity, absence of mitoses or necrosis, and a low Ki-67 index, confirming Hyams grade I olfactory neuroblastoma. Adjuvant intensity-modulated radiotherapy was administered. The postoperative course was uneventful, and at 12-month follow-up there was no evidence of recurrence or metastasis. This case highlights that ectopic maxillary sinus olfactory neuroblastoma can mimic neuroendocrine carcinoma on limited biopsy, emphasizing the importance of complete resection and thorough histopathological evaluation for accurate diagnosis and grading. Hyams grade I disease in atypical locations carries an excellent prognosis with combined endoscopic surgery and radiotherapy, underscoring the prognostic value of Hyams grading and the need for long-term surveillance.