ENT manifestation in COVID-19 patients

Objectiveto detect, analyze and discuss the different ear nose throat (ENT) manifestations those were reported in COVID19 positive patients in the reviewed and published literatures.MethodsWe performed a search in the PubMed databases, Web of Science, LILACS, MEDLINE, SciELO, and Cochrane Library using the keywords; COVID-19, Novel coronavirus, corona, 2019-nCoV, SARS-CoV-2, ENT, ear, nose, throat, otorhinolaryngology, ORL, pharynx, ORL, smell, larynx, different ENT related symptoms. We reviewed published and peer reviewed studies that reported the ENT manifestations in COVID-19 laboratory-confirmed positive patients.Resultswithin the included 1773 COVID-19 laboratory-confirmed positive patients, the most common ENT manifestations of COVID-19 were sore throat (11.3%) and headache (10.7%). While the other reported ENT manifestations were pharyngeal erythema (5.3%), nasal congestion (4.1%), runny nose or rhinorrhea (2.1%), upper respiratory tract infection (URTI) (1.9%), and tonsil enlargement (1.3%).ConclusionENT manifestations for COVID-19 are not common as fever and cough. But, a universal questionnaire using well-defined COVID-19 manifestations is needed to make the COVID-19 data precisely defined, complete and homogenous.     

Foreign bodies in the ear,nose, and throat in Japan: association with sociocultural and geographical conditions

ObjectiveForeign bodies (FBs) in ear, nose, and throat (ENT) are common ENT emergencies but are sometimes life-threatening. However, FBs could be avoidable by the efficient announcement about the risk of these occurrence to the public. Fish bones are commonly found as throat FBs, and small toys are commonly found as pediatric ear and nose FBs. We hypothesized that there were relationships between the occurrence of FBs and sociocultural/geographical conditions. The purpose of this study is to clarify the risk factors of FBs in ENT regions related to eating customs and weather conditions.MethodsFrom April 2009 to March 2014, 94,479 patients visited the Chuo Emergency Clinic (CEC) in Osaka, which is a local emergency center for Osaka prefecture in Japan. Among them, 3229 patients with throat FBs, 577 children (0–15 years of age) with ear FBs, and 1999 children (0–15 years of age) with nose FBs were enrolled into the present study. Monthly trends in the number of throat FBs were examined in relation to fish eating customs. The monthly average of the daily ratio of pediatric patients with ear or nose FBs to the total number of patients were examined in relation to weather parameters using a database of the Japan Meteorological Agency.ResultsThe incidence of throat FBs was significantly higher in July and January (p < 0.05, analyzed by ANOVA and Tukey–Kramer test), presumably because Japanese people have more chances to eat fish in these months due to the traditional fish-eating customs. There was also a significant correlation between the number of pediatric patients with ear and nose FBs and the bad weather parameters including daily rainfall (r = 0.76, p = 0.0043; r = 0.57, p = 0.050, respectively, analyzed by the Pearson product-moment correlation coefficient). This is because children would spend longer time inside on rainy days, which increases the chance of putting a small toy part in the ear and nose.ConclusionsFBs in throat and ear/nose occurred more frequently in the specific periods to eat fish and rainy days, respectively. Therefore, public announcement on the risk of occurrence of FBs based on sociocultural and geographical data is helpful to prevent FBs.     

ENT presentations in children with HIV infection

Illnesses of the ear, nose and throat (ENT) are common in children with human immunodeficiency virus (HIV) infection. We reviewed the case files of 107 HIV seropositive children in the paediatric HIV unit at St Mary's Hospital. The prevalence, age of onset and type of ENT disease were reviewed. We also determined sex distribution, maternal country of origin and mode of transmission of HIV. Fifty per cent of the HIV children had ENT illnesses. Fifty-five per cent of the children presented with their first ENT symptom before age 3 years with 98% of the children having ENT manifestations by age 9 years. The commonest ENT diseases were cervical lymphadenopathy (70%), otitis media (46%), oral candidiasis (35%) and adenotonsillar disease (31%). HIV transmission was vertical in 90%. Maternal country of origin was Africa in 70% and the UK in 13%. Compared with previous studies, the proportion of HIV children with ENT problems appears to have decreased. Although our figures report a similar ENT symptom profile, the age at onset of these symptoms has increased.     

Rhinometry: Spectrum of nasal profile among Nigerian Africans

Nasal parameters measurements are useful in anthropology to distinguish people into racial and ethnic groups.Materials and methodsA cross-sectional survey among Nigerians aged 18 to 70 years of Nigerian parentage randomly selected at the ENT Clinic of the University of Ilorin teaching hospital (U.I.T.H.), Ilorin, Nigeria without gender discrimination had measurement of their nasal parameters done using a sliding caliper: Nasal height, width, tip protrusion, alar thickness, nasal septal thickness and nares diameter.Results105 subjects were seen, the age range 18 to 70 years (mean of 28.63 + 13.06 years). There was 58 males and 47 females with a male/female ratio of 1.2:1. The mean nasal width/height (Nasal index -NI) was 90.7 in males and 88.2 in females. Males had a higher NI compared to female (p < 0.03). The commonest type of nasal variability is Type A (70.5%), Platyrrhine nose, Type B (26.7%) especially in females (mesorrhine) and Type C (leptorrhine) (2.8%).ConclusionsThere is significant association between the sex of an individual and type of Nose. Platyrrhine nose, among males and mesorrhine among females, only 2.8% being leptorrhine. The nasal indices were higher in males than in females.     

Current healthcare pathways in the treatment of rhinosinusitis in Germany

Abstract

Background: In the outpatient setting in Germany, patients with rhinosinusitis usually present at general practices (GP) or ear, nose, and throat practices (ENT) for initial diagnosis and treatment.

Objectives: The aim of this study was to analyze the referral patterns of rhinosinusitis patients in GPs and ENT practices in Germany, with respect to existing recommendations.

Material and methods: The study sample included patients from 940 GP and 106 ENT practices from Disease Analyzer database (IQVIA) who received an acute sinusitis (AS) or chronic sinusitis (CS), or nasal polyp (NP) in 2015.

Results: The total numbers of patients in GP versus ENT practices were 24,648 versus 12,095 (AS), 26,768 versus 19,826 (CS), and 516 versus 1773 patients (NP). Referrals to ENT practices were made by GP in 12.3% (AS), 14.8% (CS), and 40.5% (NP). The percentages of patients in GP versus ENT practices with subsequent hospital admissions were 6.9 versus 3.3% (AS), 6.3 versus 6.5% (CS), and 9.5 versus 13.8% (NP), respectively.

Conclusions: Although 40% of patients with NP who consult GPs are referred to ENT practices, it remains unclear how the other 60% are being treated. The hospital admission rates of patients with CS as well as of patients with NP were found to be surprisingly low.     

Unusual otolaryngological manifestations of certain systemic bacterial and fungal infections in children

ObjectiveSystemic bacterial and fungal infections may sometimes present local manifestations within otolaryngological district whose early detection may be useful in establishing a correct diagnosis and more appropriate treatment. This paper reviews certain systemic bacterial and fungal diseases presenting ENT manifestations in the pediatric population from an otolaryngological perspective.MethodsA medline searching for specific issues was performed in order to achieve more information as possible with regards to ENT manifestation of systemic bacterial and fungal infections. Limits for pediatric age were used. Two separate sections for bacterial and fungal disease are included. The section on systemic bacterial infections considers cat-scratch disease, Lyme borreliosis, actinomycosis, Lemierre's syndrome and congenital syphilis, and the section on systemic fungal infections includes candidiasis, aspergillosis and histoplasmosis.ConclusionsPediatricians and ear, nose and throat (ENT) specialists, approaching head and neck disorders in children, should therefore consider them among the possible differential diagnoses. This means that physicians need to recognize the first head and neck manifestations of systemic infections promptly in order to be able to treat them efficaciously and avoid the dangerous systemic spreading of the infective process.     

Does the prevalence of otolaryngological diseases in deaf children differ from children without hearing impairment?

There is no enough data about the prevalence of otorhinolaryngological (ORL) diseases in deaf children. In this study, we aimed to determine the prevalence of ORL diseases among deaf children and compare children from a school for the deaf with those attending regular primary schools for the presence of ear, nose and throat (ENT) problems. The subjects were 1,282 children attending three primary schools in the province of Duzce and 572 hearing-impaired children from eight schools for the deaf. Following ENT examinations, ORL findings were statistically compared between two groups using a Chi-square test and P values less than 0.05 were considered significant. Upper airway pathologies including chronic tonsillitis, rhinitis, septal deviation and tubal dysfunction, and chronic otitis media (COM) were found to be statistically higher in deaf children than in children without hearing impairment. Although the incidence of middle ear effusion was found to be higher in deaf children, it was not statistically significant. On the other hand, the incidence of impacted wax was lower in deaf children than others. In conclusion, we should have enough data on the prevalence of ORL diseases in deaf children to give a clue to help prevent ORL diseases and if we can detect them early, we can solve the problems before they become more complicated and we can rehabilitate these children better.     

Nasal injury management: an audit of accident and emergency practice

Nasal injuries are commonly assessed in the accident and emergency (A&E) departments. Where swelling precludes assessment of deformity, patients are often referred to the ear, nose and throat (ENT) outpatients once the swelling has subsided. However, not all of these pateints require referral. Patients with no deformity, or those in whom there is no deformity after any swelling has subsided, do not need further assessment. The purpose of this audit was to assess the impact of a nasal injury management guideline on nasal injury referrals to the ENT department. An audit was made of nasal injury referrals seen in ENT outpatients, before and after the introduction of a guideline. The proportion of patients seen in ENT outpatients not requiring any ENT treatment after the introduction of the guideline was reduced. We suggest that our guideline can reduce unnecessary ENT outpatient appointments for patients with nasal injuries and may prevent delayed ENT input for those with new onset nasal deformity.     

Physiological changes in ENT during pregnancy

Although a number of changes occur in ear, nose, throat during pregnancy, yet these changes are neglected because majority of these changes go away after the pregnancy is over. Almost every corner of ENT is effected during pregnancy e.g., ear, nose, larynx (voice), oesophagus, thyroid etc. This paper deals with the various physiological changes in ENT during pregnancy and the worsening of symptomatology of various ENT ailments during pregnancy. These physiological changes are mainly due to the changing levels of estrogens and progesterone hormones during pregnancy. Many of these changes lead to symptomatology referable to head & neck and various disorders managed by otolaryngologist are more prevalent during pregnancy. A thorough understanding of these various effects of pregnancy is mandatory for an otolaryngologist to treat these disorders.     

Ear, nose and throat foreign bodies in Melanesian children: an analysis of 1037 cases

OBJECTIVE: Occurrence of foreign bodies (FBs) in ear, nose and throat (ENT) in children are not uncommon in clinical practice. We described our experience with ENT foreign bodies in Melanesian children. METHOD: The study was carried out at the tertiary referral center which is also a University teaching hospital. The 15-year period from 1990 to 2004, 1037 cases of ENT foreign bodies were managed. The clinical, operative and follow up data of these patients were collected from available clinic cards and admission charts. A retrospective analysis was made with these data. RESULTS: Foreign bodies in the external auditory canal constituted 711 (68.6%) cases. It was followed by nose in 258 (24.9%), pharynx in 26 (2.5%), esophagus in 21 (2.0%) and laryngotracheobronchial (LTB) tree in 21 (2.0%) cases. Innumerable varieties of foreign bodies were removed from the ear. The common ones were stones in 277 (39.0%), seeds in 142 (20.0%), plastic ornament beads in 70 (9.8%) and cotton in 48 (6.8%) cases. Six hundred and thirteen (86.2%) of them were removed under microscope at the clinic without any complications. The difficult ones in uncooperative children were removed in the operation theatre. They numbered 98 (13.8%). The nasal foreign bodies were exclusively limited up to the age of 12 years. Common nasal foreign bodies were foam in 54 (20.9%), seeds in 51 (19.8%), stone in 28 (10.9%) and ornament beads in 24 (9.3%) cases. Two hundred and forty-six (95.3%) of them were removed in the clinic. Only 12 (4.7%) were removed in the operation theatre. Fishbone was the commonest (23, 90.2%) foreign body encountered in the pharynx of the children. Coins were the exclusive esophageal foreign bodies in children and all were removed in the operation theatre under general anesthesia. In the LTB tree the FBs were mostly localized to the right main bronchus which occurred in 11 (52.4%) cases. This was followed by the trachea in four (19.1%) cases. The different types of FBs encountered were coffee beans in eight (38.0%), peanuts in five (23.8%), plant seeds in three (14.2%) cases. We encountered two mortalities in these LTB FB patients. CONCLUSIONS: Otolaryngological foreign bodies in children are common. For early diagnosis a high index of suspicion has to be maintained by pediatric otolaryngologist.     

Epidemiological considerations and clinical features of ENT tuberculosis

Between 1 April 1996 and 30 June 1997, 1003 ear, nose and throat (ENT) outpatients and 340 inpatients diagnosed as having pulmonary tuberculosis were analysed for ENT manifestations of tuberculosis to determine the relationship to sputum positivity, whether any high risk factors exist for the ENT manifestations as compared to other pulmonary tuberculosis patients, and the response to anti-tubercular treatment. The commonest ENT manifestation was found to be laryngitis (seven cases), which was more common in pulmonary tuberculosis patients (five out of seven), all except one of whom were sputum negative. All of these patients were defaulters from anti-tuberculosis treatment or relapse cases, and vocal cords were the commonest site of involvement. One case of tuberculous tonsillitis and one case of tuberculous mastoiditis were also noted. The practical implications of an awareness of ENT tuberculosis is a benefit of anti-tubercular therapy and hence conservative management usually suffices.     

Investigation for immunodeficiency in patients with recurrent ENT infections

Patients suffering with primary immunodeficiency frequently present to ear, nose, and throat (ENT) clinics, but the diagnosis is rarely made at this time. Early diagnosis of these patients would help to prevent morbidity and even mortality. Normal results from a simple panel of blood tests will exclude the commonest immune deficiencies. An abnormal result from these tests, or a strong suspicion despite normal initial testing, should prompt discussion with an immunologist.     

Investigation for immunodeficiency in patients with recurrent ENT infections.

Patients suffering with primary immunodeficiency frequently present to ear, nose, and throat (ENT) clinics, but the diagnosis is rarely made at this time. Early diagnosis of these patients would help to prevent morbidity and even mortality. Normal results from a simple panel of blood tests will exclude the commonest immune deficiencies. An abnormal result from these tests, or a strong suspicion despite normal initial testing, should prompt discussion with an immunologist.     

Ear, nose and throat manifestations of Wegener's granulomatosis (granulomatosis with polyangiitis)

Introduction and objectivesGranulomatosis with polyangiitis (GPA), previously called Wegener's granulomatosis, is a small vessel vasculitis often associated with clinical head and neck manifestations, which are sometimes the presenting symptoms of the disease. The aim of our study was to identify ear, nose and throat (ENT) manifestations associated with GPA and propose a work-up for the management and diagnosis for patients with suspicion or confirmed diagnosis of this ENT pathology.Patients and methodsRetrospective review of the medical records of all patients diagnosed with GPA who were seen at the Department of Otolaryngology from a tertiary public hospital in Cantabria (Spain) over a 20-year period. Clinical and laboratory data, in particular those concerning ENT manifestations, were retrieved from the patients’ medical records.ResultsTwenty-five patients (age range: 30-81 years) were included in the study. Of these, 88% had ENT manifestations at some point in the course of the disease. In 28% of the cases, ENT features were the presenting manifestations. The most frequent ENT manifestations were sinonasal symptoms (52%), followed by otological manifestations (32%).ConclusionsPatients with GPA often present with clinical ENT manifestations. Consequently, routine ENT physical examination must be performed in patients with suspected vasculitis to establish a diagnosis of GPA or to better determine the degree of organ system involvement in patients with GPA.     

3D打印技术在耳鼻喉科住院医师规范化培训中的应用探索

目的 观察3D打印技术在耳鼻喉科住院医师规范化培训中应用的效果,探讨其应用的可行性及有效性。 方法 结合耳鼻喉科住院医师规范化培训教学大纲要求,运用3D打印技术制作仿真模型,应用于规范化培训理论教学中,并在此基础上进行手术指导,完成实践教学。 结果 3D打印模型有助于住院医师形成空间立体概念,短时间内理解并掌握复杂的解剖结构,有效提高其手术技能,缩短培养周期。 结论 3D 打印技术在耳鼻喉科住院医师规范化培训中具有良好的应用前景。     

Detection of hypopharyngeal cancer (Tis,T1 and T2) by ENT physicians vs gastrointestinal endoscopists

ObjectivesHypopharyngeal cancer is typically detected at a late stage by ear, nose, and throat (ENT) physicians, when the prognosis is poor. We evaluated how hypopharyngeal cancer (Tis, T1 and T2) were detected by ENT physicians and gastrointestinal endoscopists (GEs) according to the detection reasons.Materials and MethodsA total of 109 consecutive patients with hypopharyngeal cancer (Tis, T1 and T2) who received treatment in our institution from January 2014 to February 2018 was enrolled. The detection detail of hypopharyngeal cancer lesions by ENT physicians and GEs, tumor size and location, and the characteristics of the lesions missed by ENT physicians and GEs were reviewed retrospectively.ResultsTwenty seven and 82 of 109 (24.8% and 75.2%) patients were detected by ENT physicians and GEs, respectively. The most frequent original reasons for ENT physicians and GEs were both pharyngeal discomfort screening and examination of swollen neck lymph nodes (12 of 27, 44.4% for each) and pre-treatment or follow-up screening for esophageal cancer (25 of 82, 30.5%), respectively. Among the 13 cases of upper gastrointestinal tract screening of the head-and-neck cancer other than pharyngeal cancer detected by GEs, 11 (84.6%) were missed by ENT physicians. In contrast, among the 25 cases of pre-treatment screening of the esophageal cancer detected by GEs, 12 (48%) were missed by other GEs just before the consultation from other institutions.ConclusionsThe percentage of detection of hypopharyngeal cancer (especially, Tis and T1) by ENT physicians is low. A careful examination of the pharynx should be conducted by GEs.     

COVID-19 Omicron variant-induced laryngitis

ObjectivesThe COVID-19 omicron variant has a low affinity for the lower respiratory tract. However, upper respiratory tract symptoms, such as nasal discharge and sore throat, characterize the infection with this variant. Therefore, in laryngeal stenosis, disease severity assessment through blood oxygen saturation has not been useful.MethodsWe report the case of “omicron laryngitis” in a 59-year-old male who visited the ear, nose, and throat (ENT) clinic with complaints of a sore throat and difficulty in swallowing saliva that persisted for a day.ResultsLaryngoscopy revealed severe swelling of the transglottic region and exudates on the larynx. He was then diagnosed with COVID-19 and subjected to emergency tracheostomy for airway management. Until the emergence of the omicron variant, COVID-19 showed mainly lower airway and mild upper airway inflammatory features. However, upper airway stenosis should be suspected in cases presenting with “muffled speech,” “dysphagia,” “severe pain on swallowing,” and “inspiratory dyspnea or stridor.”ConclusionTherefore, laryngeal and pharyngeal evaluation using a flexible laryngoscope under appropriate infection control measures is necessary, considering the possibility of progression to fatal laryngeal stenosis, as noted in this case.     

汶川大地震后送伤员耳鼻咽喉头颈部伤情分析与处理

目的 调查分析汶川大地震后送伤员涉及耳鼻咽喉头颈部伤情的特点以及救治原则.方法 对汶川大地震中的206例进行耳鼻咽喉专科拉网式筛查及检诊,调查耳鼻咽喉头颈部伤情、致伤原因,并及时予以救治.结果 206例伤员中,收入院伤员165例,伤员中合并耳鼻咽喉头颈部伤37例(22.4%),主要包括:耳廓及外耳道外伤10例(27%),鼓室积血2例(5.4%);鼓膜破裂出血1例(2.7%);外耳道异物4例(10.8%);鼻出血4例(10.8%);鼻骨骨折及蝶骨、筛骨骨折6例(16.2%);蝶骨、筛骨骨折合并脑脊液鼻漏1例(2.7%);颧部外伤感染伴脓肿形成1例(2.7%);下颌骨及颧骨骨折4例(10.8%);口唇黏膜撕裂伤2例(5.4%);声音嘶哑2例(5.4%).致伤原因以摔伤及踩踏伤居多.所有患者处理全身其他合并伤同时,对专科情况给予适当处理,均取得良好效果.结论 地震伤救治后送伤员大部分为多发伤,耳鼻咽喉头颈部损伤多为全身其他部位的并发伤,容易被忽略,专科医生应及早对伤员进行全面检查诊断并及时治疗.     

Nasal septal deformities in ear, nose, and throat patients: an international study

PURPOSE: The purpose of this study was to investigate the incidence and characteristics of nasal septum deformities in ear, nose, and throat (ENT) patients in various geographic regions in the world. MATERIALS AND METHODS: Anterior rhinoscopy without nasal decongestion was performed in 17 ENT centers in 14 countries. The septal deformities were classified according to the classification system proposed by Mladina. RESULTS: A total of 2589 adult ENT patients (1500 males and 1089 females) were examined. Septal deformities were found in 89.2% of subjects. Left-sided deformities were slightly more prevalent than right-sided deformities (51.6% and 48.4%, respectively). The most frequent type of deformity was type 3 (20.4%). Straight septum was found in 15.4% of females and 7.5% of males. CONCLUSIONS: Almost 90% of the subjects showed 1 of the 7 types of septal deformity. There were no statistically significant differences in the incidence of their appearance among particular geographic regions. Type 3 was the most frequent type. Straight septum was twice as frequent in females than in males.