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.     

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.     

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.     

Assessment of common otolaryngological diseases among children in rural primary schools in south eastern Nigeria

ObjectivesDespite a global improvement in health care delivery, rural areas in developing countries still have poor access to specialist care. This study aims to assess the occurrences of ear, nose, and throat (ENT) disorders among rural primary school children in south-eastern Nigeria.MethodsTwo rural primary schools were selected randomly from one of the rural regions of South Eastern State of Nigeria. All the pupils of the schools who gave consent were recruited. A structured study proforma investigating the pupils' biodata, otolaryngological symptoms, ear, nose and throat examination findings, was used to evaluate each pupil in the presence of the teachers.ResultsA total of 246 children participated in the study. 145(58.9%) were males while 101(41.1%) were females with a mean age of 8.5 ± 2.4 years. The commonest symptoms reported were nasal discharge (20%) followed by nasal obstruction (11.1%), itching of the ears (11.1%) and sneezing bouts (10%), while 3.7% had subjective hearing impairment. The commonest ENT finding was cerumen auris (43%) and this was observed in 43.4% of males and 42.4% of females, 11% had abnormal tympanic membranes and 20% had grades 3/4 tonsils(Brodsky grading).ConclusionENT disorders are still common in children in the rural areas of developing countries. To avoid the morbidity associated with these preventable and easily manageable disorders, community health workers should be trained to manage common ENT disorders and mobile clinics with scheduled visits made available in areas where ENT services remain inaccessible.     

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.     

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.     

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.     

Ear, nose and throat manifestations in pediatric chronic renal failure patients undergoing peritoneal dialysis

Ear, Nose and Throat manifestations have been frequently observed in patients with chronic renal failure. Many factors viz. ototoxic drugs, associated conditions of renal failure such as electrolyte imbalance, alteration in blood urea etc. have been implicated for these manifestations. The present study has been conducted to evaluate ear, nose and throat manifestations in thirty pediatric patients (age group 4-16 year) of chronic renal failure undergoing peritoneal dialysis. Probable patho-physiology and treatment of ENT manifestations has been discussed. The remarkable findings in all these cases were the high blood urea level. Most of these manifestations were markedly improved by correction of the renal functions and ideal therapeutic measures.     

Respiratory polygraphy in children: Feasibility in everyday practice in an ENT department and value of automatic detection of respiratory events

ObjectivesUsing respiratory polygraphy (RP) in children for diagnosis of obstructive sleep apnea/hypopnea syndrome (OSAHS) can be challenging in terms of device acceptance and sensor displacement. Automatic analysis of respiratory events has never been evaluated in a pediatric population. The primary objective of this study was to determine the feasibility of pediatric RP in routine ENT department practice. The secondary objective was to evaluate the reliability of the automatic detection of obstructive and central respiratory events in children.MethodsA single-center retrospective study included 50 children (32 boys, 18 girls; mean age 5.5 ± 2.3 years) undergoing overnight RP in an ENT department between January and August 2016 for suspected OSAHS. Manual detection of respiratory events was performed by one ENT specialist experienced in RP interpretation, and compared to automatic analysis.ResultsThe device was well accepted in 98% of cases. Overall signal quality was > 50% in 76% of cases, with average signal quality of 70.8% (86% in patients > 3 yrs, 25% in patients < 3 yrs, P = 0.0013). There was no significant correlation between manual and automatic analyses, except for central apnea (Spearman coefficient 0.43; P = 0.0015). One hundred percent of patients presented OSAHS according to automatic detection, compared to 32% according to manual detection (P < 0.005).ConclusionsPediatric RP is feasible in routine practice in an ENT department, with good acceptance and satisfactory signal quality in children older than 3 years. Automatic analysis of respiratory events in children is unreliable, except for central apnea.     

Ear nose throat-related symptoms with a focus on loss of smell and/or taste in COVID-19 patients

PurposeTo determine the frequency and severity of general and ear nose throat (ENT)- related symptoms, especially smell and/or loss of sense of taste (STL) in COVID-19 disease, as well as to investigate the recovery process of STL.Materials and methodsPatients with a positive COVID-19 diagnosis were given a questionnaire consisting of general questions (age, sex, date of symptoms, smoking history, concomitant diseases), questions about the most obvious symptom at presentation (one option only), the severity and frequency of symptoms (general and ENT), and STL (recovery time and degree of recovery).ResultsThe study population consisted of 172 patients, 18–65 years old (mean age, 37.8 ± 12.5 years; 51.2% female; 76.2% nonsmokers). Cough (n = 30, 17.4%) and loss of sense of smell (n = 18, 10.4%) were the most obvious general and ENT symptoms, respectively. Eighty-eight patients (51.2%) reported loss of sense of smell, and 81 patients (47.1%) reported loss of sense of taste. The mean recovery times for loss of sense of smell and loss of sense of taste were 8.02 ± 6.41 and 8.20 ± 7.07 days, respectively. The loss of sense of smell and loss of sense of taste were the unique symptoms in four (4.54%) and one (1.23%) patients, respectively.ConclusionSTL is a common symptom in COVID-19 and may be the first and/or only symptom of this disease. In patients presenting with STL complaints, surveillance for possible COVID-19 disease and screening tests will facilitate the struggle against the disease.     

Ear, nose, and throat operations in the United States, 1979 to 1984

Using data from the National Center for Health Statistics for 1979 to 1984, I found a 5% decrease in total ear, nose, and throat (ENT) operations, the largest decline of any surgical specialty. For the same five-year period, the number of ENT surgeons increased 15%. In 1983, ENT surgeons performed 478 000 operations on tonsils and adenoids, an 18% decrease from the 1979 total (584 000). The removal of tonsils and adenoids is the eighth most common operation performed in the United States. The second most common ENT operation, nose repair and plastic operations (263 000), is the country's 14th most frequent operation. The 20 most common ENT operations constitute 87% of all ENT operations. In 1983, ENT operations represented 9% of all surgery in this country. These figures show that numbers of ENT surgical operations have decreased over the last five years, despite a constantly increasing number of ENT surgeons.     

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。     

Otolaryngologic findings in prepubertal obese children with sleep-disordered breathing

Objective

To evaluate otolaryngologic findings in obese prepubertal children with sleep-disordered breathing.

Methods

We prospectively evaluated 29 obese children referred by pediatric endocrinologist, complaining of snoring and without a history of nasal surgery or removal of the palatine tonsils and/or adenoids. Patients underwent ear, nose and throat (ENT) examination, endoscopy, measurements of weight, height, calculation of body mass index (BMI), assessment of BMI z-score and polysomnography, from which were divided into two groups: those with obstructive sleep apnea syndrome (nine children) and those with primary snoring (20 children). Then we proceeded to the statistical analysis of the data collected.

Results

The groups did not differ in age, gender, weight, height, BMI and BMI z-score. Among the findings of the ENT examination, the adenoid size was the only one that differed between the groups (p = 0.01).

Conclusion

The evaluation of the adenoid size is an important in obese children with symptoms of sleep-disordered breathing and is related to the presence of obstructive sleep apnea syndrome.     

Pediatric ear foreign body retrieval: A comparison across specialties

ObjectivesTo analyze what characteristics of patients and/or ear foreign bodies should prompt referral to otolaryngology with the goal to maximize successful removal and minimize complications.MethodsThis was a retrospective chart review of pediatric patients who presented for ear foreign body removal from January to December 2016 at a tertiary hospital center. Data collection included successful removal, major or minor complications, use of general or conscious sedation, use of otic or oral antibiotics, age of patient, comorbid behavioral disorders, and foreign body characteristics. Major complications included tympanic membrane perforation or ossicular damage. Minor complications included injury of the canal wall. Patients with retained or extruded tympanostomy tubes were excluded.ResultsOf 275 patients aged 1–18 years, 16% presented initially to otolaryngology (ENT), 48.4% presented to the emergency department (ED), 21.8% presented to a pediatrician, and 13.8% presented to ENT after prior attempts at removal. Rate of successful retrieval by ENT was significantly higher than by PCP (95.4% vs 75.0%) or by ENT after prior failed attempts (65.8%), but not when compared to removal in the ED (85.7%). Retrieval by ENT after prior failed attempts had the highest rate of minor complications (26.3% vs 2.3–6.0%). There were two tympanic membrane perforations that were noted by ENT after prior failed attempts. Rate of operative intervention was significantly higher in patients who presented to ENT after prior attempts compared to patients who presented initially to ENT (34.2 vs 4.6%, p = 0.001). Of the patients who presented to ENT after previous failed attempts, there was a higher rate of complications and operative intervention if the patient was age 5 or under or the foreign body was difficult to grasp.ConclusionsPediatric ear foreign body presentation is common. Repeated attempts at removal are associated with higher rates of minor complications and operative intervention. Early consultation to otolaryngology should be considered if the foreign body is deemed difficult to grasp such as a bead or stone, especially if the patient is age five or younger.     

Manifestaciones otorrinolaringológicas en pacientes con enfermedad de Behçet

Introduction and objectives: Behçet disease (BD) is a systemic immune-mediated vasculitis of unknown origin characterised by recurrent orogenital ulceration, ocular inflammation and skin lesions.The aim of our study was to identify ear, nose and throat (ENT) manifestations associated with BD.Patients and methodsRetrospective review of the medical records of all patients diagnosed with BD who attended a tertiary public hospital in Cantabria (Spain) over a period of 22 years. Clinical manifestations, in particular those concerning ENT, were retrieved from medical records. A medical literature review of ENT manifestations was conducted.ResultsThirty-three patients (age range: 17-64 years) were included in the study. Most of them presented oral ulcers (97%). Eight patients (24%) presented oropharyngeal ulcers and 5 patients (15%) experienced audiovestibular symptoms (high frequency sensorineural hearing loss, vertigo and bilateral vestibular hypofunction). One patient had symptoms compatible with vestibular neuronitis as the presentation manifestation of Neuro-Behçet. In 4 patients (12%) the presence of odynophagia secondary to the presence of oropharyngeal lesions, initially interpreted as acute or recurrent tonsillitis, was the first manifestation of the disease, alone or associated with cutaneous or ocular lesions.ConclusionsIn addition to the characteristic oral ulcers present in most patients with BD, ulcers in the oropharynx, occasionally interpreted as acute pharyngitis, are also common in these patients. Audiovestibular manifestations frequently appear during the course of the disease and may be the first symptom of central nervous system involvement.     

Clinical evaluation of the electronic nose in the diagnosis of ear, nose and throat infection: a preliminary study

The term electronic nose describes an electronic system that is able to mimic the human sense of smell. Electronic noses have been developed over the last 10 or more years to perform a variety of identification tasks in various industries. More recently electronic noses have attracted new interest in their application in the field of medical diagnosis. The aim of this study is to explore the use of an electronic nose to identify and classify pathogens associated with ear, nose and throat (ENT) infections. In this study 90 bacterial swab samples were collected from 90 patients with ENT infections. Some of these samples were analysed immediately with a commercial electronic nose (Cyranose C320). Similar numbers of swabs were also taken from the same site of infection and were sent for microbiology culture and sensitivity. The electronic nose diagnosis was compared with the microbiology diagnosis and it was found that the electronic nose diagnosis was correct in 88.2 per cent of the cases, which is an encouraging result.     

A new safe and cost-effective percutaneous dilatational tracheotomy: SafeTrach

Conclusion SafeTrach is a new simplified and safe technique to perform percutaneous dilatational tracheotomy (PDT) that eliminates known risk factors compared with existing percutaneous techniques. In the present clinical study, also patients with disadvantageous anatomy not suitable for conventional PDT (CPDT) were treated without complications using SafeTrach. PDT with SafeTrach (STPDT) offers an excellent solution for patients who need tracheotomy in connection with elective ear, nose, and throat (ENT) surgery. Objectives To assess a new technique for percutaneous tracheotomy. Methods Seventeen patients were tracheotomized with STPDT using SafeTrach for the initial penetration sequence and single step dilatational techniques for the dilatational sequence. The patients represented a variety of different neck anatomies. Fifteen patients were head- and neck cancer patients that were subjects of free flap transplants. Results This study showed that STPDT was safe and easy to perform and time-efficient. The median duration of the procedure was 11.5?min and the puncture was in all cases located in the midline of the trachea either between the 2nd and 3rd tracheal ring (n?=?13) or between the 3rd and 4th ring (n?=?4).     

Laryngopharyngeal reflux: Current opinion

Conclusions  The increasing importance of LPR is being recognized day by day in ENT practice. LPR has a significant negative impact in the quality of lives of the patients. Although its impact is similar in some respects to that of laryngopharyngeal disease, LPR has a more significant impact on patient’s social functioning and vitality.^[23] All ear, nose and throat practitioners need to be sensitised to the presence of LPR and the need for starting treatment wherever required. Lot of hitherto symptoms of unknown aetiology are being increasingly of treating patients with atypical reflux symptoms such as hoarseness (unexplained cause), globus, throat clearing, cough, etc., with antireflux therapy.^[24]     

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.     

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.