ENT symptoms in acute COVID-19: a narrative review

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterised by a wide spectrum of disease severity ranging from asymptomatic or oligosymptomatic cases to severe and life-threatening forms. As this new coronavirus is a respiratory virus, it is not surprising that many symptoms caused by SARS-CoV-2 infection are related to the involvement of the upper respiratory tract. In addition the most pathognomonic of symptoms, i.e. the alteration of smell, nasal obstruction, sore throat and cough have been consistently described as early symptoms of the disease. However, for other ENT symptoms, such as oral lesions and audio-vestibular changes, a causal relation is far from proven. The rapid and extensive spread of COVID-19 makes it difficult to demonstrate a causative link between several ENT symptoms and SARS-CoV-2 infection and it is reasonable to assume that at least in some cases this link is actually coincidental in some cases. Moreover, following the phenomenon of the race to publish, there has been an uncontrolled release of poor-quality articles showing the most disparate associations mainly based on a temporal association between SARS-CoV-2 infection and symptoms of various types including those of the ENT area. In this narrative review of the literature, we will critically describe the ENT symptoms of COVID-19

Submandibular space infection: a potentially lethal infection.

Summary Objectives The aims of this study were to review the clinical characteristics and management of submandibular space infections and to identify the predisposing factors of life-threatening complications. Design and methods This was a retrospective study at a tertiary academic center. We retrieved and evaluated the records of all patients admitted to the University of Padua Otolaryngology Clinic at Treviso Regional Hospital with the diagnosis of submandibular space infection for the period 1998–2006. The following variables were reviewed: demographic data, pathogenesis, clinical presentation, associated systemic diseases, bacteriology, imaging studies, medical and surgical treatment, and complications. A multivariate logistic regression analysis was undertaken using a forward stepwise technique. Results Multivariate analysis identified four risk factors for complications. Anterior visceral space involvement (odds ratio (OR) 54.44; 95% confidence interval (CI) 5.80–511.22) and diabetes mellitus (OR 17.46; 95% CI 2.10–145.29) were the most important predictive factors in the model. Logistic regression analysis also confirmed other comorbidities (OR 11.66; 95% CI 1.35–100.10) and bilateral submandibular swelling (OR 10.67; 95% CI 2.73–41.75) as independent predictors for life-threatening complications. Conclusions Airway obstruction and spread of the infection to the mediastinum are the most troublesome complications of submandibular space infections. Therefore, the maintenance of a secure airway is paramount. Patients with cellulitis and small abscesses can respond to antibiotics alone. Surgical drainage should be performed in patients with larger abscesses, Ludwig's angina, anterior visceral space involvement, and in those who do not respond to antibiotic treatment. Moreover, the clinical assessment in patients with comorbidities, especially diabetes mellitus, requires a high level of suspicion for potential life-threatening complications. Early surgical drainage should always be considered in these patients, even in seemingly less critical cases

Smell and taste dysfunction after covid-19

The sense of smell is an ancient and vital perception in mammals, with the olfactory receptor gene family making up 1% of the mammalian genome, and the human olfactory system being able to discriminate among thousands of airborne chemicals at concentrations below the detection limits of the most complex analytical systems. However, people only realise the importance of smell when it is lost. The covid-19 pandemic has put both smell and taste disturbances in the spotlight because of the functional impact and severe distress caused by the loss of these senses, their fundamental diagnostic value, and, more recently, the high rate of long term dysfunction. The linked meta-analysis by Tan and colleagues (doi:10.1136/bmj-2021-069503) gives a clear picture of the challenge humans face. About 5% of people report smell and taste dysfunction six months after covid-19, and, given that an estimated 550 million cases of covid-19 have been reported worldwide as of July 2022, large numbers of patients will be seeking care for these disabling morbidities. Health systems should therefore be ready to provide support to these patients who often report feeling isolated when their symptoms are overlooked by clinicians

Rhinoplasty in Context of Head and Neck Malignancy

Head and neck tumors comprise of multiple epithelial and solid tumors which include nasal cavity and paranasal sinus tumors. Occasionally, the surgical treatment strategy incorporates rhinoplasty procedure in order to achieve better tumor control, preserve function, and attain better cosmetic outcomes. The rhinoplasty is mainly involved with the surgical procedures that intervene with the nasal structure in order to improve the function of the nose along with optimal cosmetic objective acquisition. Multiple surgical procedures and approaches have been introduced in the past decades in refining techniques of rhinoplasty, and it continues to evolve. Most of the times, the procedure is combined with usage of synthetic products, grafts, and biomaterials, in order to ascertain the best outcomes for each of these procedures. In the head and neck oncology arena, rhinoplasty is often performed in combination with other surgical procedures, and it is mainly to improve patient’s nasal and sinus functions and cosmesis as well as to enhance quality of life of any given head and neck patients

HPV as a marker for molecular characterization in head and neck oncology: Looking for a standardization of clinical use and of detection method(s) in clinical practice

Background: A consensus about the most appropriate diagnostic method(s) for head and neck human papillomavirus (HPV)\u2010induced carcinogenesis is still lacking because most of the commercially available assays have been designed for the cervix. Methods: This article summarizes current data and trends concerning HPV diagnostic strategies in oropharyngeal squamous cell carcinoma (OPSCC). Six main approaches are described. Results: The diagnostic gold standard for HPV\u2010related OPSCC, focusing on E6/E7 mRNA detection, requires fresh samples. Because most frequently available samples are formalin\u2010fixed paraffin\u2010embedded (FFPE), the pros and cons of the different approaches were analyzed. Conclusions: In the FFPE samples, the immunohistochemistry of p16, which is considered appropriate to assess HPV\u2010driven carcinogenesis in OPSCC according to the 8th American Joint Committee on Cancer TNM classification, may not be specific enough to become the diagnostic standard in the perspective of treatment deintensification. p16 may play a safer role in combination with another highly sensible assay. Other promising approaches are based on DNA detection through real\u2010time polymerase chain reaction and RNAscope

Post-viral olfactory loss and parosmia

The emergence of SARS-CoV-2 has brought olfactory dysfunction to the forefront of public awareness, because up to half of infected individuals could develop olfactory dysfunction. Loss of smell—which can be partial or total—in itself is debilitating, but the distortion of sense of smell (parosmia) that can occur as a consequence of a viral upper respiratory tract infection (either alongside a reduction in sense of smell or as a solo symptom) can be very distressing for patients. Incidence of olfactory loss after SARS-CoV-2 infection has been estimated by meta-analysis to be around 50%, with more than one in three who will subsequently report parosmia. While early loss of sense of smell is thought to be due to infection of the supporting cells of the olfactory epithelium, the underlying mechanisms of persistant loss and parosmia remain less clear. Depletion of olfactory sensory neurones, chronic inflammatory infiltrates, and downregulation of receptor expression are thought to contribute. There are few effective therapeutic options, so support and olfactory training are essential. Further research is required before strong recommendations can be made to support treatment with steroids, supplements, or interventions applied topically or injected into the olfactory epithelium in terms of improving recovery of quantitative olfactory function. It is not yet known whether these treatments will also achieve comparable improvements in parosmia. This article aims to contextualise parosmia in the setting of post-viral olfactory dysfunction, explore some of the putative molecular mechanisms, and review some of the treatment options available

Orthonasal and retronasal odor identification in patients with parosmia

Objective: To compare retronasal and orthonasal perception in parosmic COVID-19 patients, in order to determine whether COVID-19 has a differential effect on these functions. Methods: Using the Sniffin Sticks test battery orthonasal function was examined for odor threshold, discrimination and identification. Retronasal function was assessed using 20 tasteless aromatized powders. Gustatory function was measured using the Taste Strips test. Results: This study included 177 patients (127 women, 50 men; mean age 45 years), of whom 127 (72%) were hyposmic and 50 (28%) normosmic. Compared to patients without parosmia, parosmic patients performed worse in odor identification for both orthonasal (F = 4.94, p = 0.03) and retronasal tests (F = 11.95, p < 0.01). However, an interaction effect between route of odor identification (orthonasal or retronasal) and parosmia status was found (F = 4.67, p = 0.03): patients with parosmia had relatively lower retronasal scores than patients without parosmia. Conclusion: Our results suggest that COVID-19 may affect the olfactory mucosa differently along the anterior-posterior axis, thereby possibly contributing to the pathophysiology of parosmia. Patients with parosmia also exhibit a higher degree of impairment when odors are presented through the retronasal route during eating and drinking

Otological Planning Software - OTOPLAN: A Narrative Literature Review

The cochlear implant (CI) is a widely accepted option in patients with severe to profound hearing loss receiving limited benefit from traditional hearing aids. CI surgery uses a default setting for frequency allocation aiming to reproduce tonotopicity, thus mimicking the normal cochlea. One emerging instrument that may substantially help the surgeon before, during, and after the surgery is a surgical planning software product developed in collaboration by CASCINATION AG (Bern, Switzerland) and MED-EL (Innsbruck Austria). The aim of this narrative review is to present an overview of the main features of this otological planning software, called OTOPLAN®. The literature was searched on the PubMed andWeb of Science databases. The search terms used were “OTOPLAN”, “cochlear planning software” “three-dimensional imaging”, “3D segmentation”, and “cochlear implant” combined into different queries. This strategy yielded 52 publications, and a total of 31 studies were included. The review of the literature revealed that OTOPLAN is a useful tool for otologists and audiologists as it improves preoperative surgical planning both in adults and in children, guides the intraoperative procedure and allows postoperative evaluation of the CI

Is there a role for tumor volume in prediction of prognosis for oral cancer?

Purpose: New prognostic factors in oral squamous cell carcinoma (OSCC) (tumor-, host-, and environment-related) have been introduced recently to complete those traditionally considered. Among them, tumor volume (TV) could be the most interesting and applicable in clinical practice, considering the routine use of computed tomography in tumor staging. In this retrospective study we aimed to investigate whether a correlation exists among these new prognostic factors and survival outcomes. Meterials and methods: We collected data about 140 patients affected by OSCC who underwent primary surgery. Prognostic factors were collected and Overall Survival (OS), Disease Specific Survival (DSS) and Disease Free Survival (DFS) were estimated using Kaplan-Meier method; the Log-Rank test (Mantel-Cox) and Cox regression models were applied to investigate predictors of survival. Results: The 5-year OS, DSS and DFS were 73.6 %, 89.2 % and 75.2 % respectively. Nodal metastasis (pN+), relapse and American Society of Anesthesiologists ASA-II were found independent prognostic factors for OS, and significantly associated to worst DSS (p < 0.001). TV significantly correlated with higher relapse occurrence (p = 0.03). Conclusions: In our experience, lymph-node status, ASA classification and relapse significantly influenced DSS on univariate analysis. TV could represent an interesting additional parameter, since it significantly influenced DFS. However, prospective studies with standardized TV measurements and a greater number of patients are needed to validate this result

Post-thyroidectomy dysphonia and swallowing symptoms: The role of cricopharyngeal sphincter

Dear Editor, We read the paper of Kim et al. entitled “Persistent subjective voice symptoms for two years after thyroidectomy” [1]. Authors observed that some voice quality parameters improved from pre-to post-treatment, while others deteriorated such as the Thyroidectomy-related Voice and Symptoms' Questionnaire scores. Voice abuse history in professional users was associated with worse vocal quality after thyroidectomy. We congratulate authors to have investigated this controversial topic through a prospective study. Post-thyroidectomy voice disorders are prevalent in otolaryngological consultations, but this topic is poorly investigated in the current literature [2]. In this letter, we would like to draw attention to an important condition that was not considered in the study, which is the impairment of the upper esophageal sphincter (UES) during the surgery