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

Analisi sperimentale degli effetti meccanici indotti da sollecitazioni termiche prodotte da scambiatori termici verticali (BHE) su materiali argillosi nella Provincia di Venezia.

La geotermia si occupa di studiare, interpretare e sfruttare tutti i meccanismi che hanno un collegamento diretto o indiretto con il calore immagazzinato nel sottosuolo e proveniente dall’interno della terra. Nasce dall’esigenza di trovare un’alternativa concreta alle fonti energetiche non rinnovabili tradizionali quali gli idrocarburi tra cui figurano petrolio e derivati, carbone e gas naturale. Geotermia significa correlare la componente sottosuolo affidata al lavoro del geologo alla componente in superficie, quale impianto ed edificio, di competenza dell’ingegnere termotecnico. Tra le due parti quello che non può cambiare per ottenere il medesimo risultato finale è il sottosuolo che rimane invariato nel tempo mentre l’edificio e gli scambiatori possono essere adeguati al fabbisogno di calore aumentandone l’efficienza e la potenza. Se sfruttato in maniera corretta e razionale il sottosuolo si può rigenerare in continuazione senza pregiudicarne l’assetto termico e quindi il funzionamento dell’impianto in un futuro prossimo. Premessa l’importanza della conoscenza stratigrafica del terreno lo scopo è quello di analizzare e capire come si comporta un terreno coesivo argilloso di Venezia soggetto ad una compressione monoassiale confinata dovuta al carico dell’edificio soprastante dopo essere stato sottoposto a variazioni di temperatura controllata. Verranno eseguiti esperimenti con l’ausilio di un prototipo di cella isolata e termostata al fine di poter stressare termicamente un campione di terreno racchiuso all’interno di un edometro e sottoposto ad un carico costante. Questo permetterà di riprodurre le caratteristiche dei primi metri del terreno di Venezia ove si presume che lo stress termico dovuto alle variazioni di temperatura cicliche di sonde geotermiche a circuito chiuso possa modificare la struttura interna di un’argilla normalconsolidata. Verificare questa possibilità sarà parte integrante della tesi. Il problema nasce dal fatto di voler utilizzare la tecnologia delle pompe di calore geotermiche (che approfondiremo in seguito) in una città storica qual è Venezia. Obbligati da vincoli paesaggistici e urbanistici, che vietano l’installazione di pompe di calore aria-aria con chiller all’esterno delle abitazioni, i veneziani possono ricorrere all’uso della geotermia quale fonte energetica alternativa a quelle tradizionali a combustione. La quasi assenza di giardini e cortili però obbliga il cittadino o l’ente che vuole installare delle sonde a circuito chiuso a farlo sotto l’edificio quindi a stretto contatto con le fondazioni. Quello che questa tesi di laurea vuole chiarire è l’aspetto legato alle reazioni meccaniche che materiali potenzialmente sensibili come le argille pleistoceniche ed oloceniche, presenti nel sottosuolo veneziano, possano subire a causa degli sbalzi termici ciclici causati dalle sonde geotermiche. Se l’impianto fosse ben calibrato e bilanciato la variazione termica sarebbe molto bassa pertanto non desterebbe preoccupazione, ma in caso contrario potrebbero esserci dei problemi di stabilità dovuti ad una possibile modificazione della struttura interna dei materiali, con un conseguente sprofondamento soprattutto se non c’è una distribuzione omogenea nel primo sottosuolo ove poggiano le fondazioni. Finora molti autori hanno affrontato il problema del “freeze-thaw” ossia del congelamento e scongelamento di terreni argillosi, ma mai nessuno ha valutato la possibilità che delle sonde geotermiche compiano questo processo compromettendo la stabilità di un edificio sovrastante. Si sono però mossi a senso unico verso il solo congelamento o il solo surriscaldamento per motivi totalmente estranei alla geotermia, quindi lo scopo prefissato risulta essere la correlazione tra i due episodi e l’analisi dei conseguenti risultati al fine di poter elaborare una carta della sensibilità dei terreni

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

Deep neck abscess. Retrospective study in five years

Introducción: Aunque la incidencia de los abscesos profundos del cuello ha disminuido llamativamente con el uso de antibióticos, esta infección aún ocurre con considerable frecuencia y puede estar asociada con alta morbilidad y mortalidad. Material y método: Realizamos una estudio descriptivo y retrospectivo de 11 pacientes diagnosticados de abscesos profundos del cuello entre los años 2013-2017 en el hospital universitario de Puerto Real (HUPR) que se han sometido a tratamiento quirúrgico y antibiótico junto con una revisión bibliográfica de los últimos cinco años. Resultados: Hubo un predominio del sexo masculino (81.82%) y una edad media de 52.82 años. El síntoma predominante en el momento del diagnóstico fue la odinofagia seguido del dolor cervical. Las causas más frecuentes fueron la amigdalitis en un 55% y la infección odontógena(37%). En un 82% se aislaron varios gérmenes en el mismo paciente poniendo en evidencia el predominio polimicrobiano que se trató en un 45,5% con amoxicilina y ácido clavulánico. La media de días de hospitalización fue de 9.64 días. La comorbilidad con mayor impacto evolutivo fue la diabetes. Las complicaciones más frecuentes fueron el derrame pleural y la mediastinitis con necesidad de traqueotomía en un 63.6%. Se reintervino a un 45.5% de los pacientes ya que en un 54.5% existían múltiples abscesos sincrónicos en distintas localizaciones cervicales. Conclusiones: Se debe valorar la presencia de múltiples abscesos sincrónicos. La asociación de cirugía y tratamiento antibiótico adecuado son la base del tratamiento. Destaca la evolución más tórpida en pacientes inmunodeprimidos o diabéticos.Introduction: Despite of incidence of Deep Cervical Abscess (DCA) has decreased mainly for the availability of antibiotics, this infection still occurs with considerable frequency and can be associated with high morbidity and mortality. Material and method: Retrospective and descriptive study analyzed 11 patients between 2013-2017 in Puerto Real Hospital diagnosed with deep neck infections who had undergone surgical treatment and intravenous antibiotic with systematic review in the last 5 years. Results: There was a predominance in males (81.82%) and an average age of 52.82 years. Odynophagia was the most frequent symptom at the time of diagnosis followed by cervical pain. Tonsillitis in 55% and odontogenic infection (37%) were the most frequent etiologies. Polymicrobial was the most common bacteriology treated with clavulanic amoxicillin in 45.5%. Average of hospitalization days was 9.64 days. Diabetes and smoking were the most frequent comorbidities. Pleural effusion and mediastinitis were the most frequent complications, tracheotomy was required in 63.6%. 45.5% of patients were reoperated. In 54.5% multiple type of abscess was associated. Conclusions: The presence of multiple synchronous abscesses should be valued. Surgery and adequate antibiotic are the basis of the treatment. Immunocompromised or diabetic patients have more torpid evolution

Disposable chlorine dioxide wipes for high-level disinfection in the ENT department: A systematic review

Background: Nasopharyngoscope reprocessing methods should be effective, rapid and reproducible with moderate cost. Tristel Trio Wipes system (TTWS) is a manual reprocessing method based on chlorine dioxide that has lately emerged in ENT department. This review aims to collect evidence on this system. Methods: The PubMed, Web of Science and Cochrane Library databases were searched for all the studies on TTWS or one of its components. Data were grouped according to the study type. Results: Ten articles were included in the review. TTWS ensured high-level disinfection in laboratory and clinical setting. Although the limitations of the manual systems, TTWS proved to be faster than automated endoscope reprocessing (AER) and safe for patients and health-care workers. TTWS represented cheaper system than AER or sheaths in low- and medium-volume centers. Conclusion: TTWS could be a valid, safe and fast HLD method for nasopharyngoscopes, with reasonable costs for medium-low reprocessing volumes

Topical Steroids in Rhinosinusitis and Intraoperative Bleeding: More Harm Than Good?

The aim of this study was to assess whether the chronic preoperative administration of intranasal corticosteroids (INCs) in chronic rhinosinusitis with/without nasal polyposis (CRSwNP/CRSsNP, respectively) could significantly influence bleeding during functional endoscopic sinus surgery (FESS). We prospectively enrolled 109 patients (56 CRSwNP and 53 CRSsNP) candidate for FESS who underwent clinical evaluation and anamnestic data collection. They were allocated to 2 groups depending on whether or not they were chronic INC users, as declared at their first medical evaluation: chronic "INC users" represented the treated group, while "INC nonusers" formed the control group. Lund-Mackay and American Society of Anesthesiology (ASA) scores, blood loss expressed both in milliliters and using the Boezaart scale, operation time in minutes, pre- and postoperative 22-item Sino Nasal Outcome Scores (SNOT-22) were collected. Each sample underwent histopathological evaluation. The results showed that anamnestic information, Lund-Mackay, and SNOT-22 scores were similar between the 2 groups ( P > .05). The average blood loss expressed in milliliters and operative time were slightly, but not significantly, higher in the INC user group, while the Boezaart scores proved significantly higher in the INC users ( P = .038). No differences emerged between CRSwNP and CRSsNP within each group in terms of bleeding. The pathologist described common features in the majority (78%) of INC group samples: ectatic venules embedded in a fibrous stroma and hypertrophy of the arterial muscular layer. In our experience, despite the presence of NP, chronic preoperative administration of INCs was associated with increased intraoperative bleeding according the Boezaart scale although objective recordings of blood loss were not statistically different between the INC users and nonusers