ENT management of children with adenotonsillar disease during COVID-19 pandemic : ready to start again?

Clinical manifestations of COVID-19 in children are milder, but the real burden of disease is unknown. After the lockdown, in our Region Lombardia we have been requested to progressively resume medical services including outpatient assessment and priority surgery. Therefore, we screened surgical waiting lists with identification of 47 children candidates to priority surgery (among 358). No homogeneous national health surveillance/screening programs are ongoing or have been conceived to test susceptible population among children/healthcare workers in preparation of coming down to routinely daily activities, and diagnostic strategies are not completely accurate in children. So, restoring medical services now might be untimely

Videosialoendoscopic assessment of bilateral atresia of the Wharton's duct orifice in an infant

Atresia of the submandibular ducts (particularly the duct orifice) is a rare occurrence that is mainly observed in newborns or infants; moreover, its differential diagnosis with other anomalies of the oral floor is sometimes difficult. Given the lack of data concerning the differences between atresia of the orifice of Wharton's duct and other anomalies of the submandibular duct system, we describe here the findings of videosialoendoscopic assessment of the salivary duct system in an infant who underwent traditional surgery for bilateral atresia of the orifice of Wharton's duct. During sialoendoscopy, a trifurcation of the main duct, a normal variant of the more common bifurcation of the secondary branches of the salivary duct system, was observed bilaterally. No other ductal anomalies were encountered. Complete resolution of the symptoms and complete patency of both ducts at 19-month follow-up evaluation were observed. In conclusion, although spontaneous resolution of the disease during feeding is possible, minimal incision of the orifice of the imperforated submandibular duct together with diagnostic videosialoendoscopy of the main salivary duct system may be considered as part of the modern approach to salivary obstructive disorders in pediatric age as is currently the case for sialolithiasis and recurrent juvenile parotitis

Unbalanced oxidative status in idiopathic sudden sensorineural hearing loss

An impaired cochlear perfusion seems to be an important etiopathogenetic event in idiopathic sudden sensorineural hearing loss (ISSNHL). Recently, oxidative stress has been proposed as risk factors of microvascular damage. This observational study aimed to evaluate the possible role of oxidative stress in ISSNHL. In thirty-nine ISSNHL patients and seventy healthy subjects serum reactive oxygen species concentrations (ROS) and total antioxidant capacity (TAC) were measured by spectrophotometric methods on F.R.E.E. analyzer (Diacron International, Italy). Moreover, a global oxidative stress index (Oxidative-INDEX), reflecting both oxidative and antioxidant counterparts, was also calculated. 25/39 patients showed oxidative stress due to ROS levels significantly higher than controls (348.2 \ub1 84.8 vs. 306.75 \ub1 46.7 UCarr; p = 0.001). The Oxidative-INDEX was significantly higher in patients than in controls (0.75 \ub1 2.4 vs. -0.0007 \ub1 1.28 AU, p = 0.03). As oxidative stress is a key determinant in endothelial dysfunction, our findings could suggest vascular impairment involvement in ISSNHL etiopathogenesis

Early Magnetic Resonance Imaging for Patients With Idiopathic Sudden Sensorineural Hearing Loss in an Emergency Setting

Objective: The role of magnetic resonance (MR) imaging in idiopathic sudden sensorineural hearing loss (ISSHL) is controversial due to the inhomogeneity of clinical and MR protocols. The aim of this work is to relate early MR findings obtained immediately after the admission, with the clinical presentation, the audiological findings, and the outcomes of treatment. Study Design: Prospective observational study. Setting: Tertiary referral university center. Patients: Forty-seven patients (22 M, 25 F; age: 54.417.5 yr) consecutively referred to the Department of Emergency for ISSHL. Interventions: All patients underwent the diagnostic and therapeutic work-up for ISSHL, and MR imaging within 72 hours from the admission, independently of the symptoms onset. All patients received the same treatment (systemic steroid therapy, intratympanic steroid injection, and hyperbaric oxygen therapy). Main Outcome Measure(s): MR patterns, clinical, and laboratory findings. Results: MR imaging was positive in 25 of 47 cases (53%), with a perfect agreement between clinical and MR examinations (Cohen K\ubc1) upon the affected ear. Three different radiological patterns were observed: labyrinthine haemorrhage (n\ubc5), acute inflammatory process (n\ubc14), isolated blood\u2013labyrinth barrier breakdown (n\ubc6). By binary logistic regression, only vertigo was associated with a positive MR imaging [B\ubc2.8; p\ubc0.011; OR\ubc9.5 (95% CI: 2.2\u201340.8)] and the latter was the only variable associated with an unfavorable outcome [(B\ubc2.8; p\ubc0.02 OR\ubc12.8 (95% CI: 2.9\u201356.7)]. Conclusion: Patients affected by ISSHL with associated vertigo show a higher likelihood of having a positive MR imaging, which, in turn, seems to predict an unfavorable outcome