An unusual case of unilateral sinus disease may reveal the presence of a retained foreign body

Introduction: Differential diagnosis of unilateral sinus disease (USD) is important in clinical practice as it can be broad, and for which timely and effective treatment is important. With this report we would like to present a case of a patient with a foreign body retained in the left maxillary sinus for eight years. Presentation of case: A 50-year-old gardener referred to have been injured on the job in 2010. Even though he was wearing his safety helmet with face shield and earmuffs, he had the sensation to have been hit by an object coming from the soil, while he was using his grass trimmer. However, the patient was asymptomatic with no complications. After eight years, the man started experiencing left nasal obstruction associated with purulent discharge and ipsilateral headache. A fetid odor coming from inside the nose and described as “the carcass of a dog” led him to seek medical attention. The patient underwent a functional endoscopic sinus surgery (FESS) with septoplasty and a foreign body, consisting of a metal nail, was retrieved. Discussion: This case highlights a two key learning points. The first one concerns occupational safety measures; full-face shield helmets are the best option and should be employed in order to avoid the penetration of any possibly dangerous materials. Secondly, grass trimmers with more sophisticated designs are required in order to prevent injuries like this. Conclusions: Besides being peculiar because of the onset of clinical symptoms, this case report highlights the importance of full-face shield helmets and certified machinery

Wind Tunnel Investigation of a Helicopter Model in Shipboard Operations

The paper presents the wind tunnel simulation of a helicopter model in shipboard operations. The test rig consists of a scaled helicopter model and a simplified ship model, based on the geometry of the Simple Frigate Shape 1. In the first phase of the experiment, pressure and Particle Image Velocimetry survey of the flow field on the flight deck were performed without the presence of the helicopter, to study the flow features on the ship deck, for several wind conditions obtained modifying the wind speed and direction. The influence of Atmospheric Boundary Layer was investigated as well. Then, the rotorcraft was positioned in a series of points representative of both a typical fore-aft landing trajectory toward the deck, and a vertical descent on the deck. Loads generated by the rotor were monitored by means of a six-axis load cell. Particle Image Velocimetry of the ship wake and of the helicopter inflow were carried out in order to have a better understanding of how the interacting flow fields affected the helicopter performance. The test showed a significant effect of the mutual aerodynamic influence between the helicopter and the ship model and a limited effect of the Atmospheric Boundary Layer

Late recovery with cyclosporine-A of an auto-immune sudden sensorineural hearing loss

Sensorineural hearing loss of immune-mediated origin may be present as a symptom in systemic autoimmune diseases or may occur as a primary disorder without other organ involvement (auto-immune inner ear disease). The diagnosis of auto-immune inner ear disease is still predicated on clinical features and to date specific diagnostic tests are not available. We report a case of right-sided sudden hearing loss in a female patient in which the clinical manifestations, in addition to ANA positivity and hypocomplementaemia allowed us to hypothesize an auto-immune inner ear disease. The immunosuppressive treatment with cyclosporine-A was capable of a recovery of the hearing that, however, occurred progressively with normalization of the hearing function after 1 year of treatment. cyclosporine-A could be proposed as a therapeutic option in case of auto-immune inner ear disease allowing the suspension of corticosteroids that, at high dose, expose patients to potentially serious adverse events

A registry for the collection of data in cochlear implant patients

The need to optimize the use of all the information that modern technological tools have made available to the physician ENT/audiologist has increasingly emerged within the Italian scientific community. Towards this purpose, it is necessary to create a registry of the patients using cochlear implants (CIs). This registry will include a homogeneous summary of the information deriving from multiple sources related to daily clinical practice, in order to assess auditory benefits, safety and reliability in patients with cochlear implants, and organization over the national territory. The primary objectives relative to the above-mentioned analysis are to assess the impact of the use of cochlear implants on patient health, to ensure traceability of the devices currently used, monitoring their safety and reliability over time, to guarantee access of the technique in clinical and organizational conditions that can allow the best possible benefits. The aspects concerning implementation of the registry were discussed extensively during the first meetings of the Working Group (WG). In particular, owing to the complexity and high costs related mainly to the development of the technological aspects and the need to involve technological partners external to the WG, and to respect current privacy laws, the WG members decided that the project should be limited to proposal of a paper registry to be implemented at a later stage, possibly within the framework of successive research projects. During meetings, the WG members discussed various aspects of implementation of the registry, and in particular the scientific features connected to objectives, inclusion criteria, and structure of the forms needed for data collection and organizational aspects. A registry is proposed herein

Analysis of the impact of professional involvement in evidence generation for the HTA Process, subproject “Cochlear Implants”: methodology, results and recommendations

The aim of Health Technology Assessment (HTA) is to provide decision-makers, distributors and recipients with information on the effectiveness, cost and impact of health technologies. The present study constitutes a subproject within the wider project “Analysis of the impact of professional involvement in evidence generation for the HTA process”, which is part of the strategic programme “Transfer of the results of the research in clinical practice and organisation of healthcare services”, coordinated by Laziosanità – Agency of Public Healthcare of the Lazio Region and AgeNaS (National Agency for Regional Healthcare Services). The objectives of the present subproject (cochlear implants) are as follows: a) to produce a report regarding the health impact of cochlear implants (CI) on their recipients, through a systematic review of literature and extensive selection of relative studies, combining the outcomes with metanalytical techniques. Output: report on the indications of usage in the groups of population for which benefits are controversial; b) to create a registry of patients using cochlear implants. The registry should contain a selection of anagraphic and clinical information relative to patient follow-up in order to assess factors associated with safety and impact on cochlear implant users. This source of information is essential for future observational studies. This was divided into 4 phases: 1st phase: definition of key participants in the assessment process; 2nd phase: definition of methods and timing of “Aims” (definition of the objective); 3rd phase: definition of the methods and times of the “assessment process”, 4th phase: production of the final report. From the analysis of systematic reviews and italian and international guidelines, the Working Group members approved recommendations on the following topics: results after CI in children in relation to age at implantation, bilateral CI in children, CI in deaf children with associated disabilities, CI in adults with advanced age, bilateral CI in adults and CI in adults with pre-lingual deafness. These recommendations have also been evaluated by the Consulting Committee members and approved with minimal suggestions

COVID-19: what happened to all of the otolaryngology emergencies?

To the Editor, COVID-19 is a global pandemic caused by the novel coronavirus SARS-CoV-2, and Italy was the first European country to experience a large-scale outbreak. With this, every aspect of healthcare, the economy, and society has been deeply affected in Italy, so much so that fundamental changes are expected in the post-COVID-19 era. One aspect is that access to emergency care in Otolaryngology (ORL) patients has already changed in the month following the onset of the COVID-19 outbreak, and, seemingly, many non-COVID illnesses have been disappearing. Although the government did not enact any limitations or prohibitions to emergency access for patients afflicted by acute ORL pathologies, the number of daily urgent consultations to the ORL Departments in Bari and Foggia University Hospitals has significantly reduced and, on some days, was even zero. One possible reason for this change may be patients’ fear of acquiring a nosocomial COVID-19 infection. Even so, it is difficult to believe that some acute diseases, such as massive epistaxis, otitis, or pharyngotonsillitis, could have occurred so rarely or not at all or, alternately, could have been treated at home by patients or their families. Rather, most certainly, primary care physicians, who have been performing telehealth consultations in accordance with the guidelines from the Higher Institute of Health (ISS), have been providing an invaluable service [1]; it is posited that patients who received primary care services this way may have been able to delay or even forego specialist evaluation. This telehealth treatment has not only helped to keep patients at home but has provided other benefits and should be considered in the future. Table ​Table11 shows data regarding the number of emergency department consultations by diagnosis in the 30 days preceding (from February 8th to March 8th, 2020) and 30 days following (from March 9th to April 9th, 2020) the onset of the COVID-19 outbreak at the two main tertiary referral centers in the Puglia region, as well as the percentage reduction for each diagnosis. The data revealed an overall decrease in the number of ORL emergency consultations by 80.8%. Of note, reductions were noted across all subspecialties. Although some illnesses, such as rhinitis, sinusitis, uvular edema, and tinnitus, do not usually require immediate attention, it is more difficult to explain the large reduction, ranging from 80.2% to 88.9%, of other diagnoses, such as vertigo, epistaxis, sudden hearing loss, otitis media, and peritonsillar abscesses, which often merit urgent ORL consultations. The reduction of some diagnoses may be the consequence of national lockdown orders. For example, the 84.6% reduction in the number of nasal bone fractures may be related to the near-absence of motor vehicle accidents reported during this time. In contrast, it is more difficult to explain the reduction of other acute diseases such as sudden hearing loss, whose frequency decreased 83.3%, especially when compared to non-disease conditions, such as cerumen impaction, whose reduction in presentation, interestingly, was slightly more modest at 73.7%. A reduction in the number of emergency ORL consultations by 80.8% during the COVID-19 pandemic creates new paradigms for the future. Over the past few decades, the workload performed by healthcare personnel in emergency departments has increased, and some have even noted a reduction in morale and job satisfaction, as their responsibilities include intervening in not only true emergencies but also managing many patients with non-acute complaints. One possible exacerbating factor is the length of waitlists to access outpatient care in the Italian National Healthcare System (NHS), as some patients may have to wait for months to see an otolaryngologist. This situation has motivated many to seek care in the emergency department to skip wait times and receive specialty evaluation and treatment without charge. Decreasing the utilization of emergency department services by improving access to primary care services has been a long-term aim, articulated since at least 1958, when physicians working at Hartford Hospital published a pioneering piece in The New England Journal of Medicine [2] that showed that only a minimum number of patients who visited the emergency department required inpatient care. At that time, proposed solutions were to increase utilization of outpatient care and to educate patients to seek a preliminary triage consultation with their family physicians; it is possible that the COVID-19 outbreak is pushing our current society in a similar direction. Certainly, the priority now is to fight the pandemic, but in time, many aspects of healthcare should be reviewed and better organization through telemedicine sought [3]. Hopefully, patients will have learnt to more appropriately utilize the numerous resources offered by the Italian NHS for all of its patients

Tinnitus revival during COVID‑19 lockdown: how to deal with it?

To the Editor, The novel Coronavirus Disease, officially designated as COVID-19 by the WHO, is a serious issue for public health. To contain the COVID-19, the Italian Government stated on March 9th 2020 the prohibition of any movement throughout the national area unless for work/health reasons and the obligation to remain as much as possible inside one’s own home. With the start of the so-called “Phase Two” on May 4th 2020, circulation within the same region was allowed again, due to the progressive slowdown of the outbreak. Therefore, since lockdown measures were relaxed and access to the emergency room or ENT clinic became less worrying for patients, specialists of Otolaryngology Units in Bari (Italy) observed an increase in the amount of subjects complaining of the revival of intense tinnitus. We attempt in this letter to focus on patients affected by chronic subjective tinnitus, that already had a diagnosis and self-stabilized without a massive treatment. Research studies have reported tinnitus wide impact on quality of life of subjects experiencing it, involving their emotional state, concentration and sleep quality; at this regard, Tinnitus Handicap Inventory (THI) is a self-reported tool regularly used to quantify the grade of perceived handicap as slight (0–16), mild (18–36), moderate (38–56), severe (58–76) or catastrophic (78–100) on the basis of 25 questions [1]. During the past 2 weeks, we have collected data from 16 patients among our population of chronic sufferers: THI observed was moderate in 62.5% and severe in 18.75% of cases, catastrophic in 12.5% and mild in 6.25% of subjects. Interestingly, the grade of handicap resulted increased by one-level in 12 out of 16 patients (75%); in particular, THI shifted from mild to moderate in 9 patients and from moderate to severe in 3 patients. As shown in the literature, tinnitus generation, maintenance and recrudescence are still debated. A cortical reorganization secondary to sensory deprivation has been proposed as one on the most frequent cause of tinnitus [2]. The avoidance of silence and acoustic masking have been proposed as effective measures to overcome sensory deprivation and increase masking of the symptom [3]. It is reasonable to think that, during the lockdown, the absence of environmental masking sounds from everyday life may have enhanced the tinnitus perception. Furthermore, proneness to worry and incoming stress during pandemic could be included as further potential risk factors for tinnitus worsening. As proficiently reviewed in a recent work [4], some internet/smartphone-based applications provide in tinnitus patients adequate counseling and interactive information together with sound therapy. As brain networks implicated in adaptive responses to sound stimuli and to worry are shared in many cases, an early decrease of anxiety status may release neural resources crucial for tinnitus habituation/distress perception [5]. In general, interactive platforms have been widely implemented during lockdown period due to the forced lack of real personal and working relationships; since smart-working seems to be successful for future plans, the development of smart applications and mobile services in the health care field may be promising in terms of cost-effectiveness, tolerability and simplicity of use

Postprandial glucose and HbA1c are associated with severity of obstructive sleep apnoea in non-diabetic obese subjects

Introduction: Obstructive sleep apnoea (OSA) is an underdiagnosed condition frequently associated with glycaemic control impairment in patients with type 2 diabetes. Aim: To assess the relationship between glycometabolic parameters and OSA in obese non-diabetic subjects. Methods: Ninety consecutive subjects (mean age 44.9 ± 12 years, mean BMI 42.1 ± 9 kg/m2) underwent polysomnography and a 2-h oral glucose tolerance test (OGTT). Results: OSA was identified in 75% of subjects, with a higher prevalence of males compared to the group of subjects without OSA (62% vs 32%, p = 0.02). Patients with OSA had comparable BMI (42.8 kg/m2 vs 39.4 kg/m2), a higher average HbA1c (5.8% vs 5.4%, p < 0.001), plasma glucose at 120 min during OGTT (2 h-PG; 123 mg/dl vs 97 mg/dl, p = 0.009) and diastolic blood pressure (81.1 mmHg vs 76.2 mmHg, p = 0.046) than obese subjects without OSA. HbA1c and 2 h-PG were found to be correlated with the apnoea-hypopnoea index (AHI; r = 0.35 and r = 0.42, respectively) and with percent of sleep time with oxyhaemoglobin saturation < 90% (ST90; r = 0.44 and r = 0.39, respectively). Further, in a linear regression model, ST90 and AHI were found to be the main determinants of 2 h-PG (β = 0.81, p < 0.01 and β = 0.75, p = 0.02, respectively) after controlling for age, sex, waist circumference, physical activity, and C-reactive protein. Similarly, ST90 and AHI persisted as independent determinants of HbA1c (β = 0.01, p = 0.01 and β = 0.01, p = 0.01, respectively). Conclusion: Beyond the traditional clinical parameters, the presence of a normal-high value of 2 h-PG and HbA1c should raise suspicion of the presence of OSA in obese subjects