COVID-19: When dust mites and lockdown create the perfect storm

The aim of the present study was to understand if the course of the disease of patients suffering from dust mite allergy could have been negatively affected by the COVID-19 restrictions, which have been certainly important to fight the pandemic, but forced patients to stay at home for a long time

COVID-19: the difference between the nose and the lung.

To the Editor An elegant study reported dysmorphic cells and syncytia in the deceased's lungs for COVID-19. The authors reasonably considered that most of these syncytia-forming cells were pneumocytes, as identified by specific biomarkers. However, cellular dysmorphism and syncytia are pathological features common in other respiratory infections caused by different viruses, including the human respiratory syncytial virus (HRSV) and Epstein-Barr virus (EBV), as correctly documented..

Impact of the COVID-19 pandemic on paediatric otolaryngology: a nationwide study

Objective: The COVID-19 pandemic profoundly modified the work routine in healthcare; however, its impact on the field of paediatric otorhinolaryngology (ORL) has been rarely investigated. The aim of this study was to assess the impact of COVID-19 on paediatric ORL. Methods: A questionnaire was developed by the Young Otolaryngologists of the Italian Society of ORL-Head and Neck Surgery (GOS). The questionnaire consisted of 26 questions related to workplace and personal paediatric ORL activities. The link was advertised on the official social media platforms and sent by e-mail to 469 Italian otolaryngologists. Results: The questionnaire was completed by 118 responders. During the pandemic, the main reduction was observed for surgical activity (78.8%), followed by outpatient service (16.9%). The conditions that were mostly impacted by a delayed diagnosis were respiratory infections in 45.8% of cases and sensorineural hearing loss in 37.3% of cases. Conclusions: Paediatric ORL was highly impacted by the COVID-19 pandemic, with a significant reduction of surgical and outpatient activities and a delay in time-sensitive diagnosis. Therefore, the implementation of new strategies, such as telemedicine, is recommended

Nasal delivery devices: A comparative study on cadaver model

Nasal nebulization is a more effective method of delivering topical medication than nasal spray. The purpose of this study was to assess the deposition patterns of nebulization in delivering topical agents to the nasal cavities in the human cadaveric model using a color-based method. We have compared these following nasal devices: single-dose vial irrigation, syringe-irrigation, common nasal spray, Spray-sol, MAD nasal, and Rinowash nasal douche. Endoscopic images were recorded at six anatomical regions prior to and following each nasal device application and four reviewers evaluated the amount of surface area staining. At the nasal vestibule, the blue dye distribution achieved with Spray-sol was more extensive than nasal sprays. At inferior turbinate and nasal cavity floor, single dose vial, syringe, MAD nasal, Spray-sol, and Rinowash demonstrated a greater extent of dye distribution than nasal spray. At the middle turbinate, the average score of both Spray-sol and MAD nasal was significantly higher than other nasal investigated devices. At the nasopharynx, Spray-sol nebulization covers a surface significantly greater than other devices. Compared to traditional sprays, Spray-sol and MAD nasal provided a more effective method of delivering topical agents to the deeper and higher portions of the nasal cavities

Comparison of COVID-19 and common cold chemosensory dysfunction

Anosmia constitutes a prominent symptom of COVID-19. However, anosmia is also a common symptom of acute colds of various origins. In contrast to an acute cold, it appears from several questionnaire-based studies that in the context of COVID-19 infection, anosmia is the main rhinological symptom and is usually not associated with other rhinological symptoms such as rhinorrhoea or nasal obstruction. Until now, no study has directly compared smell and taste function between COVID-19 patients and patients with other causes of upper respiratory tract infection (URTI) using valid and reliable psychophysical tests. In this study, we aimed to objectively assess and compare olfactory and gustatory functions in 10 COVID-19 patients (PCR diagnosed, assessed on average 2 weeks after infection), 10 acute cold (AC) patients (assessed before the COVID-19 outbreak) and 10 healthy controls, matched for age and sex. Smell performance was assessed using the extended "Sniffin' Sticks" test battery (4), while taste function was assessed using "taste strips" (5). Receiver Operating Characteristic (ROC) curves were built to probe olfactory and gustatory scores in terms of their discrimination between COVID-19 and AC patients. Our results suggest that mechanisms of COVID-19 related olfactory dysfunction are different from those seen in an AC and may reflect, at least to some extent, a specific involvement at the level of central nervous system in some COVID-19 patients. In the future, studies to assess the prevalence of persistent anosmia and neuroanatomical changes on MRI correlated to chemosensory function, will be useful to understand these mechanisms

COVID‐19: Recovery from Chemosensory Dysfunction. A Multicentre study on Smell and Taste

Objective/Hypothesis With the COVID-19 pandemic, chemosensory dysfunction are among the most prevalent symptoms. Most reports are subjective evaluations, which have been suggested to be unreliable. The objective is to test chemosensory dysfunction and recovery based on extensive psychophysical tests in COVID-19 during the course of the disease. Study Design Prospective cohort study. Methods A total of 111 patients from four centers participated in the study. All tested positive for SARS-COV-2 with RT-PCR. They were tested within 3 days of diagnosis and 28 to 169 days after infection. Testing included extensive olfactory testing with the Sniffin' Sticks test for threshold, discrimination and identification abilities, and with the Taste Sprays and Taste Strips for gustatory function for quasi-threshold and taste identification abilities. Results There was a significant difference in olfactory function during and after infection. During infection 21% were anosmic, 49% hyposmic, and 30% normosmic. After infection only 1% were anosmic, 26% hyposmic, and 73% normosmic. For gustatory function, there was a difference for all taste qualities, but significantly in sour, bitter, and total score. Twenty-six percent had gustatory dysfunction during infection and 6.5% had gustatory dysfunction after infection. Combining all tests 22% had combined olfactory and gustatory dysfunction during infection. After infection no patients had combined dysfunction. Conclusions Chemosensory dysfunction is very common in COVID-19, either as isolated smell or taste dysfunction or a combined dysfunction. Most people regain their chemosensory function within the first 28 days, but a quarter of the patients show persisting dysfunction, which should be referred to specialist smell and taste clinics for rehabilitation of chemosensory function. Level of Evidence 3 Laryngoscope, 202

Impact of the COVID-19 pandemic on paediatric otolaryngology: a nationwide study

Objective: The COVID-19 pandemic profoundly modified the work routine in healthcare; however, its impact on the field of paediatric otorhinolaryngology (ORL) has been rarely investigated. The aim of this study was to assess the impact of COVID-19 on paediatric ORL. Methods: A questionnaire was developed by the Young Otolaryngologists of the Italian Society of ORL-Head and Neck Surgery (GOS). The questionnaire consisted of 26 questions related to workplace and personal paediatric ORL activities. The link was advertised on the official social media platforms and sent by e-mail to 469 Italian otolaryngologists. Results: The questionnaire was completed by 118 responders. During the pandemic, the main reduction was observed for surgical activity (78.8%), followed by outpatient service (16.9%). The conditions that were mostly impacted by a delayed diagnosis were respiratory infections in 45.8% of cases and sensorineural hearing loss in 37.3% of cases. Conclusions: Paediatric ORL was highly impacted by the COVID-19 pandemic, with a significant reduction of surgical and outpatient activities and a delay in time-sensitive diagnosis. Therefore, the implementation of new strategies, such as telemedicine, is recommended

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Electrocochleography: development of metrics and optimized recording techniques

Introduzione: Tradizionalmente, gli interventi chirurgici otologici, in cui l'integrità dell'orecchio interno è compromessa, sono considerati demolitivi per l’udito, sebbene siano efficaci nel trattare alcune disabilitanti malattie. L'elettrococleografia (ECochG) è una tecnica che consente la misurazione dei potenziali evocati uditivi che derivano dall'orecchio interno e dal ganglio spirale grazie alla prossimità dell'elettrodo di registrazione. Questa tesi ha l’obiettivo di indagare i potenziali meccanismi di perdita/preservazione dell'udito mediante ECochG eseguita durante diversi tipi di procedure chirurgiche otologiche e della base cranica laterale (es. impianto cocleare, IC, malattia di Ménière, MD, resezione di schwannoma vestibolare, VS, ecc.). Inoltre, è stato utilizzato un modello animale per isolare le componenti del potenziale di sommazione (SP) al fine di consentirne una migliore interpretazione clinica. Materiali e metodi: I pazienti inclusi sono stati sottoposti a ECochG dalla finestra rotonda durante l'intervento chirurgico: gli stimoli presentati sono stati tone burst da 95 a 110 dB SPL. Anche nel modello animale è stata eseguita l'ECochG della finestra rotonda. Infine, un gruppo di pazienti programmati per ricevere un IC “lateral wall” sono stati sottoposti a ECochG direttamente attraverso il multielettrodo durante il suo inserimento, con il monitoraggio intraoperatorio attivo (AIM, Advanced Bionics, Advanced Bionics LLC, Valencia, CA). Risultati: I risultati ECochG nei pazienti con VS e MD hanno evidenziato una riduzione nell'ampiezza della risposta all’aumentare della frequenza dello stimolo. In un caso di rimozione di un tumore del forame giugulare, il potenziale d'azione composto è aumentato a tutte le frequenze (p<0.01) e la preservazione dell'udito è stata confermata dall’esame audiometrico post-operatorio. Nonostante l'esiguo numero di pazienti, sono stati osservati pattern di risposta ECochG eterogenei all'interno del gruppo con tip-fold-over, mentre tutti i controlli hanno mostrato una diminuzione della risposta ECochG-totale. Il modello animale ha evidenziato che il SP presenta almeno quattro componenti, di cui due neurali, con una miscela di polarità e ampiezze. Conclusioni: L'ECochG intraoperatoria può consentire il monitoraggio uditivo in tempo reale durante chirurgie complesse della base cranica laterale, di minimizzare il trauma durante l’inserimento del multielettrodo e di ridurre alcune complicanze come il tip-fold-over durante la chirurgia dell'IC. Segni di patologia cocleare sono risultati presenti nei pazienti con VS e MD. Infine, dovrebbe essere annoverata l’intricata origine cocleare e neurale nell’interpretazione clinica del SP.Introduction: Traditionally, ear surgeries where the integrity of the inner ear is compromised are considered destructive procedures. While these operations can be very successful for threatening certain inner ear diseases, they always determine a complete loss of hearing. Electrocochleography (ECochG) is a technique that allows for the measurement of the auditory evoked potentials that arise from the inner ear and spiral ganglion. As opposed to far-field recording techniques, ECochG is considered a near-field recording montage, mainly due to the proximity of the recording electrode to the source generators in the inner ear. The aims of these thesis were to investigate the potential mechanisms of hearing loss/preservation via electrophysiological measures during several types of otologic and skull base procedures (i.e., cochlear implantation, CI, Ménière’s disease, MD, resection of vestibular schwannoma, VS, etc.). Additionally, an animal model was used to isolate the complex sources of the summating potential (SP) for better interpretation for clinical purposes. Materials and methods: Patient interventions consisted of intraoperative round window ECochG during surgery: tone burst stimuli were presented from 95 to 110 dB SPL. Round window ECochG to tones and clicks was also performed in the animal model. Lastly, a group of patients scheduled to receive a lateral wall electrode underwent ECochG recorded directly from a CI electrode array during its insertion, with the Active Intraoperative Monitoring (AIM, Advanced Bionics, Valencia, CA). Results: ECochG findings in VS and MD patients evidenced a reduced trend in amplitude of the ongoing response with increased stimulus frequency. In a case of jugular foramen tumor removal, the compound action potential magnitudes increased at all test frequencies (p<0.01) and serviceable hearing was confirmed by audiometric testing after tumor resection. Despite the small number of patients, heterogeneous ECochG response patterns were observed within the CI fold-over group, while regarding the ECochG-total response, all controls showed a decrease in the magnitude. The animal model evidenced that the sources of the SP include at least four components presenting a mixture of polarities and magnitudes. Conclusions: Intraoperative ECochG may allow for real-time monitoring of auditory function during complex skull base surgery, minimizing trauma for electrode insertion and reducing complications such as tip fold-over during CI surgery. Findings of cochlear pathology were likely present in patients with VS and MD. Finally, the complex mixture of cochlear and neural sources should be acknowledged when interpreting the SP for clinical purposes