Endoscopic appearance of duplicated middle turbinate, case series and literature review.

INTRODUCTION AND IMPORTANCE: Duplication of the middle turbinate is an extremely rare condition encountered in rhinology clinic. Knowledge and awareness of the nasal turbinates' variations are important to perform a safe endoscopic surgery and evaluate patients with inflammatory sinus diseases. CASE PRESENTATION: Case series of two patients who visited rhinology clinic in academic university hospital. Case 1: presented with 6-month history of nasal blockage. Nasal endoscopy revealed bilateral duplication of the middle nasal turbinates. Computed tomography scans showed bilateral medially curved and anteriorly folded uncinate process, and right middle turbinate concha bullosa and its superior end of the middle turbinate was turned medially. Case 2: A 29-year-old gentleman presented with nasal obstruction mainly to the left side for several years. Nasal endoscopy showed bifid right middle turbinate and severe deviated nasal septum to the left. Upon imaging, a sinus computed tomography scan demonstrated a duplication of the right middle turbinates in the form of two middle nasal concha. CLINICAL DISCUSSION: Different rare anatomical variations can occur at different points during the embryological development. These rare variations include double middle turbinate, accessory middle turbinate, secondary middle turbinate, and bifid inferior turbinate. The appearance of double middle turbinate can be encountered in rhinology clinic only 2 % of the time. Upon reviewing the literature, only few case reports were found regarding the double middle turbinate. CONCLUSION: A double middle turbinate has important clinical implications. Anatomical variation may lead to narrowing in the middle meatus which makes the patient vulnerable to sinusitis or maybe associated with secondary symptoms. We report rare cases of middle turbinate duplication. Awareness of the nasal turbinates' variations is important for detection and management of inflammatory sinus diseases. Further studies are needed to identify the association of other pathology.

Retropharyngeal Emphysema Following Local Palate Trauma.

Retropharyngeal emphysema (RPE) is a condition that occurs when air is trapped in the retropharyngeal space. It is a rare condition that is either spontaneous or secondary to various etiologies. A case of a three-year-old patient with retropharyngeal emphysema secondary to local palate trauma was presented to King Fahd Hospital of the University. The patient was further investigated by flexible nasopharyngoscopy; however, it showed no additional complications. The patient was admitted to the hospital and managed conservatively with analgesia and antibiotics. Lateral neck X-ray showed complete resolution of retropharyngeal emphysema a few days after admission. The patient was discharged on oral antibiotics and a follow-up after one week was arranged. Upon follow-up, the patient's condition improved with no further complications.

The psychological impact of the COVID-19 pandemic on otolaryngologists: Should we be concerned?

OBJECTIVE: Physicians on the frontline of the COVID-19 pandemic are at increased risk of contracting the disease. Otolaryngologists are amongst the high-risk practitioners, as they are in close proximity to patient's upper airway, which may induce their psychological stress. METHODS: A cross-sectional survey study, conducted among otolaryngologists in Saudi Arabia from June 11 to June 22. Survey consisted of sociodemographic questionnaire, Coronavirus Anxiety Scale (CAS), Obsession with COVID-19 Scale (OCS) and Patient Health Questionnaire-9 (PHQ-9). Available otolaryngologists with no history of mental health problems were included. A P-value lower than .05 was considered statistically significant. RESULTS: The study included 129 participants; 63.6% men and 36.4% women. 81.4% of participants were living with family, 57.4% living with either a child or an elderly family member. Nearly 7.8% of participants had dysfunctional COVID-19 anxiety and 75.2% had COVID-19-related depression symptoms ranging from minimal to severe. Obsession and dysfunctional thinking regarding COVID-19 were found in 26.4% of participants. Single otolaryngologists had significantly higher CAS (P = .025), OCS (P = .048), and PHQ-9 (P < .001) scores. Participants who lived with children or elderly individuals had significantly higher OCS scores (P = .005). When comparing job ranks, residents had significantly higher scores for the CAS (P = .016) and PHQ-9 (P < .001). CONCLUSION: COVID-19 has a considerable psychological impact on otolaryngologists. Specifically, the young and single who have less social support. This indicates the importance of psychological support to this group. Additional thorough studies should explore the psychological impact of COVID-19 in this field as it may carry devastating long-term consequences if left unattended. LEVEL OF EVIDENCE: Level 4.