Olfactory impairment in patients with coronavirus disease 2019 self-perceived as asymptomatic.

BACKGROUND: Olfactory impairment may be present among patients with coronavirus disease 2019 self-perceived as asymptomatic. This study aimed to assess olfactory function among these individuals. METHODS: A cross-sectional study involving patients with coronavirus disease 2019 self-perceived as asymptomatic was conducted. Assessments included the subjective Malaysian Smell and Taste Questionnaire and the culturally adapted Malaysian version of the objective Sniffin' Sticks Identification smell test. RESULTS: In 81 participants (mean age of 31.59 ± 12.04 years), with mean time from diagnosis to smell test of 7.47 ± 3.79 days, subjective assessment showed that 80.2 per cent were asymptomatic (questionnaire score of 6) and 19 per cent had mild symptoms (questionnaire score of 7 and 8). The mean objective smell test score was 10.89 ± 2.11. The prevalence of olfactory impairment was 76.6 per cent among patients with coronavirus disease 2019 self-perceived as asymptomatic. There was no association between the questionnaire and the smell test scores (p = 0.25). There was a correlation between the smell test score and the duration from diagnosis to smell test (p = 0.04). CONCLUSION: The objective assessment demonstrated that coronavirus disease 2019 patients who perceived themselves as asymptomatic showed olfactory impairment.

The association between the reflux symptoms index and nasal symptoms among patients with non-allergic rhinitis.

BACKGROUND: Laryngopharyngeal reflux symptoms assessed with the reflux symptom index can overlap with non-allergic rhinitis symptoms. This study aims to explore the association between the reflux symptom index and nasal symptoms in non-allergic rhinitis patients. METHODS: A cross-sectional study was conducted on consecutive adults with non-allergic rhinitis. The reflux symptom index (score of more than 13 = laryngopharyngeal reflux) and nasal symptoms (categorised as mild (total score of 0-3), moderate (4-7) or severe (8-12)) were assessed. RESULTS: The study included 227 participants (aged 58.64 ± 12.39 years, 59.5 per cent female). The reflux symptom index scores increased with total nasal symptom scores (mild vs moderate vs severe, 8.61 ± 6.27 vs 12.94 ± 7.4 vs 16.40 ± 8.10; p < 0.01). Logistic regression indicated that laryngopharyngeal reflux is more likely in patients with severe nose block (odds ratio 5.47 (95 per cent confidence interval = 2.16-13.87); p < 0.01). CONCLUSION: Laryngopharyngeal reflux symptoms are associated with nasal symptom severity, and nasal symptoms should be primarily treated. Those with predominant nose block and laryngopharyngeal reflux symptoms are more likely to have laryngopharyngeal reflux.

Management of rhinosinusitis in adults in primary care.

Rhinosinusitis is a common health problem encountered in primary care. It is due to mucosal inflammation of the nose and paranasal sinuses. Less than 2% of the cases are associated with bacterial infections. Diagnosis is based on clinical symptoms and supported by nasal endoscopy and imaging studies. Intranasal corticosteroids and normal saline irrigation are important treatments. Antibiotics are seldom indicated.

Varicella zoster causing preseptal cellulitis - uncommon but possible.

BACKGROUND: Varicella has been known to be a harmless childhood disease. However, it has been reported that severe complications have taken place following Varicella infection, in both immunocompetent, as well as immunocompromised, individuals. Cutaneous complications of Varicella may manifest as preseptal cellulitis, albeit rarely. REPORT: We present a case of a 4-year-old boy who presented with symptoms and signs of preseptal cellulitis following Varicella infection. He was referred to the otorhinolaryngology team for a nasoendoscopy to rule out sinusitis, in view of the fear that a child presenting with a swollen red eye may be a case of true orbital cellulitis. He was treated successfully with intravenous antibiotics and surgical drainage of the preseptal collection. CONCLUSION: It is imperative for clinicians to be aware that a simple Varicella infection may lead to cutaneous complications in the pediatric age group, especially in children who are 4 years and younger. They may develop preseptal cellulitis, whose presentation might mimic that of orbital cellulitis. Empirical treatment with antibiotics would be advantageous for the patient. A nasoendoscopic examination may also be warranted in these cases to rule out sinusitis as a cause of orbital cellulitis.

Adenoid cystic carcinoma of the sinonasal tract: outcome of endonasal endoscopic surgery at five-year follow up.

OBJECTIVE: To study the outcome of endonasal endoscopic surgery for adenoid cystic carcinoma of the sinonasal tract over a five-year follow-up period. DESIGN: Retrospective analysis. METHODS: Four consecutive patients with adenoid cystic carcinoma of the sinonasal tract, who had undergone endonasal endoscopic surgery, were reviewed regarding age at diagnosis, sex, primary site, tumour-node-metastasis staging, treatment modalities, histopathological findings, duration of follow up, distant metastases and treatment outcome. RESULTS: All patients were diagnosed at an advanced stage and had post-operative adjuvant radiotherapy. Three patients underwent endoscopic endonasal resection and one endoscopic assisted craniofacial resection. The most common primary site was the ethmoid sinus (three patients). Three patients had no evidence of recurrence. One patient who had undergone partial clearance via endoscopic endonasal resection developed cervical node metastases a year after treatment; this patient also developed distant metastases. CONCLUSION: Adenoid cystic carcinoma is difficult to treat. Sinonasal tract tumours can be resected via endoscopic endonasal resection or endoscopic assisted craniofacial resection, but prolonged follow up is advisable. Radiotherapy is an important adjuvant treatment.