A Comparative Study of Acute Invasive Fungal Sinusitis During the First and Second Waves of the COVID-19 Pandemic.

We aimed to compare the demography, clinical profile, histopathology, fungal culture, radiology, surgery performed, medical therapy and outcomes of patients with acute invasive fungal sinusitis seen during the first and second waves of the COVID-19 pandemic by retrospectively reviewing their case records. Of 238 patients, 43(18.1%) presented during the first wave and 195(81.9%) during the second wave. Patients seen during the first wave were older (p = 0.04) and more likely to have visual impairment (p = 0.004), frozen eye (p = 0.012), altered sensorium (p = 0.007) and stage 3 disease (p = 0.03). Those seen during the second wave were more often COVID-19 positive and had newly diagnosed diabetes mellitus (p = 0.04)and stage 1 disease (p = 0.03). Most patients had a positive culture for Rhizopus species during both waves. Histopathology showed broad aseptate hyphae in all patients but angioinvasion was seen more often during the first wave (p = 0.04). The majority of patients were treated with endoscopic+/- open debridement followed by intravenous amphotericin B and oral posaconazole. While the overall survival rate was similar (first wave 65.1%; second wave 79%; p = 0.106), mortality after discharge was greater during the first wave (11.6% vs 1.5%; p = 0.001). Mortality was higher in patients with stage 3 disease (p = 0.003). Significant differences in clinical presentation, histopathology, radiological stage of disease and post-discharge survival were noted between the two waves of the COVID-19 pandemic, the causes for which were multi-factorial.

Evaluation of Contralateral Ear in Unilateral Chronic Otitis Media: Necessary or Not?

Eustachian tube appears to be central to the pathogenesis of all forms of otitis media. The reported frequency of bilateral disease ranges from 27 to 55%. The affected ear may well be the end point of the pathology in the contra lateral ear (CLE). Cross sectional observational study. One hundred patients who had unilateral chronic otitis media (COM) were enrolled in the study. Diseased ear was divided into either mucosal or squamosal type. Otoendoscopy, pure tone audiometry, impedance audiometry and X-ray mastoid (Schuller's view) findings of CLE were noted. Considering all the changes including tympanic membrane, X-ray mastoid, hearing assessment and tympanometry, we found that 70% of patients had alterations in the CLE. Our study was consistent with many previous studies that there was an increased risk of COM in the CLE of unilateral COM.