ABSTRACT
BACKGROUND: Coronavirus disease 2019, a highly transmissible respiratory infection, has created a public health crisis of global magnitude. The mainstay of diagnostic testing for coronavirus disease 2019 is molecular polymerase chain reaction testing of a respiratory specimen, obtained with a viral swab. As the incidence of new cases of coronavirus disease 2019 increases exponentially, the use of viral swabs to collect nasopharyngeal specimens is anticipated to increase drastically. CASE REPORT: This paper draws attention to a complication of viral swab testing in the nasopharynx and describes the premature engagement of a viral swab breakpoint, resulting in impaction in the nasal cavity. CONCLUSION: This case highlights a possible design flaw of the viral swab when used to collect nasopharyngeal specimens, which then requires an aerosol-generating procedure in a high-risk patient to be performed. The paper outlines a safe technique of nasal foreign body removal in a suspected coronavirus disease 2019 patient and suggests alternative testing materials.
Subject(s)
Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Foreign Bodies/etiology , Nasal Cavity , Pneumonia, Viral/diagnosis , Specimen Handling/adverse effects , Aged , Betacoronavirus , COVID-19 , COVID-19 Testing , Humans , Male , Pandemics , SARS-CoV-2 , Specimen Handling/instrumentationABSTRACT
OBJECTIVE: To collect and analyse data from the published literature concerning the rare condition necrotising otitis externa, in order to formulate a prognostic scoring model based on signs and symptoms. DESIGN: Retrospective data collection from published literature, and binary logistic regression analysis of the effect on outcome of identified signs and symptoms. RESULTS: Six factors were identified as prognostic of a poorer outcome, including facial nerve involvement, additional cranial nerve involvement, non-cranial nerve neurological involvement, extensive granulations (or oedema) in the external auditory canal, bilateral symptoms and aspergillus species as the causative organism. A four-point scoring model based on these findings is presented. CONCLUSIONS: A novel, systematic method of data analysis was utilised to construct a prognostic scoring model for necrotising otitis externa. This will better equip clinicians to treat this potentially fatal condition.
Subject(s)
Cranial Nerve Diseases/complications , Diabetes Complications/complications , Otitis Externa/etiology , Pseudomonas Infections/complications , Female , Humans , Immunocompromised Host , Male , Middle Aged , Models, Biological , Necrosis , Predictive Value of Tests , Prognosis , Pseudomonas aeruginosa , Regression Analysis , Severity of Illness IndexABSTRACT
OBJECTIVES: To demonstrate the importance of two radiological views in the assessment of oesophageal foreign bodies. CASE REPORT: The case of a child with multiple oesophageal foreign bodies appearing as a single object on an antero-posterior chest radiograph is used to illustrate the need for two radiological views in the assessment of such cases. CONCLUSIONS: Two radiological views are recommended in the assessment of oesophageal foreign bodies.
Subject(s)
Esophagus/diagnostic imaging , Foreign Bodies/diagnostic imaging , Child, Preschool , Esophagoscopy/methods , Esophagus/surgery , Foreign Bodies/surgery , Humans , Male , Radiography/methods , Treatment OutcomeABSTRACT
Rigid nasendoscopy is a commonly used method of examining the nasal cavity and postnasal space. Co-phenylcaine is useful for its vasoconstrictive and anaesthetic properties, but the length of time allowed for it to take effect is variable. We performed a single-blind, randomized, controlled trial to determine whether it was better to allow one or 10 minutes for co-phenylcaine to take effect. Fifty patients were randomized into two groups, 25 in each. Patients in the 10 minute group experienced less discomfort (p=0.02) and less pain (p=0.018) than those in the one minute group. Ease of examination was also greater in the 10 minute group, as was the quality of the image obtained (p<0.001).
Subject(s)
Anesthetics, Local/administration & dosage , Endoscopy/methods , Lidocaine/administration & dosage , Nasal Cavity , Nasal Decongestants/administration & dosage , Phenylephrine/administration & dosage , Adolescent , Adult , Aged , Aged, 80 and over , Drug Administration Schedule , Drug Combinations , Female , Humans , Male , Middle Aged , Pain Measurement , Single-Blind Method , Time FactorsABSTRACT
Nasotracheal intubation offers the head and neck surgeon more scope for surgical manoeuvre in operations of the mouth, pharynx, larynx and also the neck. Concern over the complications of using this route of intubation and lack of training may be limiting its use. A thorough knowledge of the anatomy, benefits of using nasal vasoconstrictors and attention to technique are prerequisites to maintaining the skill. This article reviews each of these topics and aims to encourage the appropriate use of nasotracheal intubation in current practice.
