Sinus, middle-ear and mastoid radiological findings of severe acute respiratory syndrome coronavirus-2.

OBJECTIVE: To assess the incidence of radiological inflammation within the paranasal sinuses, middle ear and mastoid in patients with confirmed severe acute respiratory syndrome coronavirus-2. METHODS: A retrospective cohort study was conducted to examine consecutive adults (aged over 18 years) with coronavirus disease 2019 (confirmed on polymerase chain reaction within 7 days of imaging) who underwent computed tomography of the head between 1 March 2020 and 24 June 2020. Lund-Mackay and mastoid and middle-ear opacification scores were used to categorise the extent of sinus and mastoid opacification on axial and coronal computed tomography images. RESULTS: Of 147 patients originally identified, only 83 met the inclusion criteria. Sinus opacification was present in 51.8 per cent of patients (n = 43), and middle-ear or mastoid opacification was observed in 24.1 per cent (n = 20). There was no statistically significant difference in sinus or middle-ear and mastoid opacification between patients after stratification based on 30-day all-cause mortality. CONCLUSION: Radiological computed tomography findings suggest mild mucosal disease within the sinuses, middle ear and mastoid. There was no statistical correlation between such opacification and 30-day mortality.

Fifteen-minute consultation: investigation and management of an infant with stridor.

Stridor is an abnormal sound caused by turbulent airflow through the airway. In an infant under 3 months of age presenting with stridor, there are many different underlying aetiologies. Some key assessment points help to differentiate those patients who can be reassured and monitored versus those requiring referral to an ear, nose and throat (ENT) surgeon for further assessment or management. We present a structured approach to guide the clinician through initial assessment, examination and management, including referral to ENT surgery.

Olfaction, pheromones and life.

BACKGROUND: From an evolutionary standpoint, olfaction is one of the oldest senses, and one that affects all aspects of life. This review discusses the influence of olfaction and pheromones on life. METHODS: A literature search was conducted using MEDLINE (1966-2012), Embase (1988-2012), The Cochrane Library (1993-2013) and Ovid (1966-2012). RESULTS: Olfaction plays an important role in life, from infancy through to adulthood and declining health in old age. Culture, memories and emotions, which add to life's complexity and overall enjoyment, are also influenced by olfaction. CONCLUSION: Olfaction has a chronological influence on life, affecting all aspects from the cradle to the grave; it plays a role in the quality of life as a key ingredient of human evolution, survival and enjoyment.

Drug delivery to the ear.

Drug delivery to the ear is used to treat conditions of the middle and inner ear such as acute and chronic otitis media, Ménière's disease, sensorineural hearing loss and tinnitus. Drugs used include antibiotics, antifungals, steroids, local anesthetics and neuroprotective agents. A literature review was conducted searching Medline (1966-2012), Embase (1988-2012), the Cochrane Library and Ovid (1966-2012), using search terms 'drug delivery', 'middle ear', 'inner ear' and 'transtympanic'. There are numerous methods of drug delivery to the middle ear, which can be categorized as topical, systemic (intravenous), transtympanic and via the Eustachian tube. Localized treatments to the ear have the advantages of targeted drug delivery allowing higher therapeutic doses and minimizing systemic side effects. The ideal scenario would be a carrier system that could cross the intact tympanic membrane loaded with drugs or biochemical agents for the treatment of middle and inner ear conditions.

Evidence of an increase in the incidence of odontogenic sinusitis over the last decade in the UK.

BACKGROUND: Dental disease is a recognised cause of sinusitis. We perceived an increased incidence of sinusitis secondary to dental disease in recent years. This study reviews the incidence of odontogenic sinusitis, its clinical features and treatment. METHODS: Medical records of patients with odontogenic sinusitis were identified using the senior author's clinical database and Hospital Information Support System data (January 2004 to December 2009). RESULTS: Twenty-six patients were identified, nine females and 17 males (age range, 17-73 years). Rhinorrhoea and cacosmia were the commonest symptoms (81 and 73 per cent, respectively), with presence of pus the commonest examination finding (73 per cent). Causative dental pathology included periapical infection (73 per cent), oroantral fistula (23 per cent) and a retained root (4 per cent). In all 26 cases, treatment resulted in complete resolution of symptoms; 21 (81 per cent) required sinus surgery. The number of patients with odontogenic sinusitis undergoing surgery has steadily increased, from no cases in 2004 to 10 in 2009 (accounting for 8 per cent of all patients requiring sinus surgery). Reduced access to dental care may be responsible. CONCLUSION: The incidence of odontogenic sinusitis appears to be increasing. The importance of assessing the oral cavity and dentition in patients with rhinosinusitis is therefore emphasised.

Frontal sinus models and onlay templates in osteoplastic flap surgery.

OBJECTIVE: Precise delineation of the extent of frontal sinus pneumatisation is a crucial step in osteoplastic flap frontal sinus surgery. The authors present a novel method of achieving this objective. METHODS: First, models of the frontal area are generated using three-dimensional printing based on pre-operative computed tomography image data. These models are then used to create an onlay template of the frontal sinus, which is used intra-operatively. RESULTS: In a series of 10 patients undergoing osteoplastic flap frontal sinus surgery, the described frontal sinus templates were consistently accurate to within 1 mm. CONCLUSION: Frontal sinus templates are potentially useful adjuncts to current techniques employed to guide frontal sinus surgery.

Plastic bronchitis requiring bronchoscopy.

OBJECTIVE: We report two cases of plastic bronchitis presenting with acute respiratory failure and mimicking foreign body inhalation. METHOD: The clinical findings, differential diagnoses and radiological investigation are discussed. RESULTS: Plastic bronchitis is an uncommon condition, particularly in children. The condition may present to otolaryngologists with symptoms mimicking foreign body inhalation. It is important to consider plastic bronchitis as a differential diagnosis, based on its clinical and radiological signs. Early intervention, in the form of bronchoscopy, can be both diagnostic and therapeutic. CONCLUSION: Plastic bronchitis is uncommon and its clinical and radiological features are non-specific. The recommended management is early bronchoscopy to establish the diagnosis and enable therapeutic intervention.

Spontaneous pneumomediastinum: benefits of contrast computed tomography imaging.

OBJECTIVE: We report a case of spontaneous pneumomediastinum presenting with chest and anterior neck pain. METHOD: The clinical findings, differential diagnosis and selection of radiological investigations are discussed. RESULTS: Spontaneous pneumomediastinum is an uncommon condition usually presenting in young patients. Presentation to the otolaryngology department occurs due to the presence of symptoms such as neck pain. Differential diagnoses must be considered and excluded, using the clinical features and the results of radiological investigation. Once the diagnosis is confirmed, conservative management is undertaken. CONCLUSION: Spontaneous pneumomediastinum is uncommon and the clinical features are variable. The recommended investigation is a computed tomography scan with orally administered, water soluble contrast to exclude important differential diagnoses and thus enable definitive diagnosis.

Squamous cell carcinoma of the nasal vestibule: a 20-year case series and literature review.

Squamous cell carcinoma of the nasal vestibule is a rare disease with significant morbidity and mortality, and a five-year recurrence-free survival rate of between 42 and 92 per cent. There are several staging systems: the American Joint Committee on Cancer (AJCC) skin and nasoethmoid complex system, the Union International Centre Cancer (UICC) nasal fossa system, and Wang's system. Treatment options include radiotherapy or surgery for early lesions, but more advanced cases require radical surgery with post-operative radiotherapy. We present a case series spanning the last 20 years in one centre, and we compare this series with cases reported in the literature, paying particular attention to staging, treatment and outcome. We found that patients with tumours staged T2 or T3 (Wang system) who received radiotherapy alone did poorly in comparison with those who received surgery or surgery and radiotherapy.