Vitamin D Levels in Chronic Rhinosinusitis in Patients With or Without Nasal Polyposis: A Systematic Review.

Chronic rhinosinusitis (CRS) is a large group of heterogeneous diseases characterized by extensive inflammation of the nasal mucosa and sinuses. Vitamin D (VD), as an immunoregulatory hormone, may play an important role in the pathophysiology of CRS. The purpose of this study is to review the existing literature that correlates VD levels with CRS with or without nasal polyps. A systematic manual search was conducted in the PubMed and Google Scholar databases up to July 2023. Articles from PubMed and the first 100 articles from Google Scholar were recorded for our research. Keywords used were the following: vitamin D, chronic rhinosinusitis, and nasal polyps. Among the 134 articles retrieved, only 18 were eligible. The other 116 studies were excluded as they related VD levels with other conditions (e.g., allergic rhinitis) and for other reasons. However, we identified two more eligible records through the manual research of the above-mentioned 132 studies, and finally, 20 records were included in the current review. The review concerned case-control studies, prospective, retrospective, and cross-sectional studies. Based on our review, we concluded that CRS patients are correlated with the lowest VD levels, accompanied by increased severity of the disease, especially in those with nasal polyposis. Patients can benefit from appropriate VD supplementation, and serum VD levels should be included in the laboratory assessment of CRS. However, due to the heterogeneity of the individuals involved, more well-designed clinical trials as well as randomized clinical trials should be conducted for further validation of the above findings in the general population in the future.

Epistaxis Treatment Options: Literature Review.

Epistaxis means bleeding from nostrils, nasal cavity or nasopharynx. To summarize the available epistaxis treatment options. Methods: 61 articles published in the last 20 years were included. Duplicate records, irrelevant and inaccessible ones were excluded.  Epistaxis can be treated with first aid measures such as external pressure and ice packing and applying topical agents, e.g. oxymetazoline that stops 65-75% of nosebleeds in A&E. Also, with electrocautery which is more effective and has fewer recurrences (14.5% vs. 35.1%) than chemical cauterization and applying tranexamic acid that promotes hemostasis in 78% of patients, versus 35% and 31% respectively in patients treated with oxymetazoline and nasal packing. Furthermore, nasal packing can be applied with non-absorbable materials, e.g. petroleum jelly, BIPP gauze, PVA nasal tampons (Merocel), Foley catheter, balloons (Rapid-Rhino), absorbable materials, e.g. nasal tampon (Nasopore), and with newer hemostatic materials which are more effective and with fewer complications, e.g. hemostatic gauzes (Surgicel), thrombin matrix (Floseal), gelatin sponge (Spongostan) and fibrin glue. Moreover, epistaxis can be achieved with endoscopic ligation of arteries, mainly SPA, which is more effective than conventional nasal packing (97% vs. 62%), and with endoscopic cauterization which is more effective than ligation. Finally, for intractable cases embolization can be applied using gelatin sponge, foam, PVA and coils with 80% success rate and comparable efficacy and complications to surgical methods. Epistaxis can be dealt with various methods depending on patient's history and available resources. Newer hemostatic agents in combination with endoscopic methods have advantages over traditional methods.

A large thyroglossal duct cyst and its management: a case report.

Thyroglossal duct cysts (TGDC) are congenital neck cysts, formed as a result of the failure of the thyroglossal duct to involute during embryogenesis and their mean size is 1.5-2.4 cm. We present a case of a 44-year-old male who presented with a history of a large anterior neck mass measuring 8.7x6x6.4 cm and causing dysphagia and mild dyspnea. After being mistaken for a goiter, a clinical diagnosis of TGDC was made based on history, clinical and radiographic findings. The patient was treated with Sistrunk's procedure. No recurrence was noted on follow-up. Thyroglossal duct cysts are generally well-defined small lesions, but even bigger ones are not linked with severe symptomatology. The larger size at presentation may increase the list of potential diagnoses and lead to diagnostic dilemmas. Every effort should be made to rule out malignancy before surgery. Sistrunk's procedure with dissection of the posterior hyoid space should be the standard of care.

Endoscopic Management of Glomus Tympanicum Tumor: Report of Three Cases and Review of the Literature.

Glomus tympanicum are benign tumors of vascular origin, arising from the neural crest cells and located on promontory. The treatment of choice is surgical excision of the lesion. Traditionally, it is performed under microscopic observation. With the introduction of endoscopes in the field of ear surgeries, an endoscopic approach has also evolved. Herein, we present case reports of three patients diagnosed with glomus tympanicum tumors who were operated on using an endoscopic approach. A review of the literature is also performed. The mass was completely excised in all patients, and there were no signs of recurrence at the follow-up at least a year later. Endoscopic ear surgery is a safe and effective method of managing glomus tympanicum tumors. Its main limitation is the tumor size; however, in most cases, tumors of stages I to II as per the Glasscock-Jackson classification and types A1 to B1 according to the modified Fisch-Mattox classification can be completely removed endoscopically. Careful preoperative selection of patients warrants the best outcomes.

TNFRSF13B/TACI Mutations in Patients with Chronic Rhinosinusitis with Nasal Polyps.

BACKGROUND: The pathogenesis of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) remains still inconclusive. Recent studies identified an increased expression of BAFF (a B cell-activating factor) and its receptor TACI (Transmembrane Activator and cAML Interactor) in nasal polyp samples, while TNFRSF13B/TACI mutations have been found in patients with benign lymphoproliferative disorders and primary antibody deficiencies. OBJECTIVE: The aim of our study was to evaluate the possible contribution of TNFRSF13B/TACI mutations in CRSwNP pathogenesis. METHODS: Forty-four (44) patients with CRSwNP (male/female: 33/11, mean age: 52.5 years, range: 16-83) were analyzed for TNFRSF13B/TACI mutations by PCR-sequencing. RESULTS: No pathogenic TNFRSF13B/TACI mutations were identified in our cohort study of CRSwNP patients. We detected two common missense mutations (p.P251L and p.V220A), along with other common silent mutations and intronic polymorphisms in an identical prevalence to healthy control population. CONCLUSION: TNFRSF13B/TACI mutations might not play a role in the pathogenesis of CRSwNP.

CO2 laser or dissection tonsillectomy: A systematic review and meta-analysis of clinical outcomes.

OBJECTIVE: Recent evidence has suggested that performing a tonsillectomy with CO2 laser results in favorable intraoperative and postoperative outcomes. This study aimed to compare the clinical outcomes of CO2 and dissection tonsillectomy. METHODS: We conducted a systematic search in PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL), until the 1st of September 2021 for completed studies comparing intraoperative and postoperative outcomes of CO2 laser and dissection tonsillectomy. Primary outcomes were operative time, intraoperative blood loss, and postoperative pain. Secondary outcomes included postoperative hemorrhage and tonsillar fossa healing. A random-effects pairwise meta-analysis of both randomized and non-randomized trials was performed. A subgroup analysis considering the randomization of trials was carried out, and sensitivity analyses linked to the quality of included papers or the age of patients were executed. Quality assessment was appraised with the Cochrane risk of bias and ROBINS-I tools for randomized and non-randomized trials, respectively. RESULTS: Eight trials with 632 cases contributed data to this review. For operative time, a significant difference in favor of CO2 laser tonsillectomy was documented (SMD = -1.32; 95% CI = -2.24 to -0.40; p < 0.005). This was also the case for intraoperative blood loss (SMD = -3.94; 95% CI = -5.62 to -2.26; p < 0.00001). For postoperative pain, no significant differences were detected on day one and seven between the intervention groups (SMD = -0.24; 95% CI = -1.11 to 0.63; p = 0.59 and SMD = 1.31; 95% CI = -0.14 to 2.75; p = 0.08, respectively). CO2 laser tonsillectomy was not superior to conventional dissection tonsillectomy regarding postoperative bleeding rates (OR = 0.50; 95% CI = 0.10 to 2.53; p = 0.40). CONCLUSION: This study demonstrates that CO2 laser tonsillectomy is more likely to result in a clinically meaningful decrease in operative time and blood loss compared to the conventional dissection technique in both pediatric and adult patients. We found no significant difference in postoperative pain and bleeding. Performing further level-1 trials on this topic with a standardized and validated outcome measurement method will enable more robust conclusions to be drawn.

Sinonasal Lobular Capillary Hemangioma After Continuous Self-tests for COVID-19: A Case Report and Review of the Literature.

Sinonasal lobular capillary hemangiomas (LCH) are rare benign vascular lesions commonly arising from the nasal septum. Nasopharyngeal, nasal mid-turbinate, and anterior nasal swabbing is the preferred method of screening for coronavirus disease-2019 (COVID-19). Herein, we present a case of a sinonasal LCH in a child after continuous self-tests for COVID-19, with an anterior nasal swab. The child presented with a well-defined red mass in the anterior part of the nasal septum, which was removed endoscopically. Histopathology revealed a LCH. This is the first report of a complication other than epistaxis with the use of an anterior nasal swab. Our literature review identified 32 studies reporting complications of COVID-19 screening. Cerebrospinal fluid leaks and foreign body retention are the most common ones. A proper specimen collection technique and a quick patient history with an emphasis on risk factors are the best practices to prevent complications from COVID-19 screening.

Double Coin Mimicking a Button Battery: a Rare Radiological Entity of an Esophageal Foreign Body.

Ingestion of foreign bodies is a common entity in emergency clinical practice, especially in the pediatric population. Personal history is rather challenging in these patients, while it is important to accurately define the ingested foreign body. Therefore, the history of a caregiver/eyewitness, physical examination and radiographic findings are taken under consideration. Coins - in various places and alignments - are among the most common foreign bodies of the upper digestive tract, while a history or radiological findings of button batteries are indicating the need for immediate removal. We report a rare case of a seven-year-old boy with an esophageal foreign body, whose radiographic findings were intriguing, as they were suggesting a button battery digestion, while urgent esophagoscopy revealed a double coin ingestion perfectly aligned in the same place, opposing each other.

Laryngopharyngeal Reflux and Olfaction Disorders. Is There Any Connection? A Scoping Review.

Objectives: To review the evidence regarding olfaction in patients with laryngopharyngeal reflux. Methods:Conducting a scoping review of studies evaluating olfactory sense in patients with laryngopharyngeal reflux. Online databases were searched and studies evaluating laryngopharyngeal reflux impact on other nasal functions were excluded. Other exclusion criteria were the presence of severe nasal anatomical issues, rhinosinusitis, allergic rhinitis and nasal polyps in the study group. Results:Seven studies, between 2016 and 2019, met our inclusion criteria. Olfaction threshold was significantly lower in patients with laryngopharyngeal reflux than controls in three studies and in two of these studies, all three assessed parameters, including threshold, identification and discrimination, were significantly affected in the laryngopharyngeal reflux group. In three other studies, where the Connecticut Chemosensory Clinical Research Center test had been used, smell test scores were also statistically significantly lower in the reflux group. Finally, in a survey-based study evaluating olfaction, olfactory anomalies were positively related to gastroesophageal reflux disease and gastroparesis symptom severity. Conclusions:There is scarce evidence regarding the effect of laryngopharyngeal reflux on olfaction, but preliminary evidence shows that laryngopharyngeal reflux may cause olfactory abnormalities. Thus, olfactory abnormalities can be an additional reflux manifestation. Gastroparesis, gastroesophageal reflux disease, laryngopharyngeal reflux and Helicobacter pylori infection are factors that can potentially cause olfactory sensory disturbance.

Cross-Cultural Adaptation and Validation of the Greek SPOT-25 Quality of Life Questionnaire in Patients with Otosclerosis.

Objective: To translate, adapt and validate in Greek the stapesplasty outcome test (SPOT)-25 quality of life questionnaire for patients with otosclerosis. Materials and methods:SPOT-25 was translated to Greek and completed by otosclerosis patients on the day of diagnosis, the day before surgery and three months postoperatively. Fifty controls without any otological history, symptom or finding also completed the questionnaire. Pure-tone average was obtained both preoperatively and three months postoperatively. Results:Test-retest evaluation on 56 patients was accepted. The Greek-SPOT-25 had an excellent internal consistency. All its items and subscales were significantly correlated between test and retest evaluation. Controls had significant lower SPOT-25 scores, and the postoperative scores were significantly lower than preoperative ones. Pure-tone average of four frequencies (PTA4) was significantly correlated to preoperative SPOT-25 total and subscales scores (P<0.001) before surgery and significantly correlated only with the "hearing function" subscale (p<0.05) postoperatively.

Bilateral Vocal Cord Palsy as the Only Symptom of Thymoma Associated-Myasthenia Gravis.

Bilateral vocal cord paresis is a rare phenomenon caused by different underlying etiologies. Myasthenia gravis is included in this long differential diagnosis. Usually, it happens as part of a serious clinical state of a patient, that also suffers from generalized muscle weakness, diplopia, dysphagia, eyelid ptosis. In our case, a 58-year-old woman presented in the emergency room with solely dyspnea, caused by bilateral cord palsy, and that appeared to be the only symptom of thymoma associated-myasthenia gravis. Another interesting fact about this case is the quick recovery and no need for tracheostomy and intubation in the first hours of her admission to hospital.

Immediate or interval abscess tonsillectomy? A systematic review and meta-analysis.

OBJECTIVES: Peritonsillar abscess is a common complication of acute tonsillitis. However, no consensus has been reached yet on the optimal treatment of this condition. Therefore, this study aimed to compare clinical outcomes of immediate and interval abscess tonsillectomy. METHODS: The databases of PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for completed studies published until the 1st of November 2021. Comparative studies assessing intraoperative and postoperative outcomes of immediate and interval abscess tonsillectomy were considered, with the primary outcome being postoperative hemorrhage. Operative time, intraoperative blood loss, postoperative pain, and duration of hospital stay were classed as secondary outcomes. A random-effects pairwise meta-analysis of both randomized and non-randomized trials was conducted. Subgroup analysis linked to the randomization of trials was executed. Quality assessment was performed, utilizing the Cochrane risk of bias tool and ROBINS-I tool for randomized and non-randomized trials, respectively. RESULTS: Data from 265 cases stemming from six trials were pooled together. For postoperative bleeding rates, no statistically significant difference between immediate and interval tonsillectomy was detected (OR = 1.26; 95% CI 0.27, 5.86; p = 0.77). By contrast, longer hospital stay was observed for patients subjected to interval tonsillectomy (SMD = - 0.78; CI - 1.39 to- 0.17; p = 0.01). For operative time and intraoperative blood loss, no statistically significant difference was noticed between immediate and interval tonsillectomy (SMD = 1.10; 95% CI - 0.13, 2.33; p = 0.08; and SMD = 0.04; 95% CI - 0.49, 0.57; p = 0.88; respectively). CONCLUSIONS: This study shows that quinsy tonsillectomy appears to be a safe method, providing full abscess drainage and instant relief of the symptoms. Moreover, quinsy tonsillectomy was not associated with a statistically higher postoperative hemorrhage incidence rate than immediate tonsillectomy.

In vitro Inhibition of Biofilm Formation on Silicon Rubber Voice Prosthesis: Α Systematic Review and Meta-Analysis.

INTRODUCTION: Biofilm formation on voice prostheses is the primary reason for their premature implant dysfunction. Multiple strategies have been proposed over the last decades to achieve inhibition of biofilm formation on these devices. The purpose of this study was to assess the results of the available in vitro biofilm inhibition modalities on silicone rubber voice prostheses. METHODS: We conducted a systematic search in PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases up to February 29, 2020. A total of 33 in vitro laboratory studies investigating the efficacy of different coating methods against Candida, Staphylococcus, Streptococcus, Lactobacilli, and Rothia biofilm growth on silicone rubber medical devices were included. Subgroup analysis linked to the type of prevention modality was carried out, and quality assessment was performed with the use of the modified CONSORT tool. RESULTS: Data from 33 studies were included in qualitative analysis, of which 12 qualified for quantitative analysis. For yeast biofilm formation assessment, there was a statistically significant difference in favor of the intervention group (standardized mean difference [SMD] = -1.20; 95% confidence interval [CI] [-1.73, -0.66]; p < 0.0001). Subgroup analysis showed that combined methods (active and passive surface modification) are the most effective for biofilm inhibition in yeast (SMD = -2.53; 95% CI [-4.02, -1.03]; p = 0.00001). No statistically significant differences between intervention and control groups were shown for bacterial biofilm inhibition (SMD = -0.09; 95% CI [-0.68, 0.46]; p = 0.65), and the results from the subgroup analysis found no notable differences between the surface modification methods. After analyzing data on polymicrobial biofilms, a statistically significant difference in favor of prevention methods in comparison with the control group was detected (SMD = -2.59; 95% CI [-7.48, 2.31]; p = 0.30). CONCLUSIONS: The meta-analysis on biofilm inhibition demonstrated significant differences in favor of yeast biofilm inhibition compared to bacteria. A stronger inhibition with the application of passive or combined active and passive surface modification techniques was reported.

Doctors Spreading SARS-CoV-2 Infection to Their Patients and Health Workers. What is the Likelihood of This Scenario?

Aims: In this particular study, we report our experience of eight doctors infected with SARS-CoV-2 and discuss the probability of in-hospital virus transmission to patients or the rest of the hospital personnel. The importance of PPEs is highlighted. Materials and methods:We explore the data of eight doctors who were tested positive for SARS-CoV-2 after returning from their summer vacation. More specific, we evaluated the time they spent working before they got tested after their return, the symptoms they developed and the results of their tracking through their patients and the rest of hospital workers. Results:All doctors followed their working schedule, ranging from 2-4 days after their summertime off, without knowledge of being infected. They had been keeping all suggested protection precautions, while no further virus transmission to patients and/or other healthcare workers occurred, even though they had close contact and cooperation with many of them. Conclusions:Our experience suggests that, if healthcare workers conform to established safety procedures, the likelihood of further transmission both to patients and their colleagues, even in asymptomatic state, appears to be minimal.

Erythropoietin levels in children with obstructive sleep apnea.

OBJECTIVE: High serum erythropoietin (EPO) levels have been reported in adult patients with obstructive sleep apnea (OSA), however there is a lack of related literature in children with OSA. The main objective of this study was to explore the potential use of EPO as a pediatric OSA biomarker by exploring the relationship between serum EPO levels and the presence of pediatric OSA. METHODS AND MATERIALS: A prospective study was conducted on children (4-12 years old) referred for overnight PSG. Thirty (30) consecutive children with mild. 30 consecutives with moderate, and 30 consecutives with severe OSA (OSA group), as well as 30 consecutive children with AHI≤1 (non-OSA group) were recruited. Morning blood specimens after PSG studies were obtained in order to compare EPO levels. RESULTS: Finally, 115 children included for analysis. Non-OSA group consisted of 29 children (mean age: 6.93 ± 2.10) and OSA-group of 86 children (mean age: 6.78 ± 2.53). Mean EPO values for the non-OSA and OSA groups were 5.46 ± 2.29 mIU/ml and 8.33 ± 4.10 mIU/ml respectively. OSA-group had significant higher EPO levels than non-OSA (P: 0.01) while EPO levels were significantly correlated with AHI (p < 0.001). CONCLUSION: Our study showed that serum EPO levels of children with OSA are significantly higher than those without OSA and correlate significantly with AHI. These results suggest that EPO may be considered as a biomarker candidate for pediatric OSA. Since this may be the first study on the topic further research is needed.

Facial nerve: A review of the anatomical, surgical landmarks and its iatrogenic injuries.

Facial nerve iatrogenic injuries are serious and can negatively affect the quality of life of the patients. Due to the properties of the nerve, the complications are devastating involving the aesthetic appearance and the function of the face. Moreover, the multiple branches of the nerve increase the risk of an iatrogenic injury making the detailed knowledge of the anatomical correlations around them critical. In this review, a meticulous analysis was performed including the surgical procedures posing the greater risk of an iatrogenic injury as well as the full description of all the reported anatomical landmarks involving the extracranial course of the facial nerve.

Current Treatment Options for Patulous Eustachian Tube: A Review of the Literature.

OBJECTIVE: Patulous Eustachian tube (PET) is a clinical condition that is associated with troublesome aural symptoms and is difficult to be treated successfully. The purpose of this review is to examine the published literature regarding the therapeutic value of the current treatment options for PET. METHODS: We searched Web of Science, PubMed and Medline from 1999 to 2019. The search focused on papers concerning the clinical evaluation of treatment methods in PET patients. Statistical techniques were not used. RESULTS: Prospective and retrospective case series were the types of trials available for review. We included 28 articles that evaluated the efficacy of various conservative and surgical therapeutic options. The recovery rates ranged from 50% to 100%. In most studies the assessment of efficacy was based on the subjective improvement of patient symptoms as there is no validated outcome tool available. No severe adverse events were observed in any study. CONCLUSION: On the basis of the available literature, it seems that conservative treatments can be considered as a primary therapeutic option for PET. Concerning the surgical interventions they seem to be a safe and valuable solution in patients with refractory disease. Finally, given the low level of evidence, prospective case-control studies with long follow-up and robust setting looking into the therapeutic approach of PET are required. The need for establishment of standard criteria of PET recovery should be underlined.

Do smoking and human papilloma virus have a synergistic role in the development of head and neck cancer? A systematic review and meta-analysis.

PURPOSE: Head and neck squamous cell carcinoma (HNSCC), arising from the squamous epithelium, is the most common head and neck cancer (HNC). Smoking and alcohol are well known risk factors for HNSCC, while some high-risk human papilloma virus (HPV) subtypes were specifically identified as a high-risk factors for developing oropharyngeal squamous cell carcinoma (OPSCC). In this study, we have conducted a systematic review and meta-analysis in order to investigate the possible synergistic role of smoking and HPV in the development of HNSCC. METHODS: We conducted a systematic search in two online databases PubMed and Cochrane Library, searching for studies published between 2010-2018. Sixteen studies met the inclusion criteria; a total of 2161 patients were included, comprising 1470 HPV-negative and 691 HPV-positive, respectively. RESULTS: The number of smokers between HPV-positive HNSCC patients (group A) and HPV-negative HNSCC patients (group B) was compared. We have found that smokers in HPV-positive group were statistically significantly less than smokers in HPV-negative group (OR=0.33 with 95% CI 0.18, 0.61). The test for overall effect was Z =3.61 (p=0.0003). CONCLUSION: Smoking is less common in HPV positive group than in HPV negative group, and so probably smoking does not play a major role in the pathogenesis of HPV-positive HNSCC as in the pathogenesis of HPV-negative HNSCC.