Incidence and prognosis of olfactory and gustatory dysfunctions related to SARS-CoV-2 Omicron strain infection in China: A national multicenter survey of 35,566 individuals.

Objective: This cross-sectional study aimed to determine the epidemiology of olfactory and gustatory dysfunctions related to COVID-19 in China. Methods: This study was conducted by 45 tertiary Grade-A hospitals in China. Online and offline questionnaire data were obtained from patients infected with COVID-19 between December 28, 2022, and February 21, 2023. The collected information included basic demographics, medical history, smoking and drinking history, vaccination history, changes in olfactory and gustatory functions before and after infection, and other postinfection symptoms, as well as the duration and improvement status of olfactory and gustatory disorders. Results: Complete questionnaires were obtained from 35,566 subjects. The overall incidence of olfactory and taste dysfunction was 67.75%. Being female or being a cigarette smoker increased the likelihood of developing olfactory and taste dysfunction. Having received four doses of the vaccine or having good oral health or being a alcohol drinker decreased the risk of such dysfunction. Before infection, the average olfactory and taste VAS scores were 8.41 and 8.51, respectively; after infection, they decreased to 3.69 and 4.29 and recovered to 5.83 and 6.55 by the time of the survey. The median duration of dysosmia and dysgeusia was 15 and 12 days, respectively, with 0.5% of patients having symptoms lasting for more than 28 days. The overall self-reported improvement rate was 59.16%. Recovery was higher in males, never smokers, those who received two or three vaccine doses, and those that had never experienced dental health issues, or chronic accompanying symptoms. Conclusions: The incidence of dysosmia and dysgeusia following infection with the SARS-CoV-2 virus is high in China. Incidence and prognosis are influenced by several factors, including sex, SARS-CoV-2 vaccination, history of head-facial trauma, nasal and oral health status, smoking and drinking history, and the persistence of accompanying symptoms.

Diagnostic and therapeutic strategies of acute invasive fungal rhinosinusitis.

Acute invasive fungal rhinosinusitis (AIFR) is a rare disease, but the prognosis is by no means ideal. Pathologically, fungal infection is not only located in the sinus cavity, but also invades the sinus mucosa and bone wall, the surrounding structures and tissues such as the orbit and anterior skull base are often compromised and are accompanied with intracranial and extracranial complications. Despite decades of efforts, acute invasive fungal rhinosinusitis remains a devastating disease, the mortality of the disease continues to hover around 50%. The main impediments to improving the prognosis of acute invasive fungal rhinosinusitis are the difficulties of early diagnosis and the rapid reversal of immune insufficiency. Moreover, aggressive surgery combined with systemic antifungal therapy are significant positive prognostic factors as well. Progress and standardization of AIFR treatment protocols have been limited by the scarcity of the disease and the absence of published randomized studies. Therewith, how to improve the therapeutic outcome and reduce the mortality rate has always been a challenging clinical discussion. We have summarized the relevant case series and literature from the recent years, management with optimal diagnostic and curative strategies are reviewed.

Endoscope-Assisted Resection of a Vagal Neurofibroma Using a Posterior Styloid Approach.

It is very challenging to expose and remove tumors above the hard palate in the retrostyloid space using the typical cervical approach. Other approaches, such as the cervical-parotid approach, may result in prominent scars, facial paralysis, or masticatory dysfunction. Here, we report a case of a vagal neurofibroma between the internal carotid artery and internal jugular vein in the retrostyloid space. We used a 3D model to design a surgical approach that reduced the risk to the surrounding vessels and nerves. We performed an endoscope-assisted resection of the tumor using a posterior styloid approach. Following surgery, there were no obvious scars on the face or neck, facial paralysis, or dysphagia, but mild hoarseness.

Multifocal neuroendocrine cell hyperplasia accompanied by tumorlet formation and pulmonary sclerosing pneumocytoma: A case report.

BACKGROUND: Pulmonary tumorlets are nodular hyperplastic neuroendocrine cells (NECs) that extend beyond the basement membrane. They often coexist with other lung diseases such as fibrosis and bronchiectasis, but rarely accompanied by pulmonary sclerosing pneumocytoma (PSP), which has not been reported in the literature. CASE SUMMARY: A 54-year-old woman was admitted to the hospital because she had symptoms of bloody sputum for more than 4 mo and hemoptysis for 1 wk. Computed tomography images showed atrophy accompanied by infections in the middle lobe of her right lung. Moreover, numerous nodules were identified in the middle lobe of the right lung. The patient underwent thoracoscopic pneumonectomy of the middle lobe of the right lung, and the resected mass was pathologically confirmed to have bronchiectasis, multifocal NEC hyperplasia accompanied by tumorlet, and PSP. CONCLUSION: Our report presents a rare clinical case of bronchiectasis complicated with multifocal NEC hyperplasia, tumorlet, and PSP.

Otolaryngology during COVID-19: Preventive care and precautionary measures.

Since the outbreak of novel coronavirus disease (COVID-19) in December 2019, it has spread to various regions and countries, forming a global pandemic. Reducing nosocomial infection is a new issue and challenge for all healthcare systems. Otolaryngology is a high-risk specialty as it close contact with upper respiratory tract mucous, secretions, droplets and aerosols during procedures and surgery. Therefore, infection prevention and control measures for this specialty are essential. Literatures on the epidemiology, clinical characteristics and infection control measures of COVID-19 were reviewed, practical knowledge from first-line otolaryngologists in China, the United States, and Brazil were reviewed and collated. It was recommended that otolaryngology professionals should improve screening in suspected patients with relevant nasal and pharyngeal symptoms and signs, suspend non-emergency consultations and examinations in clinics, and rearrange the working procedures in operating rooms. The guidelines of personal protective equipment for swab sampling, endoscopy and surgery were listed. Indications for tracheotomy during the pandemic should be carefully considered to avoid unnecessary airway opening and aerosol-generation; precautions during surgery to reduce the risk of exposure and infection were illustrated. This review aimed to provide recommendations for otolaryngologists to enhance personal protection against COVID-19 and reduce the risk of nosocomial infection.

[Clinicopathological analysis of aggressive angiomyxoma].

OBJECTIVE: To explore the clinicopathological characteristics of aggressive angiomyxoma (AAM) so as to boost the level of diagnosis and treatment. METHODS: Seven cases of aggressive angiomyxoma were studied with light microscope and immunohistochemistry. Antibody of Vimentin, Desmin, CD34, smooth muscle actin (SMA), estrogen receptor (ER), progesterone receptor (PR), androgen receptor (AR), S-100, p53 and Ki67 were used. RESULTS: There were 3 males and 4 females with an average age of 43.1 years. Three patients had urinary compressive complaints while others were symptom-free. All underwent surgical resection. Three patients were recurrent after operation. The tumor was generally nodular and its cut surface appeared jelly-like. Histologically, on myxoid stroma background, it was composed of a mixture of spindle and stellar cells without atypical cell and mitosis. There were various-sized vessels with thin to thick walls. The scattered muscle-like cells had a perivascular distribution. Immunohistochemistry showed that tumor cells were positive for Vimentin(+)7/7, Desmin(+)7/7, CD34(+)3/7, SMA(+)2/7, ER(+)6/7, p53(+)4/7, Ki67(+) 1% - 8% and negative for PR, AR and S-100. CONCLUSIONS: As a rare soft tissue tumor, AAM extremely rare in males. Owing to its local invasion and high recurrence, extensive resection and long-term follow-up are necessary.

[Microcystic/reticular schwannoma occurring in cervical spine: report of a case with literature review].

OBJECTIVE: To study the morphologic characteristics, immunophenotype and differential diagnosis of a case of microcystic/reticular schwannoma occurring in cervical spine. METHODS: The pathologic features and immunophenotypic profile of a case of microcystic/reticular schwannoma were studied. Immunohistochemistry was performed using EnVision two-step method. RESULTS: The patient was a 35-year-old male and presented with a bump over the fifth cervical spine on radiologic check up. Grossly, the bump was gray-white in color, soft, well-circumscribed but non-encapsulated. The tumor measured 3.5 cm × 3.0 cm × 1.8 cm in size. Histologically, it was composed of two distinctive components. One component resembled the conventional schwannoma but showed focally nuclear pleomorphism, reminiscent of changes in degenerating schwannoma. The other component consisted of epithelial-like cells arranged in a reticular or lace-like pattern, amongst a myxoid matrix. Immunohistochemical study showed that the tumor cells were strongly positive for vimentin, S-100 protein, glial fibrillary acidic protein and neuron-specific enolase, focally positive for CD68, CD10 and Ki-67, and negative for pan-cytokeratin, epithelial membrane antigen, neurofilament, carcinoembryonic antigen, smooth muscle actin, estrogen receptor, progesterone receptor and p53. CONCLUSIONS: Microcystic/reticular schwannoma is a novel variant of schwannoma, arising mainly in internal viscera but seldom in bone. Awareness of this entity is helpful in distinction from chordoma, other mucoid tumors or sarcomas.

[Cholesteatoma otitis media and supratubal recess].

OBJECTIVE: To study the significance of supratubal recess and its aeration pathway to epitympanum in the pathogenesis of cholesteatoma otitis media. METHODS: Fifty-two ears of cholesteatoma were selected as study group. Sixteen ears of traumatic facial palsy with pneumatic mastoid, which had no history of chronic otitis media were selected as control group. The status of supratubal recesses of all and their aeration pathways to epitympanum were observed in operations. RESULTS: Sixteen ears from control group clearly presented supratubal recesses. Membrane closure was founded in four of them. The aeration pathways of fifty-two ears (100%) from study group were all completely closed. Comparing with control group, the difference was obviously significant (chi2 = 41.7144, P = 0.000). Among these cases, bony closure was observed in thirty-four ears (65.4%), while membrane closure in eighteen ears (34.6%). Their epitympanum space was very narrow and mastoid was sclerotic or poorly developed. CONCLUSIONS: Blockage of the aeration pathway between supratubal recess and epitympanum was possible one of the origins of negative-pressure status of epitympanum and mastoid, which might lead to the formation of aural cholesteatoma. Anatomy variation of the aeration pathway from supratubal recess to epitympanum might be a pathogenesis factor of cholesteatoma otitis media. It suggested that opening the aeration pathway in tympanoplasty with intact canal wall up technique might be helpful to prevent recurrence of aural cholesteatoma.

[Diagnosis and treatment of pulmonary histoplasmoma: report of 3 cases].

OBJECTIVE: To investigate the diagnosis and treatment of pulmonary histoplasmoma. METHODS: The clinical data of 3 patients with pulmonary histoplasmoma. 2 males, both 49-years-old, and 1 female, 27-years-old, were analyzed. RESULTS: Nodules in the lung, regardless solitary or multiple, with clear border and calcification, were the first radiological finding. All 3 patients were misdiagnosed as with tuberculosis or primary or metastatic lung neoplasm and underwent operation. The diagnosis was confirmed after surgery. Pathological examination showed caseous necrosis and a great amount of histoplasma in the multinuclear cells. Follow-up lasting 1, 2, and 3 years respectively showed no recurrence. CONCLUSION: Pulmonary nodule, regardless solitary or multiple, with clear border and calcification, is the first radiological finding of pulmonary histoplasmoma Autopsy is necessary for diagnosis of pulmonary histoplasmoma, difficult to diagnose, however, with a good prognosis.

[The level of Bcl-2 and Fas expression in thymoma tissue from patients with myasthenia gravis].

OBJECTIVE: To evaluate the clinical significance of expression levels of apoptosis-associated genes, bcl-2 and Fas in thymoma tissue from patients with myasthenia gravis. METHODS: The study included 25 patients who underwent maximal thymectomy because of concurrent thymoma and myasthenia gravis. Clinical staging (Osserman classification) showed stage I in 6, IIA in 3, IIB in 13 and III in 3 cases. According to the WHO classification of thymomas (1999), 5, 3, 7, 7, and 3 patients had type A, AB, B1, B2, and B3, respectively, and no patient had type C. As a control group, the normal thymic tissue from 25 patients with congenital heart diseases was studied. The expression level of Bcl-2 and Fas in the tissue of thymoma and normal thymus was detected by immunohistochemistry. RESULTS: Bcl-2 and Fas expressions were significantly higher in thymomas compared with normal thymus by Radit analyses (U = 2.645, P < 0.05 and U = 3.200, P < 0.05, respectively). The expression level of Bcl-2 and Fas showed no relation to the course of the disease, age, Osserman classification and sex. CONCLUSION: The result suggests that the two apoptosis-associated factors, Bcl-2 and Fas, may play important roles in the pathogenesis of thymoma concurrent with myasthenia gravis.

[Apoptosis and expression of apoptosis-related proteins in experimental different denervated guinea-pig facial muscle].

OBJECTIVE: To study apoptosis and expression of apoptosis-related proteins in experimental different denervated guinea-pig facial muscle. METHOD: An experimental model was established with guinea pigs by compressing the facial nerve 30 second (reinnervated group) and resecting the facial nerve (denervated group). TUNEL method and immunohistochemical technique (SABC) were applied to detect the apoptosis and expression of apoptosis-related proteins bcl-2 and bax from 1st to 8th week after operation. RESULT: Experimentally denervated facial muscle revealed consistently increase of DNA fragmentation, average from(34.4 +/- 4.6)% to (38.2 +/- 10.6)%, from 1st week to 8th week after operation; Reinnervated facial muscle showed a temporal increase of DNA fragmentation, and then the muscle fiber nuclei revealed decreased DNA fragmentation along with the function of facial nerve recovered, latterly normal, average from (32.0 +/- 8.03)% to (5.6 +/- 3.5)%, from 1st week to 8th week after operation. In denervated group, bcl-2 and bax were expressed strongly; in reinnervated group, bcl-2 expressed consistently, but bax disappeared latterly along with the function of facial nerve recovered. CONCLUSION: Expression of DNA fragmentation and apoptosis-related proteins in denervated muscle are general reaction to denervation. bcl-2 can prevent early apoptotic muscle fiber to survival until reinnervation. It is concluded that proteins control apoptosis may give information for possible therapeutic interventions to reduce the rate of muscle fiber death in denervated atrophy in absence of effective primary treatment.