Clinical features of patients who had two COVID-19 episodes: a European multicentre case series.

OBJECTIVE: To investigate the clinical features of patients who had two demonstrated coronavirus disease 2019 (COVID-19) episodes. METHODS: Data of patients with both COVID-19 episodes were recruited from 22 March to 27 December 2020. The following outcomes were studied: epidemiological, comorbidities, prevalence and severity of general and otolaryngological symptom, olfactory, aroma, and gustatory dysfunctions. A comparison between first and second episodes was performed. RESULTS: Forty-five patients reported having two confirmed COVID-19 episodes. The majority of patients had mild infections in both episodes. The second clinical episode was significantly similar to the first. The symptom duration of the second episode was shorter than the first. The occurrence of loss of smell was unpredictable from the first to the second episode. CONCLUSION: The recurrence of COVID-19 symptoms is associated with a similar clinical picture than the first episode in patients with initial mild-to-moderate COVID episode. The pathophysiological mechanisms underlying the development of second episode remain uncertain and may involve either true reinfection or virus reactivation from sanctuaries.

Prevalence and 6-month recovery of olfactory dysfunction: a multicentre study of 1363 COVID-19 patients.

OBJECTIVE: To investigate prevalence and recovery of olfactory dysfunction (OD) in COVID-19 patients according to the disease severity. METHODS: From 22 March to 3 June 2020, 2581 COVID-19 patients were identified from 18 European hospitals. Epidemiological and clinical data were extracted at baseline and within the 2-month post-infection. RESULTS: The prevalence of OD was significantly higher in mild form (85.9%) compared with moderate-to-critical forms (4.5-6.9%; P = 0.001). Of the 1916 patients with OD, 1363 completed the evaluations (71.1%). A total of 328 patients (24.1%) did not subjectively recover olfaction 60 days after the onset of the dysfunction. The mean duration of self-reported OD was 21.6 ± 17.9 days. Objective olfactory evaluations identified hyposmia/anosmia in 54.7% and 36.6% of mild and moderate-to-critical forms, respectively (P = 0.001). At 60 days and 6 months, 15.3% and 4.7% of anosmic/hyposmic patients did not objectively recover olfaction, respectively. The higher baseline severity of objective olfactory evaluations was strongly predictive of persistent OD (P < 0.001). CONCLUSION: OD is more prevalent in mild COVID-19 forms than in moderate-to-critical forms. OD disappeared in 95% of patients regarding objective olfactory evaluations at 6 months.

Efficacy of corticosteroid therapy in the treatment of long- lasting olfactory disorders in COVID-19 patients.

BACKGROUND: The growing number of COVID-19 patients with long-lasting olfactory disorders makes it necessary to identify ef- fective treatments that enhance the spontaneous recovery of olfactory function. METHODS: Multicentre randomised case-control study that involved 18 patients with COVID-19 related anosmia or severe hyposmia for more than 30 days. Nine patients were prescribed systemic prednisone and nasal irrigation with betamethasone, ambroxol and rinazine for 15 days. The other 9, untreated, patients were used as controls. The olfactory function was evaluated with CCCRC test at 20 and 40 days from the first evaluation. RESULTS: In the control group, a median olfactory score of 20 (IQR 30) was detected at baseline. At the 20-day control there was no significant improvement in olfactory function. The improvement in olfactory performance became significant at the 40-day follow-up compared to baseline scores [60 (IQR 60) versus 20 (IQR 30)]. In the treatment group, patients had a mean olfactory score of 10 (IQR 15) at initial control. At the 20-day control, a significant im-provement in the olfactory scores, compared to the baseline, was detected [70 (IQR 40) versus 10 (IQR 15)]. Olfactory function further improved at 40 days [median score 90 (IQR 50)]. Patients in the treatment group reported significantly higher improvements of the olfactory scores than the controls at both the 20-day [40 (IQR 45) versus 10 (IQR 15)] and 40-day [60 (IQR 40) versus 30 (IQR 25)] evaluations. CONCLUSIONS: Based on the results of this study, the mix of drugs including steroids could represent a useful specific therapy to reduce the prevalence of this long-term morbidity.

Smell and taste recovery in coronavirus disease 2019 patients: a 60-day objective and prospective study.

BACKGROUND: The long-term recovery rate of chemosensitive functions in coronavirus disease 2019 patients has not yet been determined. METHOD: A multicentre prospective study on 138 coronavirus disease 2019 patients was conducted. Olfactory and gustatory functions were prospectively evaluated for 60 days. RESULTS: Within the first 4 days of coronavirus disease 2019, 84.8 per cent of patients had chemosensitive dysfunction that gradually improved over the observation period. The most significant increase in chemosensitive scores occurred in the first 10 days for taste and between 10 and 20 days for smell. At the end of the observation period (60 days after symptom onset), 7.2 per cent of the patients still had severe dysfunctions. The risk of developing a long-lasting disorder becomes significant at 10 days for taste (odds ratio = 40.2, 95 per cent confidence interval = 2.204-733.2, p = 0.013) and 20 days for smell (odds ratio = 58.5, 95 per cent confidence interval = 3.278-1043.5, p = 0.005). CONCLUSION: Chemosensitive disturbances persisted in 7.2 per cent of patients 60 days after clinical onset. Specific therapies should be initiated in patients with severe olfactory and gustatory disturbances 20 days after disease onset.

Patterns of smell recovery in 751 patients affected by the COVID-19 outbreak.

BACKGROUND AND PURPOSE: Post-viral olfactory dysfunction is well established and has been shown to be a key symptom of COVID-19 with more than 66% of European and US patients reporting some degree of loss of smell. Persistent olfactory dysfunction appears to be commonplace and will drive the demand for general practitioner, otolaryngology or neurology consultation in the next few months - evidence regarding recovery will be essential in counselling our patients. METHODS: This was a prospective survey-based data collection and telemedicine follow-up. RESULTS: In total, 751 patients completed the study, of whom 477 were females and 274 males. The mean age of the patients was 41 ± 13 years (range 18-60). There were 621 patients (83%) who subjectively reported a total loss of smell and 130 (17%) a partial loss. After a mean follow-up of 47 ± 7 days (range 30-71) from the first consultation, 277 (37%) patients still reported a persistent subjective loss of smell, 107 (14%) reported partial recovery and 367 (49%) reported complete recovery. The mean duration of the olfactory dysfunction was 10 ± 6 days (range 3-31) in those patients who completely recovered and 12 ± 8 days (range 7-35) in those patients who partially recovered. CONCLUSIONS: According to our results, at this relatively early point in the pandemic, subjective patterns of recovery of olfactory dysfunction in COVID-19 patients are valuable for our patients, for hypothesis generation and for treatment development.

Functional outcomes of supraglottic squamous cell carcinoma treated by transoral laser microsurgery compared with horizontal supraglottic laryngectomy in patients younger and older than 65 years.

The treatment of supraglottic carcinoma remains a controversial issue. Five accepted surgical and non-surgical oncological treatments have been currently established: standard horizontal supraglottic laryngectomy (HSL), supraglottic CO2 laser microsurgery (TLM), transoral robotic surgery, radiotherapy alone and radiotherapy in combination with chemotherapy. Some studies have shown that complications of head and neck surgeries increase significantly in patients over 65 years compared to younger patients. We designed a retrospective analysis to assess the rate of complications and functional outcomes of patients treated by TLM and HSL in cases of T1-T3 supraglottic squamous cell carcinomas (SCC) in a tertiary University Hospital. Results were compared between patients younger and older than 65 years. We found significant differences in the rate of aspiration pneumonia (p = 0.026), mean time to decannulation (p = 0.001) and mean hospital stay (p = 0.007) in patients treated by TLM, which was higher and longer in the group of patients over 65 years of age. Regarding HPL, we only found significant differences in the mean time to decannulation (p = 0.001), which was longer in the group of patients younger than 65 years. According to our results, TLM or HPL can both be a safe surgical option for patients older than 65 years, but previous evaluation of lung function before surgery is mandatory because of an increased risk of aspiration pneumonia in patients with lung problems, especially when treated by TLM. Concerning functional outcomes in patients older than 65 years, TLM reduces the postoperative rate of tracheostomy, mean time required for decannulation and mean hospital stay compared with HPL. However, no significant difference in the occurrence of aspiration pneumonia, dysphagia or in the mean length of NGT feeding was found.

The Vigo grommet trainer.

INTRODUCTION: Transtympanic grommet placement is perhaps the most common otologic outpatient procedure and is the junior resident's first step in otologic surgery. Drain placement requires a high level of skill and only after painstaking practice, will the young physician be prepared to perform the procedure. TECHNICAL NOTE: We describe a home-made training model for grommet placement, consisting of a wooden base holding a syringe, with a sheet of latex simulating the tympanic membrane. RESULTS: The model is cheap and easy to build. It allows ear tube (grommet) placement to be simulated in a practical and risk-free manner. The technique is reproducible, allowing the young physician to develop his or her skills without patient involvement. CONCLUSION: Although a simulator cannot perfectly replicate surgery, the Vigo grommet trainer is an excellent tool to provide valuable practice in acquiring and developing the skills needed to perform drain placement in the operating theater.

Síndrome del seno silente (reporte de un caso y revisión de la literatura) / Silent sinus síndrome (case report and literature review)

Introducción. El síndrome del seno silente es un proceso patológico poco frecuente, el cual asocia la presencia de enoftalmos unilateral secundario al colapso gradual del suelo orbitario, acompañado de opacificación del seno maxilar, en presencia de un cuadro de sinusitis crónica subclínica y sin síntomas nasosinusales. Caso clínico: paciente femenina de 46 años que acude por asimetría facial secundaria a hipoplasia del seno maxilar izquierdo, acompañado de enoftalmosipsilateral, confirmada radiológicamente mediante estudio tomografico, y diagnosticada de síndrome del seno silente, la cual mejoro tras turbinoplastia endoscópica mediante radiofrecuencia izquierda. Conclusión: el síndrome del seno silente se encuentra caracterizado por una fisiopatología controvertida cuya principal mecanismo parece obedecer a la hipoventilaciónsinusal yva a precisar un minucioso estudio clínico por parte de un equipo multidisciplinario integrado por el oftalmólogo, el otorrinolaringólogo y el neuro-radiólogo. En cuanto al tratamiento, puede evolucionar de forma satisfactoria tras la apertura del complejo osteomeatal, aunque en muchas ocasiones será necesariala cirugía correctiva para la base de la órbita (AU)

Introduction. The silent sinus syndrome is a rare disease, which associates the presence of unilateral enophthalmos secondary to the gradual collapse of the orbital floor, accompanied by opacification of the maxillary sinus in the presence of subclinical chronic sinusitis without sinonasal symptoms. Case report. A 46-year female patient who presented with facial asymmetry secondary to hypoplasia of the left maxillary sinus, accompanied by ipsilateralenophthalmos, radiologically confirmed by tomographic study, and diagnosed with silent sinus syndrome, which improved after left endoscopic radiofrequency turbinoplasty. Conclusion: the silent sinus syndrome is characterized by a controversial pathophysiology whose main mechanism seems to follow the sinus hypoventilation and will require clinical study by a multidisciplinary team composed by ophthalmologist, otolaryngologist and neuroradiologist. As for treatment, it can evolve satisfactorily when the drainage ostium wide, although sometimes corrective surgery for the base of the orbit will be necessary (AU)

Cellulitis periorbitaria complicada con absceso orbitario secundaria a etmoiditis aguda en la infancia / Periorbital cellulitis complicated with orbital abscess secondary to acute ethmoiditisin the childhood

Objetivos: se presenta un caso clínico de celulitis periorbitaria secundaria a un etmoiditis aguda. Caso clínico. Varón de 6 años de edad sin antecedentes médicos de interés, el cual acude a urgencias por cuadro clínico de rinosinusitis aguda de 1 semana de evolución, el cual se acompaña de fiebre (38,5º) y que previo al ingreso, comienza a presentar diplopía, exoftalmo y edema palpebral izquierdo, que se acompaña de dolor en región de ángulo interno del ojo con dificultad para la elevación palpebral ipsilateral. Se realiza TC en la cual se evidencia absceso retro-orbitario izquierdo y ocupación en senos etmoidales, maxilares y frontal izquierdo, objetivándose clínicamente drenaje mucopurulento por meato medio ipsilateral. El paciente fue tratado de forma conservadora evolucionando satisfactoriamente. Conclusiones: la celulitis periorbitaria suele ser una patología frecuentemente asociada a la infancia, aproximadamente el 83% de los casos se presentan en edades pediátricas. El riesgo de complicaciones orbitarias o cerebrales y la rápida evolución a estas amerita un correcto abordaje del paciente, mediante una buena historia clínica la cual puede ser suficiente cuando no exista sospecha de complicaciones o deberá venir acompañada de un estudio de imagen que apoye nuestra sospecha diagnostica en caso de tener evidencia de afectación oftalmológica o intracraneal. El tratamiento sera inicialmente medico con (Amoxicilina/Ac. Clavulanico o Cefalosporinas de 3ra. Generación) en caso de no evidenciar mejoría clínica tras 24-48 horas o si existen signos de alarma se debe proceder al drenaje quirúrgico (AU)

Objectives. We report a case of periorbital cellulitis secondary to acute ethmoiditis. Case report. A 6-year-old with no relevant medical history, which goes to the emergency room for acute rhinosinusitis episode 1 week duration, which is accompanied by fever (38.5 °) and prior to admission, begins to submit diplopia, exophthalmos and left eyelid edema, which is accompanied by pain in inner corner of the eye with difficulty ipsilateral eyelid elevation. CT was performed which affords retro-orbital abscess occupation of ethmoid cells, maxillary´s sinus and left frontal. Clinically objectifying mucopurulent drainage by ipsilateral middle meatus. The patient was treated conservatively evolving satisfactorily. Conclusions: periorbital cellulitis is usually a condition often associated with childhood, approximately 83% of cases occur in children. The risk of orbital or cerebral complications and rapid evolution of these warrants a correct approach to the patient, with a good history which may be sufficient when there is no suspicion of complications or must be accompanied by an imaging study that supports our suspicion diagnosed if you have evidence of ocular involvement or intracranial. Initial treatment with pharmacologic will (Amoxicillin / Ac. Clavulanate or Cephalosporins 3rd. Generation) if no evidence of clinical improvement after 24-48 hours or if there are warning signs needs to proceed to surgical drainage (AU)