Journal of Laryngology and Otology 2021-08-27

Long-term olfactory dysfunction following coronavirus disease 2019 infection, routine neck dissection at salvage laryngectomy, parotid incidentalomas, and prescribing intranasal steroids in HIV infection

Fishman, Jonathan,Fisher, Edward W

Publication date 27-08-2021


Pubmed PDF Web

Prescribing intranasal steroids in HIV-positive patients: systematic review of the literature

Seymour, N,Robinson, M,Richardson, D,Mohammed, H,Williams, D,McGilligan, J A

Publication date 13-08-2021


Background There are significant drug–drug interactions between human immunodeficiency virus antiretroviral therapy and intranasal steroids, leading to high serum concentrations of iatrogenic steroids and subsequently Cushings syndrome.
Method All articles in the literature on cases of intranasal steroid and antiretroviral therapy interactions were reviewed. Full-length manuscripts were analysed and the relevant data were extracted.
ResultsA literature search and further cross-referencing yielded a total of seven reports on drug–drug interactions of intranasal corticosteroids and human immunodeficiency virus protease inhibitors, published between 1999 and 2019.
Conclusion The use of potent steroids metabolised via CYP3A4, such as fluticasone and budesonide, are not recommended for patients taking ritonavir or cobicistat. Mometasone should be used cautiously with ritonavir because of pharmacokinetic similarities to fluticasone. There was a delayed onset of symptoms in many cases, most likely due to the relatively lower systemic bioavailability of intranasal fluticasone.

Pubmed PDF Web

Contemporary management of keratosis obturans: a systematic review

Harounian, J A,Patel, V A,Isildak, H

Publication date 05-08-2021


Objective This study aimed to examine the medical literature regarding the natural history and management of keratosis obturans.
Method Pub Med was queried via the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, and the methodological quality of each study was assessed using the Methodological Index for Non-Randomized Studies criteria.
Results Fifty-one studies were abstracted, and dual investigator screening resulted in five retrospective studies for final analysis. All studies included patients afflicted with either unilateral (n = 75) or bilateral keratosis obturans (n = 8).
The definition of keratosis obturans was present in three studies: a desquamated keratin plug within the external auditory canal. Mean and median Methodological Index for Non-Randomized Studies scores were 9.5 and 9.5, respectively. All patients underwent keratosis obturans exenteration with microscopy.
Two studies reported an outcome instrument to evaluate endpoints: marked stillette and audiometry. No complications were observed with follow-up periods from 3 weeks to 3.5 years.
Conclusion This comprehensive review highlights a lack of published evidence relating to keratosis obturans. However, it appears keratosis obturans treatment is safe and efficacious with identifiable clinical practice patterns.

Pubmed PDF Web

Parotid incidentalomas: a systematic review

Thompson, CSG,Nolli, T,Bannister, M

Publication date 26-07-2021


Objective Parotid incidentalomas on fluorodeoxyglucose positron emission tomography/computed tomography imaging are rare. A systematic review was performed to assess their aetiology and association with scanning indication, and to develop an evidence-based algorithm for their management.
MethodsA literature search was performed on 25 August 2020 using the keywords ‘incidentaloma’, ‘incidental finding’, ‘parotid’, ‘parotid gland’, ‘salivary gland’ and ‘head and neck’. Articles were reviewed by two authors before their inclusion.
Results Forty articles were included, totalling 558 incidentalomas. The mean incidence was 0.74 per cent. Lung cancer was the most common imaging indication. The most common aetiologies were cystadenolymphoma, pleomorphic salivary adenoma and metastases. Only cystadenolymphoma (p = 0.015) and pleomorphic salivary adenoma (p = 0.011) were significantly associated with a primary malignancy (lung). The most common further investigations were aspiration cytology, ultrasound imaging and core biopsy, usually prior to parotidectomy.
Conclusion If appropriate, parotid incidentalomas should be followed up with flexible endoscopy, skin examinations, and head and neck examinations. Ultrasound-guided core biopsy provides higher accuracy, avoiding repeat sampling and excision biopsy.

Pubmed PDF Web

Adam Brown Kelly and his operating chair

Flynn, MF

Publication date 04-08-2021


Background Adam Brown Kelly, well known for lending his name to Paterson–Brown Kelly syndrome, is steeped in the early history of otolaryngology. To date, little light has been shone on his contributions to the specialty in that exciting period and to his home town of Glasgow.
MethodA historical review of his life and times was undertaken based on surviving accounts of his life, published work and archived memoirs.
Results This article summarises his life and connections, with particular reference to his unique chair that has survived to this day.
Conclusion Brown Kelly remains a pioneer of modern otolaryngology, and deserving of prominence within the medical history of Glasgow.

Pubmed PDF Web

Differential expression of angiotensin-converting enzyme-2 in human paranasal sinus mucosa in patients with chronic rhinosinusitis

Kawasumi, T,Takeno, S,Nishimura, M,Ishino, T,Ueda, T,Hamamoto, T,Takemoto, K,Horibe, Y

Publication date 30-04-2021


Objective Severe acute respiratory syndrome coronavirus-2 uses angiotensin-converting enzyme-2 as a primary receptor for invasion. This study investigated angiotensin-converting enzyme-2 expression in the sinonasal mucosa of patients with chronic rhinosinusitis, as this could be linked to a susceptibility to severe acute respiratory syndrome coronavirus-2 infection.
Methods Ethmoid sinus specimens were obtained from 27 patients with eosinophilic chronic rhinosinusitis, 18 with non-eosinophilic chronic rhinosinusitis and 18 controls. The angiotensin-converting enzyme-2 and other inflammatory cytokine and chemokine messenger RNA levels were assessed by quantitative reverse transcription polymerase chain reaction. Angiotensin-converting enzyme-2 positive cells were examined immunohistologically.
Results The eosinophilic chronic rhinosinusitis patients showed a significant decrease in angiotensin-converting enzyme-2 messenger RNA expression. In the chronic rhinosinusitis patients, angiotensin-converting enzyme-2 messenger RNA levels were positively correlated with tumour necrosis factor-α and interleukin-1β (r = 0.4971 and r = 0.3082, respectively), and negatively correlated with eotaxin-3 (r = −0.2938). Angiotensin-converting enzyme-2 immunoreactivity was mainly localised in the ciliated epithelial cells.
Conclusion Eosinophilic chronic rhinosinusitis patients with type 2 inflammation showed decreased angiotensin-converting enzyme-2 expression in their sinus mucosa. Angiotensin-converting enzyme-2 regulation was positively related to pro-inflammatory cytokines, especially tumour necrosis factor-α production, in chronic rhinosinusitis patients.

Pubmed PDF Web

Energy metabolism of cells in the macula flava of the newborn vocal fold from the aspect of mitochondrial microstructure

Sato, K,Chitose, S,Sato, K,Sato, F,Ono, T,Umeno, H

Publication date 25-06-2021


Objective Cells in the vocal fold of maculae flavae are likely to be tissue stem cells. Energy metabolism of the cells in newborn maculae flavae was investigated from the aspect of mitochondrial microstructure.
Method Five normal newborn vocal folds were investigated under transmission electron microscopy.
Results Mitochondria consisted of a double membrane bounded body containing matrices and a system of cristae. However, these membranes were ambiguous. In each mitochondrion, the lamellar cristae were sparse. Intercristal space was occupied by a mitochondrial matrix. Some mitochondria had fused to lipid droplets and rough endoplasmic reticulum, and both the mitochondrial outer and inner membranes had incarcerated and disappeared.
Conclusion The features of the mitochondria of the cells in the newborn maculae flavae showed that their metabolic activity and oxidative phosphorylation were low. The metabolism of the cells in the newborn maculae flavae seems to be favourable to maintain the stemness and undifferentiation of the cells.

Pubmed PDF Web

Is routine neck dissection warranted at salvage laryngectomy?

Sharma, S,Chaukar, D A,Bal, M,"DCruz, A K"

Publication date 09-07-2021


Background There is controversy regarding management of the neck at salvage laryngectomy. The aim of this study was to perform an analysis to determine the incidence of occult node positivity in this group and analyse factors affecting it.
MethodA retrospective analysis of 171 patients who underwent salvage total laryngectomy between 2000 and 2015 for recurrent or residual disease following definitive non-surgical treatment and were clinico-radiologically node negative at the time salvage laryngectomy was carried out.
ResultsA total of 171 patients with laryngeal or hypopharyngeal cancers underwent concurrent neck dissection at laryngectomy. There were 162 patients (94.7 per cent) who underwent bilateral neck dissection, and 9 patients (5.3 per cent) who underwent ipsilateral neck dissection. The occult lateral nodal metastasis rate was 10.5 per cent. Of various factors, initial node positive disease was the only factor predicting occult metastasis on univariable and multivariable analysis (p = 0.001).
Conclusion Risk of occult metastasis is high in patients who have node positive disease before starting radiotherapy. This group should be offered elective neck dissection.

Pubmed PDF Web

Sinonasal effects of external dacryocystorhinostomy

Eyigor, H,Cetinkaya, E A,Coban, D T,Ozturk, G,Erdem, Ö

Publication date 13-07-2021


Objective External dacryocystorhinostomy is thought to cause mucociliary dysfunction by damaging the mucosa, in turn affecting ciliary activity and mucus quality. This study investigated the effect of external dacryocystorhinostomy on sinonasal function.
Methods Patients scheduled for unilateral external dacryocystorhinostomy who underwent endoscopic nasal examination and paranasal sinus computed tomography were included in this study. A saccharine test was performed on the planned surgical side and the mucociliary clearance time was determined. The sinonasal quality of life was measured in all patients, pre-operatively and at six months post-operatively, using the Sino-Nasal Outcome Test-22. The Lund–Kennedy endoscopic score was also determined in all patients, both pre- and post-operatively.
Results The study comprised 28 patients (22 females and 6 males). A statistically significant difference was found between the pre- and post-operative saccharine test results (p = 0.006), but not between the pre- and post-operative Sino-Nasal Outcome Test-22 scores (p > 0.05).
Conclusion This study is one of only a few to investigate the effect of external dacryocystorhinostomy on sinonasal function. The results showed that external dacryocystorhinostomy impairs mucociliary clearance. The surgical procedure is well tolerated and does not significantly change nasal symptom scores.

Pubmed PDF Web

Comparing intermediate-term hearing results of NiTiBOND and Nitinol prostheses in stapes surgery

Koukkoullis, A,Gerlinger, I,Kovács, A,Szakács, Z,Piski, Z,Szanyi, I,Tóth, I,Révész, P

Publication date 16-07-2021


Objective To statistically analyse the hearing thresholds of two cohorts undergoing stapedotomy for otosclerosis with two different prostheses.
MethodA retrospective study was conducted comparing Ni TiBOND (n = 53) and Nitinol (n = 38) prostheses.
Results Average follow-up duration was 4.1 years for Ni TiBOND and 4.4 years for Nitinol prostheses. The post-operative air–bone gap was 10 dB or less, indicating clinical success. The p-values for differences between (1) pre- and post-operative values in the Ni TiBOND group, (2) pre- and post-operative values in the Nitinol group, (3) pre-operative values and (4) post-operative values in the two groups were: air–bone gap – p < 0.001, p < 0.001, p = 0.631 and p = 0.647; four-frequency bone conduction threshold – p = 0.076, p = 0.129, p < 0.001 and p = 0.005; four-frequency air conduction threshold – p < 0.001, p < 0.001, p = 0.043 and p = 0.041; three-frequency (1, 2 and 4 k Hz) bone conduction threshold pre-operatively – p = 0.639, p = 0.495, p = 0.001 and p = 0.01; and air conduction threshold at 4 k Hz: – p < 0.001, p < 0.001, p = 0.03 and p = 0.058.
Conclusion Post-operative audiological outcomes for Ni TiBOND and Nitinol were comparable.

Pubmed PDF Web

Ultrasound core biopsies of neck lumps: an experience from a tertiary head and neck cancer unit

Adeel, M,Jackson, R,Peachey, T,Beasley, N

Publication date 16-07-2021


Background Traditionally, fine needle aspiration cytology was the primary diagnostic investigation for head and neck lumps; however, ultrasound-guided core biopsy offers the advantage of preserving tissue architecture with increased tissue yield. This study reviews the diagnostic utility of ultrasound-guided core biopsy for investigating head and neck lumps.
Methods Overall, 287 ultrasound-guided core biopsies were reviewed between May 2017 and April 2019 at a single tertiary site for head and neck cancer.
Results On initial ultrasound-guided core biopsy, a diagnostic sample was obtained in 94.4 per cent of patients and in 83.7 per cent of patients with lymphoma. Where the initial ultrasound-guided core biopsy was non-diagnostic, 50 per cent of samples were diagnostic on repeat ultrasound-guided core biopsy. Overall, five complications were seen related to ultrasound-guided core biopsy, and all were managed conservatively. No cases of disease recurrence were identified at the biopsy site.
Conclusion Ultrasound-guided core biopsy is a safe procedure with a high diagnostic yield when investigating head and neck lumps. Patients whose ultrasound-guided core biopsies were non-diagnostic should be considered for excisional biopsy over repeat ultrasound-guided core biopsy.

Pubmed PDF Web

The impact of radical parotidectomy with immediate facial nerve reconstruction: a quality-of-life measure

Subramaniam, N,Luu, E,Asher, R,Oates, J,Clark, J R,Low, T-H

Publication date 28-07-2021


Objective Immediate facial nerve reconstruction is the standard of care following radical parotidectomy; however, quality of life comparisons with those undergoing limited superficial parotidectomy without facial nerve sacrifice is lacking.
Method Patients who underwent parotidectomy were contacted to determine quality of life using the University of Washington Quality of Life and Parotidectomy Specific Quality of Life questionnaires. A total of 29 patients (15 in the radical parotidectomy and 14 in the limited superficial parotidectomy groups) completed and returned questionnaires.
Results Using the University of Washington Quality of Life Questionnaire, similar quality of life was noted in both groups, with the radical parotidectomy group having significantly worse speech and taste scores. Using the Parotidectomy Specific Quality of Life Questionnaire, the radical parotidectomy group reported significantly worse speech, eye symptoms and eating issues.
Conclusion Those undergoing radical parotidectomy with reconstruction had comparable overall quality of life with the limited superficial parotidectomy group. The Parotidectomy Specific Quality of Life Questionnaire better identified subtle quality of life complaints. Eye and oral symptoms remain problematic, necessitating better rehabilitation and more focused reconstructive efforts.

Pubmed PDF Web

The effect of coronavirus disease 2019 on the hearing system

Gedik, Ö,Hüsam, H,Başöz, M,Tas, N,Aksoy, F

Publication date 04-08-2021


Objective This study aimed to evaluate different auditory regions with audiological tests, based on the presumption that there may be damage to the structures in the hearing system after coronavirus disease 2019.
Methods Twenty individuals with no history of coronavirus disease 2019 and 27 individuals diagnosed with coronavirus disease 2019 were compared. Pure tone, speech and extended high-frequency audiometry, acoustic immitansmetry, transient evoked and distortion product otoacoustic emissions testing, and auditory brainstem response testing were conducted.
Results The pure tone audiometry and extended high-frequency mean threshold values were higher in the coronavirus disease 2019 group. The transient evoked otoacoustic emissions signal-to-noise ratios were bilaterally lower at 4 k Hz in individuals with a coronavirus disease 2019 history. In the auditory brainstem response test, only the interpeak latencies of waves III–V were significantly different between groups.
Conclusion Coronavirus disease 2019 may cause damage to the hearing system. Patients should be followed up in the long term with advanced audiological evaluation methods in order to determine the extent and level of damage.

Pubmed PDF Web

A review of telephone consultations for head and neck cancer follow up: a patient satisfaction survey

Stewart, R,Collins, L,Kerr, B,Gray, G,Devlin, B,Black, M,Ullah, R

Publication date 23-07-2021


Objective To review patient satisfaction with the change in practice towards telephone consultations during and after the coronavirus disease 2019 pandemic for head and neck cancer follow up.
MethodA retrospective analysis was conducted of head and neck cancer telephone appointments during a six-month period in a tertiary referral centre.
Results Patients found the telephone consultations beneficial (98 per cent), with 30 per cent stating they were relieved to not have to attend hospital. Patients who travelled further, those with lower stage disease and patients with a greater interval from initial treatment were most satisfied with the telephone consultations. Sixty-eight per cent of patients stated they would be happy to have telephone consultations as part of their regular follow up after the pandemic.
Conclusion Patients found the telephone consultations beneficial and 30 per cent considered them preferable to face-to-face appointments. This study demonstrates that telephone consultations can be used as an adjunct to face-to-face appointments in an effort to reduce hospital attendances whilst maintaining close follow up.

Pubmed PDF Web

Calculated versus measured pure tone bone conduction 3 kHz thresholds in sudden sensorineural hearing loss

Shilo, S,Ziv-Baran, T,Oron, Y,Handzel, O,Cavel, O,Eta, R A,Muhanna, N,Ungar, O J

Publication date 26-07-2021


Objective To compare the measured bone conduction threshold at 3 k Hz with the calculated threshold in newly diagnosed sudden sensorineural hearing loss.
MethodsA retrospective chart review was conducted of pure tone audiograms in confirmed sudden sensorineural hearing loss cases.
Results Of 157 patients with sudden sensorineural hearing loss, 144 had idiopathic hearing loss, 8 had vestibular schwannoma and 5 had Ménières disease. The r value for the correlation between the two methods of 3 k Hz assessment for all patients was 0.887 (p < 0.001). The mean difference between the measured and calculated 3 k Hz thresholds was 0.76 ± 7.96 dB, 0.4 ± 8.08 dB and 1.5 ± 1.8 dB in the sudden sensorineural hearing loss, idiopathic and Ménières disease groups, respectively. The mean difference between the measured and calculated 3 k Hz thresholds was significantly greater in the vestibular schwannoma group (6.86 ± 4.38 dB) than in the idiopathic group (p = 0.013).
Conclusion The 3 k Hz frequency may encompass important audiometric information. A discrepancy between the measured and calculated bone conduction 3 k Hz thresholds raises suspicion of an underlying vestibular schwannoma as an aetiology for sudden sensorineural hearing loss, and these thresholds should therefore be measured independently and routinely.

Pubmed PDF Web

A change in clinical practice for aural foreign bodies – what we learnt from the coronavirus disease 2019 pandemic

Ho, G C,Thind, R,Yap, D,Hunt, A

Publication date 05-08-2021


Objective This case series, conducted during the coronavirus disease 2019 pandemic, investigates the impact of leaving aural foreign bodies in situ for a prolonged period of time, including the risk of complications and success rates of subsequent removal attempts.
MethodA retrospective study of aural foreign body referrals over a six-month period was carried out.
Results Thirty-four patients with 35 foreign bodies were identified (6 organic and 29 inorganic). The duration of foreign bodies left in situ ranged from 1 to 78 days. Four patients suffered from traumatic removal upon initial attempts. First attempts made by non-ENT specialists (68.8 per cent) all failed and were associated with a high risk of trauma (36.4 per cent).
Conclusion Because of the coronavirus disease 2019 pandemic, this is the first case series to specifically investigate the relationship between the duration of aural foreign bodies left in situ and the risk of complications. Our data suggest that prolonged duration does not increase the incidence of complications.

Pubmed PDF Web

One year on: assessing the impact of coronavirus disease 2019 on demand for semi-urgent ENT services

Allen, H,Winstanley, J,Stubington, T J,Judd, O

Publication date 05-08-2021


Objective This study investigated how the coronavirus disease 2019 pandemic has impacted on presentations to ENT first-on-call services.
Methods All appointments to a rapid access triage clinic from 1 June to 31 August in 2019 and 2020 were reviewed retrospectively and their reasons for consultation classified. A binomial proportion test was used to determine whether the proportions of consultations per presentation differed significantly between years. This analysis was repeated with the number of unique patients per presenting complaint.
Results The proportions of nine reasons for consultation differed significantly between 2019 and 2020, including an increase in otitis media and nasal trauma presentations, and a decrease in otitis externa and tonsillitis presentations. Reattendances caused some variation in the frequency of certain diagnoses.
Conclusion Our data suggest a shift in the presentations to first-on-call services, which may be a result of changes in patient behaviour and access to healthcare services.

Pubmed PDF Web

The accuracy of dry surgical field sublabial biopsy in the diagnosis of sicca syndrome

O’ Byrne, L,Ramli, R,Khoo, S G

Publication date 05-08-2021


Background Sublabial gland biopsy is the ‘gold standard’ in establishing the diagnosis of primary Sjögrens syndrome. Bleeding and nerve damage are complications. Our centre has adopted the use of the chalazion clamp to provide a dry surgical field to address these challenges. This study aimed to assess the accuracy of minor salivary gland harvest rate using this technique.
MethodA retrospective review of all minor salivary gland biopsies was carried out in a single tertiary referral centre over a five-year period.
Results Forty-one biopsy patients were identified, with a mean age of 56.1 years. There was 100 per cent accuracy in harvest rate in our series. Twelve patients (29 per cent) were positive for primary Sjögrens syndrome. No patients had a complication immediately or at one month follow up.
Conclusion Dry surgical field sublabial gland biopsy is a safe and highly effective technique in the diagnosis of primary Sjögrens syndrome. Initial results indicate it may provide a higher harvest rate with fewer complications than traditional non-ischaemic techniques.

Pubmed PDF Web

Olfactory dysfunction at six months after coronavirus disease 2019 infection

Leedman, S R,Sheeraz, M,Sanfilippo, P G,Edgar, D W,"DAulerio, G V",Robb, D M,Richards, T,Blyth, C C,Mackey, D A

Publication date 05-08-2021


Objective This study aimed to assess olfactory dysfunction in patients at six months after confirmed coronavirus disease 2019 infection.
Methods Coronavirus disease 2019 positive patients were assessed six months following diagnosis. Patient data were recoded as part of the adapted International Severe Acute Respiratory and Emerging Infection Consortium Protocol. Olfactory dysfunction was assessed using the University of Pennsylvania Smell Identification Test.
Results Fifty-six patients were included. At six months after coronavirus disease 2019 diagnosis, 64.3 per cent of patients (n = 36) were normosmic, 28.6 per cent (n = 16) had mild to moderate microsmia and 7 per cent (n = 4) had severe microsmia or anosmia. There was a statistically significant association between older age and olfactory dysfunction. Hospital or intensive care unit admission did not lead to worse olfactory outcomes compared to those managed in the out-patient setting.
Conclusion At six months after coronavirus disease 2019 diagnosis, approximately two-thirds of patients will be normosmic. This study is the first to describe six-month outcomes for post-coronavirus disease 2019 patients in terms of olfactory dysfunction.

Pubmed PDF Web

How we do it: ‘tonsil swabs please’ – an alternative use in open neck surgery

Mathew, E,Nair, D,Rourke, T,Corbridge, R

Publication date 11-08-2021


Background Thyroid and parathyroid surgery often involves the use of heated instruments for dissection. Whilst these are beneficial, accidental thermal damage to the exposed skin edges can occur, resulting in an unsatisfactory cosmetic outcome. Tonsil swabs can be used in head and neck surgery intra-operatively to control bleeding. This paper describes an alternative use for them in protecting wound edges during the procedure.
Method Damp tonsil swabs are sutured onto the wound edges after the initial skin incision. They remain present for the duration of the surgery and are removed at the time of skin closure.
Results The tonsil swabs provide protection and help avoid accidental injury to the skin. No complications with this technique have been experienced.
Conclusion This paper describes a simple, effective and practical technique for protecting the skin during neck procedures using resources readily available in a standard ENT operating theatre.

Pubmed PDF Web

Comprehensive Management of Skull Base Tumors, 2nd edn E Y Hanna, F DeMonte Thieme, 2021 ISBN 978 1 62623 532 8 pp 668 Price £209.50 €209.99

Flood, L M

Publication date 21-05-2021


Pubmed PDF Web

JLO volume 135 issue 9 Cover and Front matter

Publication date 27-08-2021


Pubmed PDF Web

JLO volume 135 issue 9 Cover and Back matter

Publication date 27-08-2021


Pubmed PDF Web

Copyright © KNO-T, 2020 | R/Abma