Journal of Laryngology and Otology 2021-10-13

Incidental white matter hyperintensities on magnetic resonance imaging – are they clinically important?

Fishman, Jonathan,Fisher, Edward W

Publication date 13-10-2021


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Coronavirus disease 2019 associated mucormycosis meandering its way into the orbit: a pictorial review

Khullar, T,Kumar, J,Sindhu, D,Garg, A,Meher, R,Goel, R

Publication date 15-09-2021


Background There has been a recent deluge of coronavirus disease 2019 associated mucormycosis in our country. It affects the paranasal sinuses; however, it has a rapid extrasinus progression (the orbit being most common), which can be fatal if not detected early. It may meander into the orbit through various foramina without frank bone destruction.
Methods This paper reviews the various gateways of the spread of coronavirus disease 2019 associated mucormycosis to the orbit, even before advent of bone destruction or ocular symptoms. Plausible pathways of invasion and subtle imaging findings are depicted, to enable an early diagnosis.
Results Relevant anatomy and imaging examples have been illustrated to familiarise the surgeons with various routes of coronavirus disease 2019 associated mucormycosis spread to the orbit. Emphasis is laid on searching for subtle imaging findings for the detection of early orbital invasion.
Conclusion Early detection and extension of coronavirus disease 2019 associated mucormycosis is facilitated by knowledge of its gateways of spread, which aids the surgeon in prognostication and planning of the surgical approach.

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Impact of olfactory dysfunction on quality of life in coronavirus disease 2019 patients: a systematic review

Saniasiaya, J,Prepageran, N

Publication date 24-08-2021


Objective To outline the impact on quality of life in coronavirus disease 2019 patients with olfactory dysfunction.
Methods Five databases were searched for articles referring to the impact on quality of life in coronavirus disease 2019 patients with olfactory dysfunction. The search was conducted for the period from November 2019 to April 2021. The search was conducted over one month (May 2021).
Results Four studies that met the objective were included. Altogether, there were 1045 patients. Various questionnaires were used to assess quality of life. Overall, the quality of life deficit affected 67.7 per cent of patients. Quality of life domains investigated include overall quality of life (four studies), food and taste dysfunction (two studies), mental health (two studies), cognitive function (one study), functional outcome (one study) and safety domains (one study).
Conclusion Quality of life deficit was reported to be 67.7 per cent among coronavirus disease 2019 patients with olfactory dysfunction. The high prevalence of persistent olfactory dysfunction prompts more serious research, as the long-standing consequences of olfactory dysfunction are detrimental.

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Olfactory dysfunction amongst children and adolescents with laboratory confirmed coronavirus disease 2019: a systematic review

Saniasiaya, J,Kulasegarah, J,Narayanan, P

Publication date 02-09-2021


Background Despite the rapidly emerging reports of olfactory dysfunction amongst adult patients with coronavirus disease 2019, cases involving children and adolescents are scarcely reported. The literature was reviewed to elucidate olfactory dysfunction amongst children and adolescents with coronavirus disease 2019.
MethodsA search of the literature published from 1 December 2019 to 30 April 2021 was conducted using four databases, based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The search was performed over one month (May 2021).
Results Only 9 articles were identified, with a total of 316 laboratory confirmed coronavirus disease 2019 positive children and adolescents, of whom 156 reported olfactory dysfunction. Four studies reported olfactory dysfunction based on subjective tests; four studies carried out objective assessment. Most studies reported on olfaction recovery.
Conclusion The literature review revealed an olfactory dysfunction rate of 49 per cent amongst children and adolescents with coronavirus disease 2019. Persistence of olfactory dysfunction was reported in 7.1 per cent of the patients. Further studies involving objective measures need to be carried out in children and adolescents with coronavirus disease 2019.

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Infantile recurrent respiratory papillomatosis: review of adjuvant therapies

Patel, A,Orban, N

Publication date 02-09-2021


Background Recurrent respiratory papillomatosis is a potentially life-threatening condition characterised by the growth of exophytic lesions within the larynx and trachea. The principal aim of management is maintenance of an adequate airway by surgical debulking. Several adjuvant therapies have been used to varying effect to reduce the burden of this disease and increase the interval between debulking procedures. The most severe cases present in children aged under three years, who are therefore most likely to need adjuvant therapies. The current evidence base on adjuvant treatments relating to children who present aged under three years has been reviewed.
MethodsA literature review of articles in Cochrane, Pub Med and Embase databases was carried out. Given the rarity of the condition in this age group, all the literature relates to case reports and case series.
Results and conclusion The following adjuvant therapies have been used in children who presented under three years of age: quadrivalent human papilloma virus vaccine, intralesional cidofovir, pegylated interferon, alpha-interferon, cimetidine and cetuximab.

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An observational study of T2-weighted white matter hyperintensities on magnetic resonance imaging of the internal auditory meatus and brain: ignore or not?

Huang, X,Grimmond, N,Kontorinis, G

Publication date 24-09-2021


Background Magnetic resonance imaging of the internal auditory meatus frequently detects incidental white matter hyperintensities. This study investigated the association between these and the risk of stroke and transient ischaemic attack, or myocardial infarction.
Methods The records of patients with incidental white matter hyperintensities were reviewed, and data were collected on: age, sex, cardiovascular risk factors, and incidence of stroke and transient ischaemic attack, or myocardial infarction, five years later. The risk factors associated with vascular events were explored.
Results Of 6978 patients, 309 (4.4 per cent) had incidental white matter hyperintensities. Of these, 20 (6.5 per cent) had a stroke or transient ischaemic attack within five years, and 5 (1.7 per cent) had a myocardial infarction. The number of cardiovascular risk factors was significantly associated with the incidence of stroke and transient ischaemic attack (p = 0.004), and myocardial infarction (p = 0.023).
Conclusion The number of cardiovascular risk factors predicts the likelihood of vascular events; appropriate risk factor management is recommended for patients with incidental white matter hyperintensities of presumed vascular origin.

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The potential role of imaging techniques in avoiding neck dissection during salvage surgery after head and neck carcinoma treated with bioradiotherapy

Rovira, A,Tornero, J,Taberna, M,Oliva, M,Montal, R,Nogues, J,Mari, A,Viñals, J M,Lozano, A,Maños, M,Mesia, R

Publication date 06-09-2021


Objective This study aimed to evaluate the effectiveness of computed tomography and positron emission tomography-computed tomography prior to salvage surgery after head and neck carcinoma treated with bioradiotherapy and to look at the role of neck dissection in this setting.
Method This study was a retrospective chart review of a series of consecutive patients with locally advanced head and neck squamous cell carcinoma treated with bioradiotherapy. Radiological and pathological stages were compared to evaluate the accuracy of computed tomography and positron emission tomography-computed tomography in detecting occult neck metastasis in the context of recurrence of primary tumour. In order to assess the impact of neck dissection on survival, Kaplan–Meier survival curves after salvage surgery with and without neck dissection were derived.
ResultsA total of 268 patients were identified, of which 22 underwent salvage surgery. The negative predictive value of computed tomography and positron emission tomography-computed tomography was excellent. Neck dissection did not represent an improvement on overall, disease specific and regional recurrence free survival (p = 0.67, p = 0.91 and p = 0.62, respectively) amongst clinically and radiologically negative necks.
Conclusion Conservative treatment of the neck should be considered when dealing with patients with primary site recurrence or persistent disease after bioradiotherapy without evidence of neck disease.

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The readability and reliability of online information about adenoidectomy

Ahmadi, O,Wood, A J

Publication date 16-08-2021


Objective There is limited understanding amongst patients and parents of paediatric patients regarding adenoidectomy. Most patients access health-related information online. The aim of this study was to assess the suitability of online information on adenoidectomy.
Method The term ‘adenoid’ was used to search Google, and the first 50 websites identified were screened. For each website, the readability and quality were assessed.
Results Of the 41 websites that met the inclusion criteria, the mean readability scores corresponded to ‘difficult to read’ and university-level reading categories. For the quality of the websites, the mean score corresponded to ‘fair’ with 39 per cent of the websites containing either ‘poor’ or ‘very poor’ quality data. The ENT UK information is one of the most readable and reliable online resources.
Conclusion The online information on adenoidectomy is largely set at an inappropriate readability level and of variable quality. Surgeons should consider assisting their patients with online searches regarding adenoidectomy.

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Rhino-orbital-cerebral mucormycosis: fungal epidemic in a viral pandemic

Chouhan, M,Solanki, B,Shakrawal, N

Publication date 02-09-2021


Background Treatment of coronavirus disease 2019 infection can result in immunosuppression. Rhino-orbital-cerebral mucormycosis is a frequent co-infection, even after recovery.
Methods An ambispective interventional study was conducted of 41 coronavirus patients with rhino-orbital-cerebral mucormycosis at a tertiary care centre from March to May 2021.
Results There were 28 males and 13 females with a mean age of 48.2 years (range, 21–68 years). Twelve had long-standing diabetes mellitus and 28 had been recently diagnosed. Thirty-six had received systemic corticosteroids for coronavirus disease 2019. Nasal signs were present in 95 per cent of patients, ophthalmic symptoms and signs in 87 per cent, palatal necrosis in 46.3 per cent, facial signs in 24.3 per cent, nerve palsies in 60.9 per cent, and intracranial involvement in 21.9 per cent. Treatment with amphotericin B was based on clinical features and co-morbidities. Endonasal debridement was performed in 51.2 per cent of patients, total maxillectomy in 14.6 per cent and orbital exenteration in 9.7 per cent. At the last follow up, 37 patients (90.24 per cent) were on antifungal therapy; 4 (9.75 per cent) did not survive.
Conclusion Early detection may improve survival. Follow up of high-risk patients after coronavirus disease 2019 infection is paramount.

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Ten-year experience with multidisciplinary diagnosis and treatment of odontogenic sinusitis

Elwany, S,Ibrahim, A A,Hussein, W K A,Medra, A M,Elwany, N

Publication date 02-09-2021


Background Odontogenic sinusitis is an underdiagnosed entity and is one cause of failure of conventional treatments of sinusitis. Unfortunately, there is no consensus so far on the best management protocol. This retrospective study aimed to suggest a practical management protocol that can reduce misdiagnosis and improve treatment outcomes.
Methods The study included 74 patients with confirmed odontogenic sinusitis who were diagnosed and treated over 10 years (2010–2019). The patient data were recorded and analysed.
Results Dental pain was reported in only 31.1 per cent of patients. Fifty-six patients (75.7 per cent) had received dental treatment during the last year, but only 13 (23.1 per cent) reported it. Dental pathology was missed on initial computed tomography evaluation in 24 patients (32.4 per cent). Forty-one patients (55.4 per cent) were successfully treated by dental procedures and antibiotics. Fourteen patients needed functional endoscopic sinus surgery in addition to dental procedures.
Conclusion Successful management of odontogenic sinusitis requires good communication between rhinologists, radiologists and dentists. Dental treatment should be the logical first step in the treatment protocol, unless otherwise indicated.

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Effects of location, size and shape of tympanic membrane perforations on hearing: analysis of 400 cases

Balcı, M K,İşlek, A,Bakiş, Y B,Önal, H K

Publication date 20-09-2021


Objective This study aimed to evaluate the effect of size, location and shape of tympanic membrane perforations on hearing levels of a large study group treated in a tertiary referral centre.
Method Medical data of 458 patients with tympanic membrane perforations were evaluated.
ResultsA total of 336 patients had normal middle-ear findings during the surgical procedures. There was a significant difference in terms of mean pure tone average and air–bone gap values between posterior-inferior and anterior-inferior perforations (p = 0.005 and p = 0.044, respectively). The mean air–bone gap value of kidney-shaped perforations was significantly higher. Posterior-superior and posterior perforations were significant indicators for ossicular chain defects (p < 0.001; odds ratio, 14.2 and p = 0.004; odds ratio, 3.4, respectively).
Conclusion Perforations located in the posterior-inferior quadrant caused the greatest hearing loss. The difference between posterior-inferior and anterior-superior or inferior perforations was statistically significant. Posterior perforations had a significant relationship with ossicular chain pathologies. Kidney-shaped perforations caused higher pure tone average and air–bone gap values than annular, elliptical or pinpoint perforations.

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The audiovestibular profile of Brown-Vialetto-Van Laere syndrome

Omar, R,Rajput, K,Sirimanna, T,Rajput, S,Pagarkar, W

Publication date 09-09-2021


Background Brown-Vialetto-Van Laere syndrome, a rare disorder associated with motor, sensory and cranial nerve neuropathy, is caused by mutations in riboflavin transporter genes SLC52A2 and SLC52A3. Hearing loss is a characteristic feature of Brown-Vialetto-Van Laere syndrome and has been shown in recent studies to be characterised by auditory neuropathy spectrum disorder.
Method This study reports the detailed audiovestibular profiles of four cases of Brown-Vialetto-Van Laere syndrome with SLC52A2 and SLC52A3 mutations. All of these patients had auditory neuropathy spectrum disorder.
Results There was significant heterogeneity in vestibular function and in the benefit gained from cochlear implantation. The audiological response to riboflavin therapy was also variable, in contrast to generalised improvement in motor function.
Conclusion We suggest that comprehensive testing of vestibular function should be conducted in Brown-Vialetto-Van Laere syndrome, in addition to serial behavioural audiometry as part of the systematic examination of the effects of riboflavin.

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Olfactory dysfunction and coronavirus disease 2019 severity: a prospective cohort study

Aydemir, L,Sen, C,Kara, H,Demir, A A,Bozbora, E,Uysal, E,Kesimli, C,Orhan, K S,Comoglu, S,Keles Turel, M N

Publication date 09-09-2021


Objective The primary goal of this study was to evaluate the association between olfactory dysfunction or taste impairment and disease severity and radiological findings in coronavirus disease-2019. The secondary goal was to assess the prevalence, severity and course of olfactory dysfunction or taste impairment in patients with coronavirus disease 2019.
Method This prospective observational cohort study evaluated patients hospitalised with coronavirus disease 2019 between April 1 and 1 May 2020. Olfactory dysfunction and taste impairment were evaluated by two questionnaires. Chest computed tomography findings and coronavirus disease-2019 severity were assessed.
Results Among 133 patients, 23.3 per cent and 30.8 per cent experienced olfactory dysfunction and taste impairment, respectively, and 17.2 per cent experienced both. The mean age was 56.03 years, and 64.7 per cent were male and 35.3 per cent were female. No statistically significant association was found between olfactory dysfunction (p = 0.706) and taste impairment (p = 0.35) with either disease severity or chest computed tomography grading.
Conclusion Olfactory dysfunction or taste impairment does not have prognostic importance in patients with coronavirus disease 2019.

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Tonsil surgery in children under two years of age

Madej, O,Kubba, H

Publication date 16-09-2021


Background More young children are undergoing tonsillectomy, driven by sleep-disordered breathing concerns. Their specific risks are not well described.
MethodA retrospective review was conducted of children aged 1–23 months undergoing tonsillectomy at one institution between 2014 and 2018.
ResultsA total of 157 children were identified (3.9 per cent of all tonsillectomies in those aged 0–16 years). Sixty-seven per cent were male. The youngest child was six months old; the smallest weighed 6.9 kg. Sixty-eight (43.3 per cent) had co-morbidities. The indication for tonsillectomy was sleep-disordered breathing in 94 per cent; 29.9 per cent had co-existing airway lesions, mostly laryngomalacia and tracheobronchomalacia. Of the children, 83.4 per cent were managed post-operatively on the surgical ward, and 63.7 per cent stayed 1 night. Emergency paediatric intensive care unit admission occurred in 3.8 per cent. Early respiratory complications and emergency paediatric intensive care unit admission were more common if the patient was medically complex, aged less than 18 months or weighed less than 12 kg. Re-operation for bleeding occurred in 1.9 per cent.
Conclusion Most children stay 1 night on a general ward, with an uneventful course. Complications are occasionally severe, mostly in the very young and medically complex.

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Cervical lymphadenopathy following coronavirus disease 2019 vaccine: clinical characteristics and implications for head and neck cancer services

Abou-Foul, A K,Ross, E,Abou-Foul, M,George, A P

Publication date 16-09-2021


Objective Patients with coronavirus disease vaccine associated lymphadenopathy are increasingly being referred to healthcare services. This work is the first to report on the incidence, clinical course and imaging features of coronavirus disease vaccine associated cervical lymphadenopathy, with special emphasis on the implications for head and neck cancer services.
Methods This was a retrospective cohort study of all patients referred to our head and neck cancer clinics between 16 December 2020 and 12 March 2021. The main outcomes measured were the proportion of patients with vaccine-associated cervical lymphadenopathy, and the clinical and imaging characteristics.
Results The incidence of vaccine-associated cervical lymphadenopathy referrals was 14.8 per cent (n = 13). Five patients (38.5 per cent) had abnormal-looking enlarged and rounded nodes with increased vascularity. Only seven patients (53.9 per cent) reported full resolution within an average of 3.1 ± 2.3 weeks.
Conclusion Coronavirus disease vaccine associated cervical lymphadenopathy can mimic malignant lymphadenopathy and therefore might prove challenging to diagnose and manage correctly. Healthcare services may encounter a significant increase in referrals.

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A spontaneous retropharyngeal haematoma: a suspected side-effect of indomethacin

Crossley, E,Goldie, S,Kirkby-Bott, J,Hellier, W

Publication date 31-08-2021


Background Retropharyngeal haematomas are most commonly associated with trauma and anti-coagulant use. This paper describes the first reported case of a spontaneous retropharyngeal haematoma suspected to be due to indomethacin use.
Case report It is proposed that the combination of indomethacin affecting platelet aggregation, alongside the patient coughing, may have led to this retropharyngeal haematoma.
Conclusion The complexities of management are discussed and the current literature reviewed. In the absence of airway compromise or a rapidly enlarging haematoma, patients can be managed conservatively with observation and close discussion with the haematology department. Follow-up imaging is not necessary if the patients symptoms settle; however, any increase in parathyroid hormone levels must be investigated to exclude a parathyroid adenoma.

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Two abstracts from oral presentations at the Royal Society of Medicine Matthew Yung Short Papers Competition (March 2021)

Publication date 13-07-2021


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JLO volume 135 issue 11 Cover and Front matter

Publication date 13-10-2021


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JLO volume 135 issue 11 Cover and Back matter

Publication date 13-10-2021


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