Molecular Characterization of Fungal Colonization on the Provox™ Tracheoesophageal Voice Prosthesis in Post Laryngec-tomy Patients

Background: Tracheoesophageal voice prostheses (TVPs) have been the gold standard in rehabilitation, after laryngectomy, producing faster and premier voicing towards esophageal speech. Fungal colonization shortens the device’s lifetime and leads to prosthesis dysfunction, leakage, and subsequent respiratory infection. Therefore, in the current study, we aimed to investigate the fungal colonization patterns and to propose prophylactic measures that shall increase the longevity of voice prosthesis. Methods: Failed TVPs were removed - due to leakage and/or aspiration - from 66 post laryngectomy patients and examined. They were referred to Amiralam and Rasoul Hospital, the main centers of Ear, Nose, and Throat in Tehran, Iran from April 2018 to January 2020. Fungal colonization patterns were assessed using DNA sequencing techniques. Furthermore, the susceptibility to fluconazole, amphotericin B, nystatin, and white vinegar was evaluated according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Resident fungal species from the upper airways colonized all the 66 TVPs (100%). Diabetes (31%) and smoking (98%) were the predominant underlying disease and predisposing factors, respectively. Among the 79 fungal agents isolated from the 66 TVPs, Candida glabrata (n=25, 31.7%) was the most common. A significant reduction in minimum inhibitory concentration (MIC) values were observed for white vinegar when used alone (P<0.05). Conclusion: White vinegar at a very low concentration could decrease the amount of fungal colonization on TVPs without any adverse effects; its wide accessibility and affordability ensure a decrease in the overall health cost.

Who operates on the children?

An unexpectedly high burden of elective paediatric surgery is being performed by the Ear, Nose and Throat (ENT) surgeons in Moshi, Tanzania. We believe this brief survey demonstrates the capacity for elective paediatric surgery in the sub-Saharan setting, comparable to the elective operative numbers of an equivalent tertiary centre in Liverpool, UK.

Acute Vertigo After COVID-19 Vaccination: Case Series and Literature Review

Objective: The aim of this study was to present some cases of acute vertigo potentially related to the coronavirus disease 2019 (COVID-19) vaccine and review the available literature about cochleovestibular dysfunction after the COVID-19 vaccination.Methods: In the period from May to July 2021, we evaluated 33 patients (mean age 54.3 ± 14.1) with “acute vertigo” post COVID-19 vaccination. A detailed medical history was taken on comorbidities, types of vaccines received, and symptoms associated. All patients underwent otoneurological evaluation, such as head impulse test, nystagmus evaluation, test of skew (HINTS) examination. Head shaking test-induced nystagmus, hyperventilation-induced nystagmus, and parossistic positional nystagmus were studied to search for vestibular impairment.Results: Symptoms included 16 patients (48.5%) with objective vertigo, 14 patients (42.4%) with subjective vertigo, and 3 patients (9.1%) with dizziness. Of the associated ear, nose, and throat (ENT) symptoms, the most expressed was tinnitus (18.2%). Bedside examination showed absent nystagmus in 7 patients (21.2%), 9 patients (27.3%) had horizontal or rotatory nystagmus, 17 patients (51.5%) had a vertical or oblique nystagmus, negative HST, or “central HINTS.”Discussion and Conclusions: The 9 patients had an evoked nystagmus pathognomonic for benign paroxysmal positional vertigo; in the remaining 17 cases, peripheral vestibular dysfunction could be excluded and central disorder may be suggested. Due to the prevalence of nystagmus of non-peripheral origin, a central nervous system involvement could not be excluded. However, due to the small sample size, a definite cause–effect relationship between vaccination and vertigo cannot be inferred. In light of expected third dose, large-scale and well-designed studies are needed to better define possible adverse reactions of the COVID-19 vaccine.

Ear, Nose, and Throat Foreign Bodies in Children: A Retrospective Study

Background: This study analyzed the presentation, characteristics, and management of foreign bodies in different age groups of pediatric patients with ear, nose, and throat foreign bodies. Methods: A retrospective study was performed using data from October 2012 to September 2020. A total of 1285 patients with ear, nose, and throat foreign bodies who were less than 12 years of age and who presented to the emergency room were included in this study. Their biographical data, clinical presentations, foreign body types and locations, and management outcomes were obtained from medical records and analyzed as three age groups (infancy: <2 years old; early childhood: 2–5 years old; and late childhood: 6–12 years old). Results: The early childhood group had the highest number of patients (n = 672; 52.2%). Throat was the most common location (59.2%), and bone was the most common type of foreign body. Among the children who visited our hospital, foreign bodies were actually found in only 657 patients (51.1%) and removed by an otolaryngologist in 625 (95.1%) cases. Conclusion: Our study could provide guidance for the diagnosis and management of pediatric patients who present to emergency departments with foreign bodies.

The virtual ear, nose and throat follow-up clinic: a 10-year quality improvement project

Background/Aims Ear, nose and throat services have seen one of the greatest increases in service demand over the last 6 years. This study aimed to determine if a virtual clinic system could reduce the volume of patients who need to be seen in person in an ear, nose and throat outpatient clinic. Methods Clinical outcome data for one consultant's team in a single ear, nose and throat department between 2009–19 were analysed. Data were prospectively collected on all patients who used the virtual clinic in this 10-year period and the outcomes analysed. Results A total of 3071 patients entered the virtual clinic during the 10-year period. Of these, 61% were discharged from the clinic via virtual follow-up and 39% required an in-person review appointment. On average, 187 patients per year did not have to attend an in-person follow-up appointment, with estimated cost savings of £27 000 per year. Conclusions The virtual ear, nose and throat clinic service has clear benefits for patients and services, delivering healthcare without unnecessary in-person appointments through a shared, clinician–patient decision process.

COMPARATIVE STUDY BETWEEN CONVENTIONAL INFERIOR TURBINECTOMY AND ENDOSCOPIC INFERIOR TURBINOPLASTY FOR TREATMENT OF INFERIOR TURBINATE HYPERTROPHY

Objective: To compare efficacy of endoscopic turbinoplasty versus conventional inferior turbinectomy for hypertrophy of inferior turbinate. Study Design: Comparative prospective study. Place and Duration of Study: Ear, Nose and Throat (ENT) Department Combined Military Hospital (CMH) Multan, from Jun 2019 to May 2020. Methodology: This study comprised of 50 patients of various age groups and both genders. Patients were grouped into two groups A and B, each group having 25 patients through random sampling. Patients in group A had endoscopic turbinoplasty whereas patients in group B had partial turbinectomy through conventional surgical method. Patients were followed regularly in both groups and were inspected postoperatively at 2 weeks, after 1 month and after 3 months. Results: Patients who underwent Endoscopic turbinoplasty experienced less pain (p˂0.05) postoperatively at 2 weeks compared to conventional surgical turbinectomy. In addition, these patients showed statistically significant healing and reduced crusting at 1 month postoperatively. At 3 months post operatively all patients had healed completely as opposed to only 72% with surgical turbinectomy. Conclusion: Endoscopic turbinoplasty is more effective than conventional surgical technique for inferior turbinate hypertrophy as it leads to less post-operative pain, reduced nasal crusting and earlier healing.

Pediatric Otological Disorders: An In-Hospital Study

Introduction: Social factors influencing the likelihood of developing pediatric Ear, Nose, and Throat (ENT) disorders include socioeconomic status, the type of family, overcrowding, and access to health care, which are prevalent in developing countries like Nepal. Nepalese populations are not well documented with regards to pediatric ENT disorders. Objective: The aim of the study was to determine the prevalence of ENT disorders in pediatric patients attending hospitals. Methods: This is a cross-sectional descriptive study that was conducted at Janaki Medical College, Janakpur between January and September of 2021. Consecutive children from Janaki Medical College between the ages of 6 months and 18 years with otological complaints participated in the study. Afterward, the diagnosis was derived from patients’ OPD cards or by contacting them by phone. Results: The mean ages of male and female participants were 3.2± 2.7 years old and 4.9 ± 2.6 years respectively. Out of the study participants who complained about otological complaints, the majority (37.45%) had ear wax on their ears, followed by foreign bodies (21.30%) and acute otitis externa (9.2%). Among foreign bodies encountered, rubber (35.48%) was most common, followed by seed (24.19%). Conclusions: Pediatric ear diseases are very common. In the majority of cases, ear wax and foreign bodies were found. By raising awareness about ear hygiene and disease, we can reduce the problems associated with them. Keywords: Ear, nose, and throat; otology; pediatric; prevalence.

Analysis of Consumer Exposure Cases for Alcohol-Based Disinfectant and Hand Sanitizer Use against Coronavirus Disease 2019 (COVID-19)

The development and distribution of vaccines and treatments as well as the use of disinfectants and hand sanitizers to cope with coronavirus disease 2019 (COVID-19) infection has increased rapidly. As the use of disinfectants and hand sanitizers increased, the number of unintended exposures to these substances also increased. A total of 8016 cases of toxic exposure to disinfectants and hand sanitizers were reported to the American Association of Poison Control Centers (AAPCC) from 1 January 2017 to 30 May 2021. The cases have been characterized by substance, sex, patient age, exposure reason and site, treatments received, and outcomes. The number of exposures correlates closely to the rise of COVID-19 cases, rising significantly in March 2020. About half of the total cases involved children less than 10 years old and 97% of those exposures per year were unintentional. In addition, the most common exposure site was the patient’s own residence. Over-exposure to disinfectants and hand sanitizers can cause symptoms such as burning and irritation of the eyes, nose, and throat, coughing, chest tightness, headache, choking, and, in severe cases, death.

Fat graft myringoplasty: A clinical study and review of literature

Objectives: There are numerous surgical techniques that have been demonstrated and utilized to repair small perforations in the tympanic membrane (TM) with various graft materials such as veins, perichondrium, periosteum, and others. In our study, fat was taken as the graft material and the main aim of the study was to evaluate the success rate of graft uptake, assessment of hearing improvement, and complications of the operative procedure. Material and Methods: In this single-center study, 46 patients underwent fat myringoplasty, 52 ears were operated from October 2016 to September 2017 for a period of 1 year. A detailed history, general physical, and a through ear, nose, and throat examination were done. Audiometric assessment was done using pure tone audiometry. Patients between the age group of 15 and 50 years were included in the study. Results: A total of 46 patients were included in the study who met the inclusion criteria. Six patients had bilateral perforations and 40 patients had unilateral perforation, a total of 52 perforations were operated. Forty-three (82.69%) patients had successful graft uptake and graft failure was seen in 9 (17.30%) patients. Maximum gain in hearing was seen in in patients with hearing loss between 20 and 30 dB, that is, 24 patients (46.1%). Conclusion: Fat myringoplasty is a methodized, precise, inexpensive, mini-invasive, and cosmetic outpatient procedure for small perforations of TM. It can be done under local anesthesia and has a good success rate if the patient selection is done appropriately.