A review of smell and taste dysfunction in COVID-19 patients

@#and taste loss were early subclinical symptoms of COVID-19patients. The objective of this review was to identify theincidence of smell and taste dysfunction in COVID-19,determine the onset of their symptoms and the risk factorsof anosmia, hyposmia, ageusia or dysgeusia for COVID-19infection.Methods: We searched the PubMed and Google Scholar on15th May 2020, with search terms including SARS-COV-2,coronavirus, COVID-19, hyposmia, anosmia, ageusia anddysgeusia. The articles included were cross sectionalstudies, observational studies and retrospective orprospective audits, letters to editor and shortcommunications that included a study of a cohort ofpatients. Case reports, case-series and interventionalstudies were excluded. Discussion: A total of 16 studies were selected. Incidence ofsmell and taste dysfunction was higher in Europe (34 to86%), North America (19 to 71%) and the Middle East (36 to98%) when compared to the Asian cohorts (11 to 15%) inCOVID-19 positive patients. Incidence of smell and tastedysfunction in COVID-19 negative patients was low incomparison (12 to 27%). Total incidence of smell and tastedysfunction from COVID-19 positive and negative patientsfrom seven studies was 20% and 10% respectively.Symptoms may appear just before, concomitantly, orimmediately after the onset of the usual symptoms. Occurspredominantly in females. When occurring immediately afterthe onset of the usual symptoms, the median time of onsetwas 3.3 to 4.4 days. Symptoms persist for a period of sevento 14 days. Patients with smell and taste dysfunction werereported to have a six to ten-fold odds of having COVID-19.Conclusion: Smell and taste dysfunction has a highincidence in Europe, North America, and the Middle East.The incidence was lower in the Asia region. It is a strong riskfactor for COVID-19. It may be the only symptom and shouldbe added to the list of symptoms when screening for COVID-19.KEYW

Five cases of iatrogenic cerebrospinal fluid (CSF) rhinorrhoea: Early management is crucial

Endoscopic sinus surgery (ESS) is a standard treatment forrhinosinusitis, which failed optimum medical therapy.Iatrogenic cerebrospinal fluid (CSF) rhinorrhoea can occurduring ESS warrants early repair of the leakage. Thecommon sites for CSF leakage are cribriform plate, foveaethmoidalis, and anterior ethmoid sinuses. We present fivecases of iatrogenic CSF rhinorrhoea due to ESS and itsmanagement.

Quality of life and recurrence of disease in patients with eosinophilic and non-eosinophilic chronic rhinosinusitis with nasal polyposis

Objective: To assess the quality of life (QoL) and recurrenceof disease in patients with eosinophilic (ECRSwNP) andnon-eosinophilic chronic rhinosinusitis with nasal polyposis(non-ECRSwNP) post endoscopic sinus surgery (ESS).Methodology: A cross-sectional comparative study wascarried out in the Otorhinolaryngology – HNS Department,Universiti Kebangsaan Malaysia Medical Center (UKMMC).Subjective assessments of nasal symptoms and quality oflife (QoL) using SNOT-22 and Visual Analogue Scale (VAS)and objective endoscopic assessment was undertakenusing a modified Hadley endoscopic examination.Results: There was no significant statistical difference in thequality of life between the ECRSwNP and non-ECRSwNPgroups as evidenced by the SNOT-22 score and the VAScomparison (p>0.05). However, there was a significantdifference in terms of recurrence of disease with thepresence of nasal polyps on endoscopic examination. (p =0.016)Conclusion: In conclusion, we found that there is nosignificant difference in QoL between ECRSwNP and nonECRSwNP.There is higher frequency of recurrence of nasalpolyps amongst ECRSwNP.

Follicular thyroid cancer with sternal metastasis - challenges and outcomes

Sternal metastasis from differentiated thyroid carcinoma (DTC) is rare and presents a conundrum for surgeons. We present a lady diagnosed with follicular thyroid carcinoma and sternal metastasis who underwent thyroidectomy, sternectomy and sternoplasty with titanium mesh and acrylic plate. She developed a surgical site infection, of which multiple conservative approaches were attempted. She eventually required removal of the implant. Closure of sternal defect was completed with bilateral pectoralis major advancement flaps. This article highlights a series of complications faced during the course of treatment and how they were managed in a tertiary healthcare centre.

Caring for the dying in a developing country, how prepared are we?

End of life care is framework to allow for a peaceful, comfortable and dignified death while considering the patients’ personal and religious values, bioethics and knowledge of the disease process. A well planned end of life pathway should allow for the flexibility to shift from an active (or aggressive) treatment approach to one of comfort and care when initial interventions have failed. The need for this pathway is most apparent in the intensive care setting. Implementation of a pathway will face various challenges due to religious and cultural beliefs, education of healthcare providers to carry out difficult discussions and larger socioeconomic implications. Clear medico-legal framework will be required to support this pathway. In conclusion, an end of life pathway tailored to our local needs is the way forward in allowing for dignified death of terminally ill patients; this will require the active participation of medical societies, religious leaders, healthcare providers, patients and their care givers.

Pansinusitis with subdural empyema in an adult: a rare entity

We report a case of an elderly diabetic woman who presented to emergency department with sudden right sided body weakness. On imaging she had subdural empyema complicating acute rhinosinusitis. Evacuation of emphysema and endoscopic sinus surgery resulted in full neurological recovery. Clinician must have a high index of suspicion of possible intracranial suppurative complication as its often manifest as nonspecific clinical presentation in elderly diabetic patients with acute rhinosinusitis, despite improvements in antibiotic therapies

Fungal sinusitis in immunocompetent patient: a case report

We present a case of fungal sinusitis which occur in an immunocompetent patient and responded well with sinus clearance under clinic setting. Early diagnosis is essential in order to avoid high morbidity and mortality associated with the destructive disease and to initiate treatment before irreversible condition arise. It is necessary to distinguish the invasive disease from the non-invasive as the treatment and prognosis are different in each

Respiratory epithelial adenomatoid hamartoma of the nasal septum

Objective@#Hamartomas are relatively uncommon, non-neoplastic malformations indigenous to the involved anatomic site. Respiratory epithelial adenomatoid hamartoma (REAH) is a subset of hamartoma characterized by prominent glandular proliferation lined by ciliated epithelium originating from the surface epithelium. Their location in the nasal cavity is rare and when present, mostly associated with the posterior nasal septum. We present such a case arising from the anterior nasal septum. @*Methods@#Design: Case report Setting: Tertiary University Referral Center Patient: One @*Results@#A 32-year-old lady who presented with a long-standing nasal block was found to have a broad-based nasal mass arising from the left anterior nasal septum. The lesion was histologically diagnosed as respiratory epithelial adenomatoid hamartoma following surgical excision. @*Conclusion@#Respiratory epithelial adenomatoid hamartoma although rare must be taken into consideration in the differential diagnosis of nasal lesions.

Nonkeratinizing carcinoma of the sinonasal tract: A diagnosis of confusing nomenclature

@#<p style="text-align: justify;"><strong>OBJECTIVE</strong>: To describe a rare case of nonkeratinizing carcinoma of the sinonasal tract and review the literature on the nomenclature of its many synonyms.<br /><br /><strong>METHODS</strong>: <br /><strong>Design</strong>: Case Report<br /><strong>Setting</strong>: Tertiary Referral Center<br /><strong>Patient</strong>: One<br /><br /><strong>RESULTS</strong>: A 45-year-old female presented with a 6-month history of left nasal obstruction associated with epistaxis. Computed tomography revealed a mass expanding the left nasal cavity with the epicenter arising from the anterior ethmoidal air cells. Endoscopic resection of the tumor was carried out but as there was residual tumor, she then underwent endoscopic-assisted medial maxillectomy via a lateral rhinotomy. A subsequent computed tomography scan showed residual tumor adhering to the ipsilateral periorbita. The patient has so far declined intensity modulated radiotherapy that was advised though she is still under regular follow-up.<br /><br /><strong>CONCLUSION</strong>: Nonkeratinizing carcinoma of the sinonasal tract is a rare entity and there are very few reports concerning this type of malignancy. This may be partly due to its many synonyms, such as cylindrical cell carcinoma, Schneiderian carcinoma and transitional cell carcinoma. Nomenclature of this tumor should be standardized to avoid confusion and misdocumentation.</p>

Tube extrusion and cheese wiring five years post dacryocystorhinostomy

@#<p style="text-align: justify;"><strong>OBJECTIVE</strong>: Dacrocystorhinostomy (DCR) with silicone tube stenting is a common procedure for congenital nasolacrimal duct obstruction (NLDO). The incidence of congenital NLDO is about 6% in the newborn. The duration the tube is left in place varies depending on surgeon preference. Cheese wiring is one of the tube-related complications when the tube is left behind for a long duration. The term cheese wiring refers to the silicone stent or tubing cutting through soft tissue close to the punctum or canaliculi like wire cuts through cheese. We present a case of tube extrusion with cheese wiring five years post DCR.</p> <p style="text-align: justify;"><strong>METHODS</strong>:<br /><strong>Design</strong>: Case report <br /><strong>Setting</strong>: Tertiary Referral Center<br /><strong>Patient</strong>: One</p> <p style="text-align: justify;"><strong>RESULTS</strong>: A 16-year-old Indian male with congenital bilateral NLDO underwent right and left DCR at ages 9 and 11, respectively. The patient presented with smelly nasal discharge five years later to the ENT clinic. On initial examination the right tube was in place but the left tube was not visualized. Nasal endoscopy however revealed that both tubes were still there and were subsequently removed.</p> <p style="text-align: justify;"><strong>CONCLUSION</strong>: DCR with silicone intubation is a common practice. Early follow up is essential to prevent complications. If tube extrusion is suspected, early endoscopic examination is essential to confirm it.</p>

Endonasal Endoscopic Transsphenoidal Pituitary Surgery for Pituitary Adenoma: A retrospective Analysis Of Surgical Outcome

The purpose of this retrospective joint rhino-neurosurgical study from January 1998 until September 2009 is to document the demographic data, clinical presentations, radiological findings, approaches and incidence of residual tumour. Forty-seven patients with pituitary adenoma underwent trans-sphenoidal hypophysectomy of which 25 patients with complete medical and radiological data were included in the study. The medical and radiological data were analyzed. There were 12 males and 13 females with age ranging from 17 to 76 years old (mean 49.2). Fourteen of the patients were Chinese, eight Malays and three Indians. Twelve of the patients had functioning tumour of which five each presented with acromegaly and Cushing disease respectively and two with amenorrhoea. The rest of 13 patients had non functioning tumour presenting with visual disturbances. Sixteen of the patients had pituitary macroadenomas and the rest 9 microadenomas. Eighteen patients had undergone transcollumellar trans-sphenoidal hypophysectomy and the rest 7 patients had undergone transnasal transsphenoidal hypophysectomy. About 68.8% of pituitary macroadenomas had residual tumour, compared to only 22.2% of patient with pituitary microadenomas. Radiologically, about 45.5% of residual macroadenoma had suprasellar extension and the majority had spread to suprasellar cistern and carvenous sinus (54.5%). About 16.6% of patients had undergone post operative radiotherapy. In conclusion, this study showed that patient with pituitary macroadenomas had higher incidence of residual tumour compared to pituitary microadenomas

Sensitisation to common allergens in children with allergic rhinitis

Introduction: Allergic rhinitis is common in otorhinolaryngology practice. According to ‘Allergy Rhinitis and its Impact on Asthma (ARIA), Clinical and Experimental Allergy Reviews’ guidelines, the management of allergic rhinitis includes allergen avoidance. Therefore, it is important to know the allergens to which the patient is sensitised. This study was carried out to determine the prevalence of sensitisation to common allergens among children with allergic rhinitis seen in a tertiary referral centre in Malaysia. Materials and Methods: All children aged five to 12 years who had been referred to Otorhinolaryngology clinic Universiti Kebangsaan Malaysia Medical Center (UKMMC) from 2005 to 2010 with symptoms consistent with allergic rhinitis and had a skin prick test (SPT) were included in the study. The common allergens that had been used in the SPT were aeroallergens, food allergens and contact allergens. The database of SPT results was collected and reviewed. Results: A total number of 580 children were included in this study with 69.3% showing positive SPT. From the positive SPT results, a total of 1,515 sensitisations were observed with 60.9% sensitised to aeroallergens, 38.6% sensitised to food allergens and 0.6% sensitised to contact allergens. Among the aeroallergens, the house dust mite accounted for more than half of the sensitisations: Dermatophagoides pteronyssinus (27.9%), Dermatophagoides farinae (26.4%), Blomia tropicalis (26.0%). The most common food allergen sensitisation was seafood – crab (18.5%), prawn (18.0%) and squid (8.7%). Each of the other food allergens tested accounted for less than five percent of the positive SPT result. The contact allergen tested in this study was latex. Conclusion: This data represents a common allergen sensitisation in children with rhinitis symptoms residing in urban areas with house dust mites being the most common allergen sensitised in these children.

Septal turbinates: An entity with physiological importance

Septal turbinate refers to a widened region of the septum located superior to the inferior turbinates and anterior to the middle turbinates. Although a common anatomical variant, its significance is not well reported. We report a 56-year-old Malay man who presented with a three year history of chronic nasal obstruction secondary to septal turbinate and type II deviated nasal septum. His nasal symptoms improved dramatically following commencement of intranasal steroids. He remained free of symptoms during seven years of follow up. The physiologic implication and management of septal turbinates is discussed.

Extramedullary plasmacytoma of the nasopharynx: A rare tumour with 7-year follow up

Objective@#To report a case of extramedullary plasmacytoma, a rare localized tumour involving the head and neck region in a 56-year -old gentleman.@*Methods@#Design: Case Report Setting: Tertiary University Referral Center Patient: One @*Result@#The patient presented with a 5-month history of right-sided nasal obstruction and intermittent epistaxis in 2003. Nasal endoscopy revealed a friable, dark red mass arising from the roof of the nasopharynx, occluding the right choana. No invasion of adjacent tissues or cervical lymphadenopathy was evident. A biopsy of the mass was diagnosed as plasmacytoma. Serum and urine electrophoresis failed to detect any monoclonal bands. All other screening tests to rule out multiple myeloma were negative. These findings confirmed the diagnosis of extramedullary plasmacytoma. He recieved radiotherapy to the nasopharynx of 50 Gy for a total of 23 fractions. No recurrence was noted at 7-year follow-up.@*Conclusion@#Extramedullary plasmacytoma of the nasopharynx represents a tumour with good prognosis but requires long term follow up in anticipation of local recurrence and progression to Multiple Myeloma.