Clinical usefulness of transcutaneous laryngeal ultrasonography in otolaryngology practice during COVID-19 pandemic: a literature review.

As a consequence of the outbreak of SARS-CoV-2, the clinical practice of otolaryngologists underwent profound transformations. Non-aerosol-generating procedures have been researched and implemented. Transcutaneous laryngeal ultrasonography (TLUSG) provides a rapid and noninvasive method to assess laryngeal function and can support the management of laryngeal disorders. With the aim of investigating the clinical usefulness of TLUSG in otolaryngology practice, a review of the literature published on PubMed, Cochrane Library and Ovid/ Medline databases was performed up to March 2022. 38 studies were eligible to be included in the review. The selected papers were divided into six topics of interest: evaluation of vocal cords function, diagnosis of laryngeal disorders in infants and children, evaluation of swallowing disorders, assessment of laryngeal cancer and other laryngeal lesions, ultrasound-guided cricothyroidotomy, ultrasound-guided laryngeal electromyography. The results of this review demonstrated that TLUSG, applied to ENT practice, can be a valid method for dynamic laryngeal assessment and airway management, since it is time-efficient, non invasive, well tolerated and easily performed.

The Impact of the COVID-19 Lockdown on Quality of Life in Adult Cochlear Implant Users: A Survey Study.

BACKGROUND: The COVID-19 pandemic rapidly spread through Europe in the first months of 2020. On the 9th of March 2020, the Italian government ordered a national lock-down. The study's objectives were: to investigate the effect of lockdown on CI users; and to detect the difference in the perception of discomfort existing between unilateral cochlear implant (UCI) users and bilateral cochlear implant (BCI) users, due to the lockdown experience. METHODS: A 17-item, web-based, anonymous online survey was administered to 57 CI users, exploring hearing performance, emotions, practical issues, behavior, and tinnitus. Participation in the study was voluntary. RESULTS: all CI users obtained an abnormal score in all questionnaire themes. For the emotion theme and the practical issue theme, the age range 61-90 showed a significant difference between UCI and BCI users in favor of BCI users (emotion theme: UCI mean = 3.9, BCI mean = 2.3, p = 0.0138; practical issues: UCI mean = 4, BCI mean = 3, p = 0.0031). CONCLUSIONS: CI users experienced the lockdown negatively as regards behavior, emotions, hearing performance, and in practical issues. CI subjects with UCI in old age suffered more from the experience of lockdown than subjects with BCI in the same age, with regards to emotions and practical issues.

Effectiveness of SARS-CoV-2 Vaccines for Short- and Long-Term Immunity: A General Overview for the Pandemic Contrast.

BACKGROUND: The recent COVID-19 pandemic produced a significant increase in cases and an emergency state was induced worldwide. The current knowledge about the COVID-19 disease concerning diagnoses, patient tracking, the treatment protocol, and vaccines provides a consistent contribution for the primary prevention of the viral infection and decreasing the severity of the SARS-CoV-2 disease. The aim of the present investigation was to produce a general overview about the current findings for the COVID-19 disease, SARS-CoV-2 interaction mechanisms with the host, therapies and vaccines' immunization findings. METHODS: A literature overview was produced in order to evaluate the state-of-art in SARS-CoV-2 diagnoses, prognoses, therapies, and prevention. RESULTS: Concerning to the interaction mechanisms with the host, the virus binds to target with its Spike proteins on its surface and uses it as an anchor. The Spike protein targets the ACE2 cell receptor and enters into the cells by using a special enzyme (TMPRSS2). Once the virion is quietly accommodated, it releases its RNA. Proteins and RNA are used in the Golgi apparatus to produce more viruses that are released. Concerning the therapies, different protocols have been developed in observance of the disease severity and comorbidity with a consistent reduction in the mortality rate. Currently, different vaccines are currently in phase IV but a remarkable difference in efficiency has been detected concerning the more recent SARS-CoV-2 variants. CONCLUSIONS: Among the many questions in this pandemic state, the one that recurs most is knowing why some people become more seriously ill than others who instead contract the infection as if it was a trivial flu. More studies are necessary to investigate the efficiency of the treatment protocols and vaccines for the more recent detected SARS-CoV-2 variant.

Cavernous Sinus Involvement and Near Miss Mediastinitis following Mandibular Tooth Infection Treated during the COVID-19 Pandemic: Clinical Diagnosis and Treatment.

Odontogenic infections represent a frequent condition that in some cases, if not treated promptly, can spread quickly to the rest of the body and turn into life-threatening infections. In this work, the case is reported of a 59-year-old woman, diabetic and overweight, who presented to the Odontostomatology and Otolaryngology Section of the Policlinic of Bari with mandibular tooth infection that had developed into a deep neck space infection leading to the involvement of cavernous sinuses and near mediastinum. The diagnosis, the surgical drainage of the phlegmon and removal of infection foci, appropriate control of the airways, and a correct antibiotic therapy made it possible to avoid a potentially fatal condition. Prompt management and early diagnosis of deep space neck infections, such as phlegmon and/or necrotizing fasciitis, with the auxilium of CT scans and tools such as LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis), NLR (Neutrophil-to-Lymphocyte Ratio), and LRINECxNLR scores (Laboratory Risk Indicator for Necrotizing Fasciitis and Neutrophil to Lymphocyte Ratio), are advised to evade delays and complications that could potentially worsen the patient's outcome.

COVID-19 lockdown and seasonal allergic rhinitis: our experience in 40 patients.

INTRODUCTION: The aim of this article was to study the course of seasonal allergic rhinitis during COVID-19 lockdown in order to understand if being quarantined at home for a long time can constitute a protective factor for allergic patients. MATERIALS AND METHODS: Telehealth consultations were performed by the departments of Otolaryngology of Foggia and Bari University Hospitals. Participants took part in a phone interview and were asked about their sinonasal symptoms during the COVID-19 lockdown, by answering the sinonasal outcome test (I-SNOT-22) questionnaire. Further data concerning the medications used to treat allergy and the number of days per month in which they were used were collected. The responses about the COVID-19 lockdown were compared to those obtained by the same patients in our clinics the previous year. The statistical analysis was executed by using the paired sample t-test and the Bartlett test considering as significant values with p values <0.05. RESULTS: Forty patients affected by cypress pollen allergy visited at Foggia and Bari University Hospitals were enrolled in this study. All I-SNOT-22 scores concerning the COVID-19 lockdown were lower than those of the previous year; moreover, 18 (81.8%) clinical parameters were statistically significant (p<0.05). Also, in regard to the treatment, results about COVID-19 lockdown were overall better than those of 2019, with 50% (n=3) of the investigated drugs, reporting statistical significance (p<0.05). CONCLUSIONS: The present study was able to evidence the fundamental role of primary prevention in Allergology. Paradoxically, the home quarantine ordered by the Italian Government appeared to be an effective measure not only in the fight against COVID-19 but also against pollen exposure.

Voice Differences When Wearing and Not Wearing a Surgical Mask.

OBJECTIVE: The purpose of our study was to investigate the impact of surgical mask on some vocal parameters such as F0, vocal intensity, jitter, shimmer and harmonics-to-noise ratio in order to understand how surgical mask can affect voice and verbal communication in adults. METHODS: The study was carried out on a selected group of 60 healthy subjects. All subjects were trained to voice a vocal sample of a sustained /a/, at a conversational voice intensity for the Maximum Phonation Time (MPT), wearing the surgical mask and then without wearing the surgical mask. Voice samples were recorded directly in Praat. RESULTS: There were no statistically significant differences in any acoustic parameter between the masked and unmasked condition. There was a non-significant decrease in vocal intensity in 65% of the subjects while wearing a surgical mask. CONCLUSIONS: The statistical comparison carried out between all the acoustic voice parameters observed, extracted wearing and not wearing a surgical mask did not reveal any significant statistical difference. Most of the subjects, after wearing the surgical mask, presented a decrease in vocal intensity measured. Our conclusion was that wearing a mask is likely to induce the unconscious need to increase the vocal effort, resulting over time in a greater risk of developing functional dysphonia. The reduction of intensity can affect also social interaction and speech audibility, especially for individuals with hearing loss.

ENT surgical emergencies during the COVID-19 outbreak.

INTRODUCTION: The restrictive measures adopted by the Italian Government during the COVID-19 outbreak caused dramatic changes in routine public health care. Surprisingly, emergency activity also registered a reduction in frequency. METHODS: This multicentre retrospective study aims to investigate eventual changes in ENT surgical emergencies in a highly populated area of southern Italy during the COVID-19 pandemic. Data concerning the period between the February 1 and the May 31, 2020 were collected from the main three hospitals in the district and compared with the same period of 2019. RESULTS: A substantial reduction was found in the number of ENT emergency interventions in 2020 compared to the same period of 2019, particularly in the main lockdown phase and in the tertiary referral centre. CONCLUSIONS: The reduction in the absolute number of emergency ENT interventions can be only partially explained by social distancing and home confinement. We have reason to believe that some of these patients may have not sought medical support due to fear of nosocomial SARS-CoV2 infection. This study could represent a trigger for further implementation of health system responses to emergencies in a period of transition that is likely to last for a prolonged period of time.

Acoustic voice analysis in the COVID-19 era.

OBJECTIVE: Among the different procedures used by the ENT, acoustic analysis of voice has become widely used for correct diagnosis of dysphonia. The instrumental measurements of acoustic parameters were limited during the COVID-19 pandemic by the common belief that a face mask affects the results of the analysis. The purpose of our study was to investigate the impact of surgical masks on F0, jitter, shimmer and harmonics-to-noise ratio (HNR) in adults. METHODS: The study was carried out on a selected group of 50 healthy subjects. Voice samples were recorded directly in Praat. All subjects were trained to voice a vocal sample of a sustained /a/, at a conversational voice intensity, with no intensity or frequency variation, for the Maximum Phonation Time (MPT), wearing the surgical mask and then without wearing the surgical mask. RESULTS: None of the variations in acoustic voice analysis detected wearing a surgical mask and not wearing a surgical mask were statistically significant. CONCLUSIONS: Our study demonstrates that the acoustic voice analysis procedure can continue to be performed with the use of a surgical mask for the patient, even during the COVID-19 pandemic.

Transcutaneous laryngeal ultrasonography: A promising tool for otolaryngologists during COVID-19.

PURPOSE: With the current COVID-19 outbreak, otolaryngologists are most exposed to the risk of infection due to the nature of the specialty.This is why they are required to find safer diagnostic alternatives minimizing aerosol-generating procedures. The aim of this study is to explore the accuracy of transcutaneous laryngeal ultrasonography (TLUSG) in order to assess vocal fold movement. MATERIALS AND METHODS: We performed blindly both TLUSG and flexible fiberoptic laryngoscopy(FFL) on 38 patients, from March to June 2020. Patients were divided into two groups:the former with normally mobile vocal folds and the latter with unilateral vocal fold paralysis. RESULTS: On FFL findings, 10/38 patients (26,31%) had unilateral vocal fold paralysis; on TLUSG results, 9/38 patients (23.68%) presented impaired vocal fold motion. In comparison to laryngoscopy, the sensitivity, specificity, positive predictive value and negative predictive value of TLUSG for assessment of vocal fold mobility was 80%, 96.42%, 88.88%, 93.10% respectively. A significant association between the two techniques was found on the Chi-square test: X2 = 19.7722 (p value <0.00001). Cohen's K value showed a substantial agreement: K = 0,79. CONCLUSION: Although TLUSG could undoubtedly not replace laringoscopy, it represents a noninvasive and useful diagnostic tool for otolaryngologists especially during covid-19 pandemic.Data collected about its high sensitivity and specificity suggest that TLUSG could be a reliable method to screen vocal fold paralysis without performing aerosol-generating procedures, thus providing clear visualization of laryngeal real-time movements, even in non-compliant or high-risk infection patients. Our results allow us to consider TLUSG as part of the preoperative assessment of vocal folds in patients undergoing thyroidectomy.

Gaining Back What Is Lost: Recovering the Sense of Smell in Mild to Moderate Patients After COVID-19.

The purpose of our cohort study was to quantify olfactory deficits in Coronavirus disease 2019 (COVID-19) patients using Sniffin' Sticks and a pre-post design to evaluate olfactory recovery. Thirty adult patients with laboratory-confirmed mild to moderate forms of COVID-19 underwent a quantitative olfactory test performed with the Sniffin' Sticks test (SST; Burghardt, Wedel, Germany), considering olfactory threshold (T), odor discrimination (D), and odor identification (I). Results were presented as a composite TDI score (range 1-48) that used to define functional anosmia (TDI ≤ 16.5), hyposmia (16.5 < TDI < 30.5), or functionally normal ability to smell (TDI ≥ 30.5). Patients also self-evaluated their olfactory function by rating their ability to smell on a visual analogue scale (Visual Analog Scale rating) and answering a validated Italian questionnaire (Hyposmia Rating Scale). Patients were tested during hospitalization and about 2 months after symptoms onset. During the hospitalization, the overall TDI score indicated that our cohort had impairments in their olfactory ability (10% was diagnosed with anosmia and more than 50% were hyposmic). Almost all patients showed a significant improvement at around 1 month following the first test and for all the parts of the SST except for odor identification. None of the subjects at 1 month was still diagnosed with anosmia. We also quantified the improvement in the TDI score based on initial diagnosis. Anosmic subjects showed a greater improvement than hyposmic and normosmic subjects. In conclusion, within a month time window and 2 months after symptoms' onset, in our cohort of patients we observed a substantial improvement in the olfactory abilities.

COVID-19: When dust mites and lockdown create the perfect storm.

The aim of the present study was to understand if the course of the disease of patients suffering from dust mite allergy could have been negatively affected by the COVID-19 restrictions, which have been certainly important to fight the pandemic, but forced patients to stay at home for a long time.