Late Recurrence of a Rare Middle Ear Neuroendocrine Tumor With an Intracranial Extension to the Temporal Fossa: A Case Report.

We report a clinical case of an extremely rare neuroendocrine tumor of the right middle ear (MeNET) that recurred after 13 years with a local extension into the right temporal fossa. In the current medical literature, there are approximately 150 cases of MeNETs and even fewer cases with more than 10 years of follow-up, recurrence, and intracranial tumor progression. Therefore, we believe that this paper can make an important contribution to the existing and future knowledge about this disease. The purpose of this article is to present our experience in treating such a rare neoplasm in a 35-year-old woman. The patient initially complained of worsening hearing in her right ear over the past year. The final diagnosis was made based on the findings of computed tomography (CT), magnetic resonance imaging (MRI), and histological and immunohistochemical evaluation of excisional biopsies of the original and recurrent tumors. The primary tumor masses were removed with clear resection margins, and the ossicular chain was reconstructed. The patient has been monitored clinically and radiologically with temporal bone CTs every year and MRIs three times in general since then. A postoperative audiogram showed remaining mixed hearing loss in the right ear that eventually worsened as the tumor grew. Tumor recurrence and progression after 156 months (13 years) were seen on CT and MRI, requiring further treatment. After resection of the recurrent tumor, paresis of the right facial nerve developed, which was treated with dexamethasone. The surgical treatment caused the initial symptoms to disappear, but the facial nerve paresis persisted with mild functional improvement. The patient is not receiving adjuvant radiotherapy and is being monitored closely because the tumor may recur in the future.

The Use of Tele Practice in Assessment of Middle Ear Function in Adults Living with HIV During the COVID-19 Pandemic.

Coronavirus disease (COVID-19) pandemic is the latest threat to global health that causes severe acute respiratory syndrome (SARS). Tele-practice has inadvertently sprung to the forefront to become a common practice amongst healthcare providers during COVID-19. Limited evidence exists on the use of tele-practice in assessing middle ear function in adults living with HIV during the COVID-19 pandemic. The aims of this study were to investigate the use of tele-practice for assessment of middle ear function in adults with HIV during the COVID-19 pandemic. A quantitative observational, cross-sectional design was adopted. A total of 134 adults diagnosed with HIV were purposively selected from the HIV clinic. An audiology researcher, in the role of site-facilitator, captured video otoscopic images of the tympanic membrane using a video otoscopy for all participants through asynchronous tele-practice. All captured images were sent to two independent otorhinolaryngologists for diagnosis. Findings of this study indicated that tele-practice can be used to assess middle ear function in adults living with HIV during COVID-19 pandemic. When asynchronous tele-practice was used, there was a moderate diagnostic agreement (k = 0.58) between the two otorhinolaryngologists on abnormality versus normality, but poor agreement (k = 0.15) on the nature of abnormality (e.g. OME vs CSOM). Current findings highlight the urgent need for a widespread use of tele-practice during the continued clinical follow up and management of adults living with HIV, and the implementation of tele-practice, particularly in low- and middle-income countries (LMICs) where capacity versus demand challenges related to ear and hearing care continue to exists.

Effusion Prevalence at Tympanostomy During COVID-19: Follow-Up.

OBJECTIVE: We previously reported pandemic year (2020) intraoperative middle ear effusion (MEE) rate at time of bilateral myringotomy tube (BMT) placement was 18% lower compared to pre-pandemic year (2019). After mandatory stay at home orders (MSHO) and pandemic social distancing precautions were relaxed, we aimed to assess the impact of a persistent pandemic with new COVID-19 variants on MEE presence during BMT. METHODS: This study is a retrospective chart summary exempted by Nemours institutional review board at a single tertiary children's hospital. Children < 18 years who underwent BMT during March 1, 2019-June 31, 2019 (pre-COVID), March 1, 2020-June 31, 2020 (PY1), and March 1, 2021-June 31, 2021 (PY2) were included. Statistical analysis included chi-squared and KruskalWallis. RESULTS: A total of 1069 BMTs were reviewed: 551 (52%) during pre-COVID, 227 (21%) during PY1, and 291 (27%) during PY2. There were no significant differences in age, sex, or BMI across comparison groups. Intraoperative MEE was significantly higher pre-COVID (83%) compared to PY1 (65%) and PY2 (69%) (P < .001) despite a small rebound in PY2. CONCLUSION: Intraoperative MEE remains lower in subsequent pandemic years despite relaxed public health measures and may be impacted by persistent public health measures like masking, lower return to daycare, variable social distancing, and/or change to access to health care.

Prenatal COVID-19 Infection Does Not Increase the Risk of Congenital Hearing Loss

Introduction: The global pandemic caused by the novel coronavirus (SARS-CoV-2), commonly known as COVID-19, has had profound effects at every level of society. Other known viral illnesses during pregnancy, such as cytomegalovirus, can affect the developing fetus and cause congenital hearing loss. The long-term effects of COVID-19, including the risk of congenital hearing loss, are not currently established. Method(s): A retrospective cohort study was performed at a quaternary care facility. Sixty-four consecutive patients with a COVID-19 infection during pregnancy were identified. Charts were reviewed for trimester of positive COVID-19 test, maternal and neonatal comorbidities, symptomatology, vaccination status, and results of newborn screening and follow-up hearing testing, if performed. Result(s): Sixty-four women with positive COVID-19 test during pregnancy (6 in second trimester, 59 in third trimester) were identified. Most (n=54, 84.4%) patients were asymptomatic at time of positive test and 29.7% (n=19) had received at least 1 dose of a COVID-19 vaccine. Newborn hearing screening was performed in 58 patients (90.6%). Failed initial screening occurred in 3 (5.2%) right ears and 4 (7.0%) left ears. Two patients passed on repeat screening, and the remaining 1 patient was found to have a mild conductive hearing loss in the right and middle ear dysfunction on the left. Conclusion(s): This study demonstrates no significant increased risk of congenital hearing loss in prenatal COVID-19 infection. Additional investigation into timing of infection and effect of vaccination status will be performed to provide guidance to women navigating pregnancy during the pandemic.

RESTING TREMOR AFTER COVID-19 INFECTION

CASE: The patient is a 66 year-old woman with history of hypertension and recovered COVID-19 presenting to the outpatient clinic for eight months of persistent resting tremor of her left arm. The tremor started shortly after she developed headache, fatigue, and epistaxis found to have COVID-19. The tremor is mild, occurs multiple times throughout the day, and usually resolves spontaneously after several seconds. The patient denies any paresthesias, muscle weakness, motor slowing, or ataxia. She has no family history of Parkinson's disease or essential tremor. On physical exam, vital signs are normal. Motor strength is 5/5 and sensation is intact throughout. Brachioradialis deep tendon reflex is 1/4 bilaterally though slightly increased on the right side. Cranial nerves II through XII are intact. Gait is normal with no evidence of shuffling. No pronator drift is evident. No cogwheel rigidity is noted. Finger-to-nose motion is normal. Throughout the appointment, the patient is noted to have an intermittent mild resting tremor in her left arm that lasts several seconds and resolves spontaneously. Laboratory results including a basic metabolic panel and thyroid stimulating hormone level are normal. Incidentally, the patient underwent a recent brain MRI for chronic sensorineural hearing loss that showed normal appearance of the internal auditory canals/ middle ear structures and no evidence of intracranial pathology. The patient was subsequently started on daily propranolol. A subsequent telemedicine visit one month later revealed that her resting tremor had nearly resolved. IMPACT/DISCUSSION: The outpatient presentation of resting tremor warrants consideration of a broad differential that includes Parkinson's disease and other causes of parkinsonism, including neurodegenerative diseases and essential tremor, among others. Furthermore, previous studies have demonstrated new onset movement disorders associated with COVID-19 including myoclonus, ataxia, action/postural tremor, catatonia, dystonia, chorea, and functional movement disorders. The exact pathophysiology of COVID-19 related movement disorders is not well understood. Of note, these prior studies did not specifically address evaluation of COVID-19 related movement disorders in the outpatient setting. CONCLUSION: The patient described above likely developed new onset left arm tremor secondary to COVID-19. Her reassuring physical exam findings, laboratory results, and head MRI suggest against other etiologies. The patient was successfully treated with propranolol. This case demonstrates the importance of neurologic assessment in the outpatient setting, particular in patients with a history of COVID-19 diagnosis. Though limited data exists on outpatient evaluation and management of movement disorders secondary to COVID-19, it is important to recognize this phenomenon as a potential diagnosis.

Middle ear status - structure, function and pathology: A scoping review on middle ear status of COVID-19 positive patients.

BACKGROUND:  The coronavirus disease 2019 (COVID-19) pandemic is the latest public health emergency that has presented challenges globally. Limited evidence exists on the association between COVID-19 and middle ear pathologies, regardless of the respiratory nature of some of the core symptoms. OBJECTIVE:  This scoping review aimed at exploring evidence on the effects of COVID-19 on middle ear functioning as part of symptom mapping and preventive planning for ear and hearing care. METHOD:  Electronic bibliographic databases, including Medline, ProQuest, PubMed, Science Direct, ERIC and Scopus, were searched to identify peer reviewed publications, published in English, between December 2019 and January 2022, related to the effects of COVID-19 on middle ear functioning. The keywords used as MeSH terms included 'middle ear pathology', 'middle ear disorder', 'otitis media', 'hearing loss', 'hearing impairment', 'audiology' and 'COVID-19' or 'coronavirus'. RESULTS:  From eight studies that met the inclusion criteria, the findings revealed that middle ear pathologies occur in this population, with the occurrence ranging from 1.15% to 75%. Tympanic membrane structural changes, otitis media and conductive hearing loss (CHL) were commonly reported. The current findings must be interpreted with caution given that most of the studies reviewed had extremely small sample sizes or were case studies or series, thus limiting generalisability. CONCLUSION:  The findings highlight the value of strategic research planning to collate data during pandemics, ensuring that future studies use appropriate and well-designed methodologies. Trends and patterns of middle ear pathologies in this population must also be established to determine the need for periodic monitoring.

COVID-19-Associated Middle Ear Myoclonus in a 10-Year-Old Male.

Middle ear myoclonus is a rare condition attributed to abnormal, repetitive contractions of the middle ear muscles including the tensor tympani and/or stapedius muscles. This condition generates objective tinnitus that is characterized by a "clicking" noise that is audible to both the patient and an outside observer. No specific pathophysiologic process has been identified as the cause of middle ear myoclonus, making its diagnosis and treatment challenging. In this report, we present a presumptive case of COVID-19-associated middle ear myoclonus in a 10-year-old male.

A Rare Case of Middle Ear Mucormycosis Presenting with Facial Nerve Palsy

Introduction: Mucormycosis is an uncommon emerging fungal infection with high morbidity and mortality among diabetic and immunocompromised patients. The most common clinical manifestation is rhino-orbito-cerebral mucormycosis. Occurrence of middle ear mucormycosis with facial palsy is very rare. Case description: We report a case of a 59-year-old male patient who was presented with ear pain, ear discharge, and facial asymmetry. On clinical examination House-Brackman grade IV facial nerve palsy was noted and otoendoscopy showed external auditory canal edema, subtotal tympanic membrane perforation, necrotic malleus, lenticular process erosion with pale granulation tissue in anterior epitympanum. High resolution computed tomography (HRCT) temporal bone revealed soft tissue density in middle ear, mastoid, and external auditory canal with mild erosion of tegmen tympani and rarefaction of facial canal at first genu and tympanic segment with thickening and edema of first genu of facial nerve. Based on histopathological diagnosis of mucormycosis, patient was started on liposomal amphotericin B injection and clinical improvement was noted after a total dose of 3500 mg over 16 days. Conclusion: Early diagnosis and treatment with antifungals, glycemic control, and other supportive treatment with regular facial physiotherapy remain the mainstay of management in mucormycosis. Amid an increased number of COVID-19-associated rhino-orbito-cerebral mucormycosis, we report an unusual case of facial nerve palsy secondary to middle ear mucormycosis emphasizing the need for surgeons to have a broad mind to look for fungal infection in patients presenting with above-mentioned complaints and refractory to antibiotics. © The Author(s). 2022.

The impact of national lockdown due to COVID-19 pandemic on frequency of occurrence of secretory otitis media in children - our experience

Objective: To present the impact of national lockdown due to COVID-19 pandemic on the incidence of persistent secretory otitis media in children. Patients: Children aged from four to 13 years who were surgically treated from 1st January 2017 to 31th December 2020 at the University Department of Otolaryngology, Head and Neck Surgery, University Hospital Center Osijek. Methods: Patients underwent otomicroscopy, tympanometry, tone audiometry and fiberendoscopy of the epipharynx. After confirmation of the existence of secretory otitis the children were treated surgically, using adenotomy and myringotomy by inserting ventilation tubes in the equilateral ear. Results: This study included 107 children who were surgically treated with adenotomy and myringotomy by inserting ventilation tubes. The results showed a significant decline in the number of operations in 2020 compared to the previous three years, presumably due to national lockdown closures. We recorded the largest difference comparing 2018 and 2020, when the number of operations decreased by 87%. Conclusions: Drastic reduction of activities during the national lockdown closure, schooling from home and emphasizing the proper and regular implementation of personal hygiene have contributed to reducing the incidence of one of the most common infections in children. Lower frequency of acute otitis media has a positive effect on reducing the frequency of development of secretory otitis in children. Compared to the previous three years, there has been a significant decline in the number of children requiring surgical treatment. This is the first retrospective study on the impact of national lockdown on reducing the need for surgical treatment of persistent secretory otitis in children. © 2022 Hrvatski Lijecnicki Zbor. All rights reserved.

Smartphone-Enabled versus Conventional Otoscopy in Detecting Middle Ear Disease: A Meta-Analysis.

Traditional otoscopy has some limitations, including poor visualization and inadequate time for evaluation in suboptimal environments. Smartphone-enabled otoscopy may improve examination quality and serve as a potential diagnostic tool for middle ear diseases using a telemedicine approach. The main objectives are to compare the correctness of smartphone-enabled otoscopy and traditional otoscopy and to evaluate the diagnostic confidence of the examiner via meta-analysis. From inception through 20 January 2022, the Cochrane Library, PubMed, EMBASE, Web of Science, and Scopus databases were searched. Studies comparing smartphone-enabled otoscopy with traditional otoscopy regarding the outcome of interest were eligible. The relative risk (RR) for the rate of correctness in diagnosing ear conditions and the standardized mean difference (SMD) in diagnostic confidence were extracted. Sensitivity analysis and trial sequential analyses (TSAs) were conducted to further examine the pooled results. Study quality was evaluated by using the revised Cochrane risk of bias tool 2. Consequently, a total of 1840 examinees were divided into the smartphone-enabled otoscopy group and the traditional otoscopy group. Overall, the pooled result showed that smartphone-enabled otoscopy was associated with higher correctness than traditional otoscopy (RR, 1.26; 95% CI, 1.06 to 1.51; p = 0.01; I2 = 70.0%). Consistently significant associations were also observed in the analysis after excluding the simulation study (RR, 1.10; 95% CI, 1.00 to 1.21; p = 0.04; I2 = 0%) and normal ear conditions (RR, 1.18; 95% CI, 1.01 to 1.40; p = 0.04; I2 = 65.0%). For the confidence of examiners using both otoscopy methods, the pooled result was nonsignificant between the smartphone-enabled otoscopy and traditional otoscopy groups (SMD, 0.08; 95% CI, -0.24 to 0.40; p = 0.61; I2 = 16.3%). In conclusion, smartphone-enabled otoscopy was associated with a higher rate of correctness in the detection of middle ear diseases, and in patients with otologic complaints, the use of smartphone-enabled otoscopy may be considered. More large-scale studies should be performed to consolidate the results.

Decrease in Invasive Pneumococcal Disease in 7 United States Children's Hospitals during the COVID-19 Pandemic

Background. During the 2020 SARS-CoV-2 pandemic, physical distancing and mask use guidelines were implemented resulting in a decline in the number of infections caused by influenza, respiratory syncytial virus and otitis media. A surveillance analysis from England and Taiwan showed a decline in invasive pneumococcal disease (IPD) (Clin Infect Dis. 2021;72: e65-75 and J Infect. 2021;82:296-297). We hypothesized that COVID mitigation efforts resulted in a decrease in incidence of pediatric IPD within the U.S. during 2020 compared to previous years. Methods. We reviewed all cases of IPD among 7 children's hospitals from the U.S. Pediatric Multicenter Pneumococcal Surveillance Group from 2017-2020. IPD was defined by the isolation of Streptococcus pneumoniae from normally sterile sites (eg. blood, cerebrospinal, pleural, synovial or peritoneal fluid). Pneumococcal pneumonia was defined as an abnormal chest radiograph in the presence of a positive blood, pleural fluid or lung culture. Mastoiditis was identified by positive middle ear, subperiosteal abscess or mastoid bone culture. Serotypes were determined by the capsular swelling method. Hospital admission numbers were obtained for incidence calculations. Statistical analyses were performed using STATA11. A p< 0.05 was considered significant. Results. A total of 410 IPD cases were identified. The cumulative incidence of IPD (0-22 years of age) decreased from 99.2/100,000 admissions in 2017-2019 to 53.8/100,000 admissions in 2020 (risk ratio 0.54, CI: 0.40-0.72, p< 0.00001). Pneumococcal bacteremia and pneumonia decreased significantly in 2020 (p< 0.05), and although not statistically significant, there were fewer cases of meningitis and mastoiditis when compared to previous years (p=0.08) (Figure 1). Sex, race, age or presence of comorbidities were not significantly different between groups. Most common serotypes in 2020 were 35B, 3 and 15B/C (Figure 2). Conclusion. The observed decline in IPD cases during the first year of the SARSCoV-2 pandemic is likely associated with mask use and physical distancing limiting transmission of S. pneumoniae via droplets and viral infections frequently preceding IPD. These precautions might be useful in the future to decrease IPD, especially in high-risk patients.

Tympanostomy tubes in the age of quarantine.

OBJECTIVES: After state-mandated COVID-19 quarantine measures were lifted in 2020, pediatric otolaryngologists noticed that many children who were previously scheduled for tympanostomy tube (TT) placement for indications of acute otitis media (AOM) or chronic middle ear effusions (OME) no longer required surgery. This study aims to describe the effect of home-quarantine on pediatric patients with recurrent AOM and OME to increase our understanding of these conditions. METHODS: This was a retrospective review of pediatric patients that were originally scheduled for TT for recurrent AOM and/or OME, but had their procedure cancelled due to COVID-19. The chi-square test was used to compare the proportion of patients who no longer met indications for surgery stratified by original indication. Data was also collected for TT volume in the months before and after the start of the pandemic. RESULTS: Of 59 patients originally scheduled for TT, 31.0% of the 42 patients who returned for follow-up still met indications for a procedure after a period of home-quarantine. Of these, 76.9% had persistent OME, 61.5% had recurrent AOM, and 69.2% had persistent conductive hearing loss. After elective surgery resumed, there was a substantial decrease in the number of TT procedures performed compared to pre-pandemic data. CONCLUSION: After a period of quarantine, many patients previously scheduled for TT experienced resolution of their AOM or OME. Despite a nationwide recovery in outpatient surgical volume across otolaryngology practices, TT volumes remain low one year after the start of the pandemic, suggesting that continued COVID-19 precautionary measures are contributing to this lingering effect.

Immunohistochemical and qPCR Detection of SARS-CoV-2 in the Human Middle Ear Versus the Nasal Cavity: Case Series.

Viral infections have already been implicated with otitis media and sudden sensorineural hearing loss. However, the pathophysiology of COVID-19 as it relates to otologic disorders is not well-defined. With the spread of SARS-CoV-2, it is important to evaluate its colonization of middle ear mucosa. Middle ear and nasal tissue samples for quantitative RT-PCR and histologic evaluations were obtained from post-mortem COVID-19 patients and non-diseased control patients. Here we present evidence that SARS-CoV-2 colonizes the middle ear epithelium and co-localizes with the primary viral receptor, angiotensin-converting enzyme 2 (ACE2). Both middle ear and nasal epithelial cells show relatively high expression of ACE2, required for SARS-CoV-2 entry. The epithelial cell adhesion molecule (EpCAM) was use as a biomarker of epithelia. Furthermore, we found that the viral load in the middle ear is lower than that present in the nasal cavity.

Evidence of SARS-CoV-2 Virus in the Middle Ear of Deceased COVID-19 Patients.

The presence of SARS-CoV-2 in the middle ear reveals the etiopathogenesis of otitis media in COVID-19, as well as an epidemiological risk during otologic examination and surgical procedures in COVID-19 patients. The study included 8 deceased patients with COVID-19. Tissue samples from the middle ear were subjected to virology, histopathology, scanning (SEM) and transmission (TEM) electron microscopy investigation. Ethmoidal mucosa samples were processed for virology analyses. qPCR resulted positive for 75% of nasal mucosa samples and 50% of middle ear samples. Ct values showed lower viral loads in middle ear samples. A proportion of 66.6% patients with positive results in the nasal mucosa showed positive results in the middle ear, and the subtype analysis of the complete genome sequences indicated B.1.1.7 lineage for all samples. In histopathological and SEM samples, no pathological aspects were identified. TEM revealed on the background of death critical alteration of cellular morphology, suggestive structures resembling SARS-CoV-2, goblet cells and immune cells. SARS-CoV-2 can be present in the middle ear of COVID-19 patients even if there is not clinical evidence of acute otitis media. Otolaryngologists could be particularly exposed to COVID-19 infection.

Respiratory viruses in the healthy middle ear and middle ear with otitis media with effusion.

To investigate the presence of respiratory viruses in the middle ear cavity of the individuals with a healthy middle ear and the children with otitis media with effusion (OME). A total of 72 middle ear samples were collected from 25 children with OME (Group 1) and 47 individuals with no middle ear disease (Group 2). Multiplex real-time polymerase chain reaction was used to investigate the presence of 20 different respiratory viruses. Virus results were compared with bacteriomes of the same populations. At least one respiratory virus was detected in 56% of the patients in Group 1 and 12.8% of the individuals in Group 2. The viral co-infection rate for Group 1 and 2 was 8% and 2.1%, respectively. In Group 1, adenovirus was the most frequently detected virus with a rate of 24%, either alone (16%) or concurrent with other viruses (8%), followed by influenza B (12%), rhinovirus, and bocavirus (8%) each. Parainfluenza 4, coronavirus OC43, and RSV A/B were detected in 4% of the sample each. In Group 2, rhinovirus was detected in two samples (4.3%) followed by adenovirus, coronavirus OC43, coronavirus E299, and coronavirus NL63 with a rate of 2.1% each. The detection rate of respiratory viruses was significantly higher in children aged 6 to 11 years. There was no positive association between virus and bacteria found in the middle ear cavity. The current study has provided comprehensive data indicating the presence of diverse respiratory viruses in the healthy middle ear cavity. Our results also suggest that respiratory viruses might have a contribution to OME pathogenesis.

Otoskills training during covid-19 pandemic: a before-after study.

BACKGROUND: The ongoing COVID-19 pandemic has disrupted the surgical training of residents. There is a real concern that trainees will not be able to meet their training requirements. Low-fidelity surgical simulation appears to be an alternative for surgical training. The educational benefits of repeating ossiculoplasty simulations under a microscope have never been evaluated. With this study we aimed to evaluate the differences in performance scores and on a global rating scale before and after training on an ossiculoplasty simulator. METHODS: In this quasi-experimental, prospective, single-centre, before-after study with blinded rater evaluation, residents performed five microscopic ossiculoplasty tasks with a difficulty gradient (sliding beads onto rods, the insertion of a partial prosthesis, the insertion of a total prosthesis, and the insertion of a stapedotomy piston under microscopic or endoscopic surgery) before and after training on the same simulator. Performance scores were defined for each task, and total performance scores (score/min) were calculated. All data were collected prospectively. RESULTS: Six out of seven intermediate residents and 8/9 novices strongly agreed that the simulator was an effective training device and should be included in the ENT residency program. The mean effect of training was a significant increase in the total performance score (+ 0.52 points/min, [95 % CI, 0.40-0.64], p < 0.001), without a significant difference between novice and intermediate residents. CONCLUSIONS: This preliminary study shows that techniques for middle-ear surgery can be acquired using a simulator, avoiding any risk for patients, even under lockdown measures.

Using a 4K three-dimensional exoscope system (Vitom 3D) for mastoid surgery during the coronavirus disease 2019 pandemic.

OBJECTIVE: Microscopic surgery is currently considered the 'gold standard' for middle-ear, mastoid and lateral skull base surgery. The coronavirus disease 2019 pandemic has made microscopic surgery more challenging to perform. This work aimed to demonstrate the feasibility of the Vitom 3D system, which integrates a high-definition (4K) view and three-dimensional technology for ear surgery, within the context of the pandemic. METHOD: Combined approach tympanoplasty and ossiculoplasty were performed for cholesteatoma using the Vitom 3D system exclusively. RESULTS: Surgery was performed successfully. The patient made a good recovery, with no evidence of residual disease at follow up. The compact system has excellent depth of field, magnification and colour. It enables ergonomic work, improved work flow, and is ideal for teaching and training. CONCLUSION: The Vitom 3D system is considered a revolutionary alternative to microscope-assisted surgery, particularly in light of coronavirus disease 2019. It allows delivery of safe otological surgery, which may aid in continuing elective surgery.

Coronavirus Disease-19 and Otology/Neurotology.

The severe acute respiratory syndrome corona virus 2, responsible for the worldwide COVID-19 pandemic, has caused unprecedented changes to society as we know it. The effects have been particularly palpable in the practice of medicine. The field of otolaryngology has not been spared. We have had to significantly alter the way we provide care to patients, changes that are likely to become a new norm for the foreseeable future. This article highlights some of the changes as they apply to otology/neurotology. Although this is written from the perspective of an academic physician, it is also applicable to private practice colleagues.