Intratemporal mucormycosis: a rare COVID-19 sequelae.

A man in his 50s presented with a 2-month history of left ear discharge associated with hearing loss and weakness of left half of face since 15 days. The patient had no comorbidities, but he gave history of being treated for COVID-19 pneumonia 2 months ago post which he started experiencing left-sided aural symptoms. Clinical examination of ear revealed a subtotal perforation with multiple granulations in middle ear. Facial nerve examination revealed grade 3 lower motor neuron palsy. The biopsy of the granulations was sent to aid in diagnosis which later confirmed left ear mucormycosis. Otological involvement with facial palsy and sudden sensorineural loss in a patient with prior history of COVID-19 has not been reported until in literature. We try to communicate our experience to bridge the gap in understanding and managing this extremely rare occurrence of mucormycosis in the ear of a patient diagnosed with COVID-19 infection.

Unilateral, permanent hearing loss following severe COVID-19 infection.

Hearing loss following COVID-19 infection has been scarcely reported in the literature.A previously well middle-aged man presented to the emergency department with breathlessness and cough 8 days after testing positive for COVID-19 in the community. The patient was treated in the intensive care unit due to respiratory failure. Following extubation and step down to ward-level care 2 months later, the patient reported sudden left-sided hearing loss and tinnitus. Ear examination was unremarkable and pure tone audiometry revealed profound left sensorineural hearing loss. MRI of the internal acoustic meatus did not show any cerebellopontine lesions. Intravenous steroid therapy as well as oral steroids were not successful in improvement of hearing.A few cases of COVID-19-associated sensorineural hearing loss have been reported; the majority report irreversible loss. Awareness of this phenomenon and early referral for specialist review and audiological assessment to attempt salvage of hearing can reduce hearing disability.

Deep neck space infection extending to the mediastinum that was treated conservatively.

Deep neck space infections (DNSIs) are challenging to diagnose and manage. A female ex-smoker presented with difficulty breathing and chest pain. She was initially treated for exacerbation of emphysema with intravenous antibiotics. The ear, nose and throat team were later asked to review the patient for left submandibular swelling and odynophagia. CT of the neck was performed 10 days later, due to limited availability during COVID-19. It showed an extensive retropharyngeal collection from the level of the vallecula to just above the carina. Normally, a DNSI extending to the mediastinum would require prompt surgical management. However, the patient was clinically well once imaged, so the abscess was managed conservatively with intravenous antibiotics.

Stylohyoid Eagle syndrome and EXTracranial INternal Carotid arTery pseudoaneurysms (EXTINCT) with internal jugular vein nutcracker syndrome: a challenging clinical scenario.

We report a 4-year delay in diagnosing a combined carotid arterial and jugular venous styloid compression. The symptoms, which included dull neck pain, dizziness, intermittent diplopia, tinnitus, severe incapacitating right side headache and eye bloating, were challenging and wrongly attributed initially to various facial neuralgias. The patient presented during COVID-19 pandemic and was labelled as 'carotidynia' first and later as a transient perivascular inflammation of carotid artery syndrome. Combined targeted duplex ultrasonography and CT angiography with 3D reconstruction revealed a long styloid process and its tendinous-ligamentous attachments, injuring the internal carotid artery. Moreover, there was substantial internal jugular vein compression on a long C1 transverse process with a nutcracker syndrome. Release of the tendinous portion of the long styloid process and repair of the carotid artery pseudoaneurysm ended the patient's complaints and allowed him to have a better quality of life.

Primary thyroid squamous cell carcinoma presenting as a left-sided neck lump.

The elderly patient presenting with a neck lump often raises concerns regarding a malignancy. Thyroid gland malignancies are well recognised and subtype characteristics thoroughly researched, whereas rarer types of thyroid carcinoma are reported infrequently and often behave more aggressively. An 83-year-old woman was referred from the general practitioner (GP) to otolaryngology due to a 7-month history of an unexplained enlarging left-sided neck swelling. A fine-needle aspiration revealed cytology consistent with squamous cell carcinoma (SCC). Staging imaging failed to reveal evidence of a primary foci elsewhere. The definitive diagnosis was that of a primary thyroid SCC: a rare entity with limited citations in the literature. Surgical resection has been found to comprise the optimal treatment for this disease. Recognition of the possibility of primary thyroid SCC in elderly patients presenting with a neck lump, with prompt referral to a head and neck specialist permits a timely progression to potentially curative surgical management, a more promising prognosis and reduced mortality rates.

Otoneurological presentations of COVID-19.

COVID-19 usually begins with respiratory symptoms but may also cause neurological disturbances by direct (viral invasion) or indirect (immune-mediated) mechanism. Common neurological injury described in the literature include infectious toxic encephalopathy, viral encephalitis and Guillain-Barré syndrome. We present two cases diagnosed with COVID-19 who presented with isolated neurological deficit along facial nerve and vestibular nerve. Both recovered with medical management and rehabilitative exercises. Isolated neurological impairment in otorhinolaryngological practice may be the primary presentation or delayed feature of COVID-19.

Undiagnosed pharyngeal perforation following a penetrating neck trauma in a 5-year-old child: a proposed treatment algorithm.

External penetrating wounds of the neck leading to pharyngeal perforations are relatively uncommon. The small area of the neck contains the vital vascular, aerodigestive and nervous structures, which are difficult to access surgically. Pharyngeal perforations are challenging to treat, especially in children, as primary wound inspection may be difficult, leading to life-threatening complications like retropharyngeal abscesses, mediastinitis or airway compromise. The following is a case report of a 5-year-old girl who had a road traffic accident causing a neck laceration with a pharyngeal tear, which was only identified during emergency neck exploration in the operating room. A review of known literature and a proposed algorithm for managing penetrating neck injuries with pharyngeal injury is described.

Sequential contralateral facial nerve palsies following COVID-19 vaccination first and second doses.

A 61-year-old man presented to the ENT emergency clinic with a history of unilateral facial nerve palsy occurring shortly after each dose of the Pfizer-BioNTech COVID-19 vaccine. The first episode developed 5 hours after administration of the first dose and the second 2 days after administration of the second dose. Investigations at initial presentation to the emergency department were unremarkable, and the patient was diagnosed with Bell's palsy on both occasions. We describe the first case of Bell's palsy occurring after each dose of any UK-approved COVID-19 vaccine. Single episodes of unilateral facial nerve palsies have been reported in clinical trials and in subsequent case reports. There has been no evidence, however, of an episode after each dose. We also describe the earliest onset of symptoms from timing of administration of the vaccine, further suggesting the Bell's palsy was associated with the vaccine.

Catastrophic bilateral sudden sensorineural hearing loss following COVID-19.

Since December 2019, when it was first detected in Wuhan, the SARS-CoV-2 (COVID-19) has spread across the globe. The pandemic has had an unprecedented impact on the global population with >110 million confirmed cases and 2.5 million deaths. The most common initial symptoms of COVID-19 infection are cough, dyspnoea, fever, malaise and anosmia. Severe clinical manifestations include respiratory compromise, pneumonia, organ failure and death. There have been many other less common symptoms as a result of COVID-19 described in the literature, including significant rates of olfactory dysfunction. However, we believe there has been only one other previously documented cases of bilateral hearing loss.Sudden sensorineural hearing loss is a relatively common presentation seen by otolaryngologists. It is defined as rapid hearing loss, ≥30 dB occurring over 3 consecutive days in three contiguous sound frequencies. The exact pathological process is yet to be fully characterised, though it is most commonly unilateral and commonly develops shortly following viral infection. Treatment typically consists of glucocorticoid steroids administered orally, via intratympanic injection or a combination of both routes though there are currently no standardised management of these patients.Bilateral sudden sensorineural hearing loss (SSNHL) is rare, accounting for <2% of all cases. We describe a case of bilateral SSNHL in a 68-year-old patient who presented with profound hearing loss shortly after symptomatic infection with COVID-19, which at the time of publication is the first such case reported in the literature.

COVID-19 infection in the palatine tonsil tissue and detritus: the detection of the virus compartment with RT-PCR.

Two patients suffering from chronic recurrent tonsillitis were reported. The first patient was confirmed infected with COVID-19, 3 weeks prior to tonsillectomy. The detritus and tonsil specimen were further analysed through real-time PCR (RT-PCR) and revealed amplification of the fragment N and ORF1ab genes of SARS-CoV-2. The second patient had a negative IgM and positive IgG antibody for COVID-19; however, the nasopharyngeal swab indicated negative for SARS-CoV-2. Tonsillectomy was performed 2 weeks after the swab; the tonsil specimen was analysed through RT-PCR and revealed amplification of the N2 and RdRp gene of SARS-CoV-2. According to both results, the presence of the SARS-CoV-2 gene remains to be detected in tonsil and/or detritus after 2-3 weeks after recovery. Hence, it is suggested that it is necessary to use adequate protection when performing tonsillectomy on early recovered patients with COVID-19. Furthermore, tonsillectomy would be more advisable to be performed after the fourth week after recovery from COVID-19.

Emergency presentation of iatrogenic airway stenosis following intubation in a patient with COVID-19 and its management.

A 59-year-old man presented to the emergency department with recent onset biphasic stridor, dyspnoea and increased work of breathing on the background of prolonged intubation for the novel COVID-19 2 months previously. Flexible laryngoscopy revealed bilateral vocal fold immobility with a soft tissue mass in the interarytenoid region. The patient's symptoms improved with oxygen therapy, nebulised epinephrine (5 mL; 1:10 000) and intravenous dexamethasone (3.3 mg). The following morning, the patient was taken to theatre, underwent suspension microlaryngoscopy and found to have bilateral fixation of the cricoarytenoid joints and a large granuloma in the interarytenoid area. He underwent cold steel resection of the granuloma and balloon dilatation between the arytenoids, with the hope of mobilising the joints. This failed and CO2 laser arytenoidectomy was performed on the left side. The stridor had resolved postoperatively, with normalisation of work of breathing and the patient was discharged home on the first postoperative day.

Sudden irreversible hearing loss post COVID-19.

Sudden onset sensorineural hearing loss (SSNHL) is frequently seen by otolaryngologists. The exact pathophysiology of the disease is still unknown, with the most likely causative factor being following a viral infection. Immediate steroids are the best treatment to improve prognosis. Despite a plethora of papers in the literature describing SSNHL, there are only a few reported cases of hearing loss following COVID-19, none of which have been reported in the UK. This paper presents the first UK case of SSNHL following COVID-19. Physical examination and imaging excluded any other cause of hearing loss. A literature review showed that four other cases have been previously described. Hearing loss can be a significant cause of morbidity and can easily be missed in the intensive care setting. Being aware and screening for SSNHL following COVID-19 enables an early course of steroids, which offers the best chance of recovering hearing.

Peritonsillar abscess and concomitant COVID-19 in a 21-year-old male.

Transoral drainage of peritonsillar abscess during the COVID-19 pandemic is a high-risk procedure due to potential aerosolisation of SARS-CoV-2. This case describes conservative management of peritonsillar abscess in a 21-year-old male with COVID-19.

Tracheal swab from front of neck airway for SARS-CoV-2; a bronchial foreign body.

We report the case of a bronchial foreign body, following a tracheostomy site swab for SARS-CoV-2, aiming to raise awareness and vigilance. A qualified nurse was performing a routine SARS-CoV-2 swab on a 51-year-old woman, fitted with a tracheostomy in the recent past following a craniotomy. This was part of the discharging protocol to a nursing home. During the sampling, part of the swab stylet snapped and was inadvertently dropped through the tracheostomy site. Initial CT imaging was reported as showing no signs of a foreign body but some inflammatory changes. Bedside flexible endoscopy through the tracheostomy site revealed the swab in a right lobar bronchus. This was subsequently removed by flexible bronchoscopy. This case highlights the need for clear guidance on how samples for SARS-CoV-2 are taken from patients with front of neck airways (laryngectomy/tracheοstomy) and the potential pitfalls involved.