Hearing Outcomes of Infants Born to Mothers With Active COVID-19 Infection.

Introduction COVID-19, caused by SARS-CoV-2, is a highly contagious respiratory tract infection. A major concern of SARS-CoV-2 infection in pregnant women is vertical maternal-fetal transmission and the ramifications on infant hearing. This retrospective study aims to investigate whether perinatal exposure to SARS-CoV-2 has an impact on the hearing of the offspring. Materials The study population included neonates born to unvaccinated COVID-19 positive mothers in the University Hospital of Patras, Greece from March 2020 to January 2021. Polymerase chain reaction (PCR) tests were performed on the neonates on the first, second,, and seventh day of life. All neonates underwent transient evoked otoacoustic emissions (TEOAEs) within the first three months of life and were all examined at the age of nine months. Results Thirty-two neonates (21 male) were born within the study period and all were transferred to the Neonatal Intensive Care Unit (NICU). Their mean (SD) gestational age was 36.9 (+2.23) weeks and their birth weight was 2,943 (+537) g. Nine of them were preterm and six of them had a low birth weight. Apgar scores calculated at 1' and 5', were in the normal range for 31 (97%) out of 32 neonates. One infant required urgent intubation at birth with an Apgar score of 1' 3 and 5' 4. Four neonates required mechanical ventilatory support, two neonates required nasal CPAP and eight neonates required supplementary oxygen. All infants were negative for TORCH infections. PCR tests were performed within the first day of life and repeated at 48 hours and on the seventh day of life. All PCR tests came back negative. Out of 32 neonates, seven failed the TEOAE test and were tested again a month later with a positive outcome. At nine months of follow-up, all 32 infants passed the TEOAE test. Conclusion In conclusion, in our study, there was no evidence of vertical transmission of SARS-CoV-2 from mothers infected during the third trimester or hearing impairment of the offspring.

Early Diagnosis of Anal Canal Duplication: The Importance of a Physical Examination.

Anal canal duplication (ACD) is an extremely rare congenital anomaly of the intestinal tract that presents as an extra opening of the anal canal without communication with the anorectum. We present the case of a five-year-old male presenting to the pediatrician without symptoms and upon physical examination, a duplicated anal canal along the midline was discovered. The patient was admitted for surgery and the canal was removed via mucosal stripping. Postoperatively, the patient recovered well. The present study aims to expand on our knowledge of a very rare pathological entity and emphasize the importance of a complete pediatric physical examination.

Cervical Diffuse Idiopathic Skeletal Hyperostosis: Rare Cause of Emergency Tracheostomy.

Diffuse idiopathic skeletal hyperostosis (DISH) is a rare and potentially life-threatening syndrome. We present the case of a patient complaining about severe dyspnoea and diagnosed with vocal cord paresis. An emergency tracheotomy was performed to restore his breathing. Diagnostic imaging revealed large mass-occupying cervical osteophytes compressing the larynx. The osteophytes were removed via an anterior cervical approach, and vital signs were normalized. However, postoperatively, a fistula was discovered between the upper part of the oesophagus and the trachea. As a result, a gastrostomy tube had to be placed indefinitely. Literature review confirms the rare frequency of emergency tracheostomy due to DISH syndrome. The aim of the present study is to expand on our knowledge of a rare pathological entity that can frequently be misdiagnosed.

Inferior Turbinate Hypertrophy: A Comparison of Surgical Techniques.

Introduction Nasal obstruction is one of the most frequently reported symptoms in clinical practice. The second most common cause of nasal obstruction is inferior turbinate hypertrophy, a nasal pathology for which surgical treatment is often required. This study aims to determine the most effective surgical method in patients with inferior turbinate hypertrophy (ITH). Materials and methods The study was performed from September 2018 to October 2019 in the Otolaryngology-Head and Neck Surgery Department of the Evangelismos Hospital of Athens. The study population comprised 205 patients that underwent surgery and were monitored in the hospital. Radiofrequency ablation (RFA) was the method used in 73 patients, 68 patients were treated with the microdebrider-assisted turbinoplasty (MAT), and the remaining 64 patients were operated on using electrocautery (EC). Following surgery, postoperative complications were assessed and quantified. Results Overall, 205 patients underwent surgery. The first group (n=73) was operated on using radiofrequency ablation and had a complication rate of 30.1%. Out of 73 patients, 51 recovered without complications. The remaining 22 had complications, consisting of 16 patients with bleeding and six with postnasal drip. The second group (n=68) was treated using the microdebrider method. The complication rate was 26.5%, where 50 patients did not present with any symptoms post-operatively and 18 exhibited symptoms. Specifically, postnasal drip was more prevalent with this method as all 18 patients showed postnasal drip as their complication. The third group (n=64) was treated with electrocautery. Patients in this group had the most complications (n=24), 16 were attributed to postnasal drip and eight to infections, treated promptly with oral antibiotics. The complication rate using this method was 37.5%. Conclusion In our study, the microdebrider-assisted turbinoplasty offered the lowest complication rate, followed by radiofrequency ablation and electrocautery. However, all three methods managed to alleviate the nasal obstruction and treat inferior turbinate hypertrophy. More research is needed as a lack of consensus remains regarding the optimal surgical technique for lower turbinate hypertrophy.

Newborn Hearing Screening: Analysing the Effectiveness of Early Detection of Neonatal Hearing Loss in a Hospital in Greece.

Introduction The introduction of newborn hearing screening programs (NHSP) has drastically contributed to the early diagnosis of hearing loss (HL) in children, with the prospect of children developing speech as early as possible. This retrospective study aims to present and discuss the preliminary results of the NHSP at the University Hospital of Patras, Greece, highlighting the strengths and weaknesses of the program. The evaluation of the implementation of NHSP is important to confirm the effectiveness of the process and elaborate system failures. Materials The study describes the results of previous data collected from the NHSP in the Rio hospital of Patra and analyzed the conditions of the sample collected. The random sample involved newborns born between November 2018 - December 2020 at the University Hospital in Patra, Greece, which was assessed using transient evoked otoacoustic emissions (TEOAEs). Testing was performed twice per week on Thursday and Friday with a random sample, specifically examining the babies in the hospital these days. From the 2014 newborns assessed, 1491 were healthy neonates, while the other 523 required hospitalization in the neonatal unit. Results In total, there were 2014 live births; 1491 healthy neonates were screened with TEOAEs. Of them, 44 did not pass the first test. After retesting one month later, 31 passed the test, while the other 13 were referred to a hearing centre for further audiological testing with auditory brainstem response (ABR) tests. Two infants never showed up for the follow-up appointment. Of the remaining 11, six infants had normal hearing, three had otitis media with effusion or other conductive HL. The last two infants had HL. Specifically, one had bilateral sensorineural HL greater than 40db, and one had unilateral sensorineural HL greater than 40db. Risk factors were identified in 523 newborns admitted to the unit. The most common risk factors identified were the use of ototoxic drugs, low Apgar scores, and prematurity. Of all the newborns, 491 passed the test the first time, and the rest 32 infants came back 1-2 months after leaving the neonatal unit. All the babies who had failed in the first screening test appeared for the follow-up appointment for the second screening test. Of these, 24 babies passed the test, but eight did not. Of these, four were diagnosed with media otitis with effusion or other conductive HL. Sensorineural HL was identified in the last four babies using ABR tests. In detail, two had unilateral sensorineural HL greater than 40db, while two had bilateral sensorineural HL greater than 40db. Conclusion In conclusion, we found that for the NHS programs to be effective, they must be implemented long-term and have monetary support. Early diagnosis and cochlear implantation are the keys to excellent outcomes. Cooperation between different specialties and a patient-centred approach will help physicians holistically face neonatal HL. Building trust between the parents and doctor is essential for the program's success and reducing the lost-to-follow-up rate. To run a successful program, trained staff, equipment, and financial support are required. However, the gold standards for the success of the program are proper implementation of the program, close follow-up, strict adherence to the guidelines in the neonatal intensive care unit (NICU), and the early detection and diagnosis of HL.

Atypical Retropharyngeal Abscess of Tuberculosis: Diagnostic Reasoning, Management, and Treatment.

Retropharyngeal abscess caused by tuberculosis (TB) is an unusual life-threatening disease. We present the case of a patient, mainly complaining about dysphagia, cephalalgia, and neck pain. History, examination, and laboratory data were inconclusive. Diagnostic imaging revealed retropharyngeal abscess with atypical characteristics. Aspiration through the pharynx was performed. The aspirated fluid sent for microscopic examination by polymerase chain reaction (PCR) gene probe, revealed Mycobacterium tuberculosis (MTB). Subsequently, the patient was treated with a standard nine-month anti-TB chemotherapy. The combination of fine-needle aspiration and antitubercular agents was successful. The aim of the present study is to inform the importance of early diagnosis with targeted therapy.

Endoscopic Surgical Repair of a Giant, Postoperative, Neglected Meningoencephalocele.

Meningoencephalocele is a rare and potentially lethal disease, requiring early diagnosis and treatment. A 30-year-old male patient was diagnosed with a massive meningoencephalocele. His medical history included cerebrospinal fluid (CSF) rhinorrhea since the age of 7 years, which was attributed to right eye mining during infancy due to Coats disease. Following failed attempts of open surgical repair and CSF diversion during childhood, no further attempts of surgical management were made. He presented a long history of recurrent episodes of meningitis, resulting in long-lasting hospitalization in the intensive care unit. Eventually, he underwent surgical repair through an endoscopic multilayer approach. Subsequent endoscopic and radiological assessment demonstrated no recurrence during a follow-up period of one year. Endoscopic treatment is highly successful. An effective and definite surgical repair is of paramount importance in order to avoid life-threatening complications, improve patient's and caregiver's quality of life, and avoid unnecessary health-system costs.

Ameloblastoma on the Maxillary Sinus: Cause of Unilateral Nasal Obstruction.

Ameloblastoma is a rare, benign (99%) or malignant (1%) tumour, which has derived from dental mesenchyme. We present a case of a patient mainly complaining about obstruction on the right nasal cavity. Endoscopy and computed tomography revealed a soft tissue mass occupying the maxillary sinus to the middle meatus causing complete obstruction of the right nasal cavity. Endoscopic en block removal of the lesion and biopsy confirmed follicular ameloblastoma. Literature review confirms the extremely rare frequency of ameloblastoma. The aim of the present study is to expand on our knowledge of a rare pathological entity that can frequently be misdiagnosed.

Spinal Accessory Nerve Duplication: A Case Report and Literature Review.

Aim of the present study is to expand our knowledge of the anatomy of the 11th cranial nerve and discuss the clinical importance and literature pertaining to accessory nerve duplication. We present one case of duplicated spinal accessory nerve in a patient undergoing neck dissection for oral cavity cancer. The literature review confirms the extremely rare diagnosis of a duplicated accessory nerve. Its clinical implication is of great importance. From this finding, a further extension to our knowledge of the existing anatomy is proposed.