Changing Teaching Trends During Covid-19 And Its Impact On Ent Residency Program In India: A Cross Sectional Study.

Introduction: The COVID-19 pandemic has presented an unmatched challenge to the ENT residency programs to adapt to a form of web-based learning process and stimulation-based training. It also focuses on the mental stress underwent and the viewpoint of the residents to the paradigm shift in clinical care and academics. Methods: An anonymous questionnaire was created in an online survey generator with 22 questions with limited options (yes/no) and was circulated through email and what's app which has been responded to by 240 ENT residents throughout the country. The questionnaire was divided into five sections, demographics, knowledge about COVID-19 and its management, impact on clinical activity, academics and mental well-being section. Results: Out of 240 respondents, 190(79.2%) were junior residents and 50(20.8%) were senior residents. Although many of them knew the necessary precautions to be taken, 94(39.8%) turned out to be positive themselves with the high fear of transmitting to their family members. Three-fourth participants suggested extending the training period after graduation for the loss incurred. However, half of them sought an opportunity to train themselves for the management of communicable disease, 95% of the residents opined that they are having a negative impact on the job performance due to loss of surgical hands-on which has been drastically reduced. Conclusion: The issues mentioned have been addressed through STEPs - Safety of the residents, Time utilisation by research, Education continuation by online web learning and stimulatory programs, psychological support for mental well-being. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03377-7.

Delayed Presentation of Onodi Cell Mucocele with Optic Neuropathy: A Rare Case and Literature Review.

A mucocele of a paranasal sinus is a mucus filled cystic mass lined by epithelium filling the involved sinus whose ostium is obstructed. While frontoethmoidal mucoceles are common, Onodi cell mucoceles are less frequently seen. Due to its anatomic proximity to optic nerve, it can lead to devastating visual complications. A 29 year old female presented with progressive loss of vision in right eye since 20 days leading to complete loss of vision since 12 days without any nasal complaints. Endoscopy showed fullness in right spheno-ethmoidal region. Computed Tomography scan revealed a mucocoele of the right Onodi air cell causing compression of intracanalicular part of right optic nerve. Despite urgent surgical decompression of mucocele, vision could not be restored. Poor visual acuity at presentation may be associated with bad prognosis. Hence, a high index of suspicion followed by appropriate imaging (CT scan and/or MRI nose and paranasal sinus) is crucial for early diagnosis in case of unexplained progressive diminution of vision, even in setting of no nasal complaints.

Odontogenic Fibromyxoma of Maxilla: a Rare Case with Intriguing Pathology.

Fibromyxoma is a rare benign odontogenic tumor of mesenchymal origin which has a potential for a highly aggressive turnout. We present the case of a 30 year old lady who came with a slow-growing swelling in the oral cavity, which turned out to be a fibromyxoma in an unusual location-maxilla. The lesion was excised completely without any bony or soft tissue remnant and the histopathological examination confirmed the diagnosis. The rest of the course was uneventful and the patient is in follow up without any recurrence.

Wave of Invasive Fungal Disease on the Shores of COVID-19: A Case Series of COVID-19 Associated Rhino-Orbital Fungal Rhinosinusitis and Literature Review.

Coronavirus disease 2019 (COVID-19) may be associated with a wide range of bacterial and fungal co-infections. Acute invasive fungal sinusitis is an aggressive infection affecting immunocompromised patients and high mortality rate. Here, in this case series, we have reviewed three cases of COVID-19 associated rhino-orbital invasive fungal disease. Patients with COVID-19 associated pneumonia with diabetes mellitus are at an increased risk of developing invasive pulmonary fungal infections probably due to their reduced immunological competence. Concurrent glucocorticoid therapy probably heightens the risk of mucormycosis. Physicians should be aware of and should have high index of suspicion of possible fungal infection in post COVID-19 patients. Aggressive management both medical and surgical, is required to improve outcomes of secondary invasive fungal infections in patients with COVID-19 infection. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03213-y.

Olfactory and Gustatory Dysfunctions in Patients With Laboratory-Confirmed COVID-19 Infection: A Change in the Trend.

To study the presence of olfactory and gustatory dysfunctions in patients with laboratory-confirmed COVID-19 infection in our set up. Longitudinal study, 1st March 2020-15th August 2020, at a tertiary care hospital. RT PCR positive for SARSCoV-2 patients, above 18 years age included. Excluding patients with previous history of changes in smell or taste sensation, severely ill at the time of admission, history of taking drugs at the time of COVID 19 infection that affect the smell or taste sensation. 435 patients included after obtaining an institutional ethical clearance. After an informed consent, these patients were followed up telephonically, to record any subjective improvement in olfactory or gustatory symptoms and an approximate duration of recovery. Olfactory and/or gustatory dysfunction 10.8% (47/435). Mean (SD) age-34.53(10.8) years. Females affected significantly more [X2 (1, N = 435) = 7.45, p value is 0.006, significant at p < 0.05]. Olfactory dysfunction significantly associated with gustatory dysfunction [X2 (1, n = 435) = 182.29, p < 0.00001]. 19.8% (N = 435) of individuals remained asymptomatic. Nasal symptoms rare (4%, N = 47). Mean (SD) recovery olfactory and gustatory dysfunction 12.1 (7.7) and10.8 (6.3) days respectively. Subjective loss of smell or taste dysfunction was far less common. Women and younger population reported olfactory or gustatory dysfunction commonly. Olfactory and gustatory changes without nasal symptoms, suspicion of COVID-19 infection is relevant. Recovery is complete and early.

'Is It Brain Talking to the Ear': Neuro-otological Evaluation of Tinnitus Using Auditory Brainstem Response Audiometry.

Tinnitus is hypothesized to be an auditory phantom phenomenon resulting from spontaneous neuronal activity somewhere along the auditory pathway. The neural abnormalities underlying tinnitus are largely unknown. We evaluated the functional characteristics and the auditory system synchronization using Auditory Brainstem Response (ABR) in normal hearing tinnitus patients. In this observational comparative cross-sectional study, patients with chief complaints of Tinnitus and equal number of age and sex matched controls without hearing loss and tinnitus were enrolled. All patients underwent a full ENT assessment, pure tone audiometry and Brainstem evoked response audiometry (BERA) tests. The study population consisted of 100 patients with tinnitus, 55 controls without tinnitus and 45 controls with tinnitus. Statistical analysis showed significant relation (p < 0.05) between hearing loss and tinnitus between cases and controls with tinnitus, between absolute latency of wave III amongst cases and controls without tinnitus, Interpeak Latency between wave III and V amongst cases and controls with tinnitus and interpeak latency of wave I and wave III amongst controls without and with tinnitus. Brainstem evoked response audiometry results that we obtained from the patients of tinnitus and controls with and without tinnitus are different from one person to another. This suggests impaired neural firing synchronization and transmission in the central auditory pathway in tinnitus patients. These findings also indicate that the pathology underlying tinnitus is not the same in every individual, with possible brainstem involvement in some cases.

Mammary Analogue Secretory Carcinoma of Submandibular Gland: A Case Report with Review of the Literature.

Secretory carcinoma (SC) is a rare salivary gland tumor and has been recently included in the fourth edition of the World Health Organization classification of head and neck tumors. To understand the histopathologic findings and clinical behavior of mammary analogue secretory carcinoma (MASC) of the submandibular gland in a 23 year old female. MASC is an intriguing and rare malignant salivary gland tumor first described in 2010. It shares histologic, immunohistochemical and genetic features with secretory carcinoma of the breast. The clinical behavior of MASC ranges from slowly growing tumors to aggressive tumors that can cause widespread metastasis. Many cases of MASC were discovered in archived cases previously classified as pleomorphic adenoma, acinic cell carcinoma, mucoepidermoid carcinoma, and adenocarcinoma. They are only a few reported in submandibular gland. MASC is a newly recognized variant of salivary gland malignancy. Further research is needed to better delineate its overall prevalence and to define an appropriate treatment algorithm for this new clinical entity.

Diagnostic and therapeutic endonasal rhinologic procedures generating aerosol during COVID-19 pandemic: a systematized review / Procedimentos endonasais de rinologia diagnósticos e terapêuticos geradores de aerossóis durante a pandemia de Covid-19: uma revisão sistematizada,

Abstract Introduction Most rhinologic procedures, particularly endoscopic sinonasal procedures, are liable to produce aerosols. The severe acute respiratory syndrome coronavirus 2 (SARS-Co V-2) transmits via respiratory droplets, but the degree of its spread through airborne routes by aerosol is unclear. Objective The aim of this article is to counsel rhinologists on how to modify their conventional practice during the COVID-19 pandemic by prioritising the need of procedures, identifying aerosol- generating procedures and using precise personal protection equipment for various endonasal procedures. Methods We did a review of articles indexed for MEDLINE on PubMed, ENT Cochrane, DOAJ and Web of Science databases using the keywords nasal endoscopy, SARS-CoV-2, COVID-19, aerosol generating medical procedures and rhinology to formulate guidelines for the safety of healthcare workers. Results The review included evidence from 28 articles from the otorhinolaryngology, surgery, infectious disease, head and neck surgery and cancer biology literature. We have provided recommendations and relevant information for rhinologists during the COVID-19 pandemic, based on the available studies and data, to warrant high-quality patient care and requisite levels of infection prevention during rhinology procedures. Conclusion In rhinology, marked care is advised during nasal packing, electrocauterisation and use of high-speed rotating devices in potentially infected tissue as they are considerable aerosol- producing procedures. The choice of personal protective equipment is based on the risk of exposure and possible modes of aerosol generation.

Resumo Introdução A maioria dos procedimentos rinológicos, principalmente os procedimentos endoscópicos nasossinusais, é suscetível à produção de aerossóis. A síndrome respiratória aguda grave coronavírus-2 (SARS-CoV-2) é transmitida através de gotículas respiratórias, mas o grau de sua disseminação através de aerossóis por via aérea não é claro. Objetivos Orientar os rinologistas sobre como modificar sua prática convencional durante a pandemia de Covid-19, priorizar a necessidade de procedimentos, identificar procedimentos geradores de aerossol e usar equipamento de proteção individual de precisão para vários procedimentos endonasais. Método Fizemos uma revisão de artigos indexados na Medline por meio das bases de dados PubMed, ENT Cochrane, DOAJ e Web of Science, com as palavras-chave nasal endoscopy, SARS-CoV-2, Covid-19, aerosol-generating medical procedures e rhinology para formular diretrizes para a segurança dos profissionais de saúde. Resultados A revisão incluiu evidências de 28 artigos de otorrinolaringologia, cirurgia, doenças infecciosas, cirurgia de cabeça e pescoço e biologia do câncer. Fornecemos recomendações e informações relevantes para rinologistas durante a pandemia de Covid-19, com base nos estudos e dados disponíveis, para garantir atendimento de alta qualidade ao paciente e níveis necessários de prevenção da infecção durante procedimentos de rinologia. Conclusões Em rinologia, recomenda-se cuidado acentuado durante o tamponamento nasal, eletrocauterização e uso de dispositivos rotativos de alta velocidade em tecidos potencialmente infectados, pois esses procedimentos são consideráveis produtores de aerossóis. A escolha do equipamento de proteção individual é baseada no risco de exposição e nos possíveis modos de geração de aerossol.

Diagnostic and therapeutic endonasal rhinologic procedures generating aerosol during COVID-19 pandemic: a systematized review.

INTRODUCTION: Most rhinologic procedures, particularly endoscopic sinonasal procedures, are liable to produce aerosols. The severe acute respiratory syndrome coronavirus 2 (SARS-Co V-2) transmits via respiratory droplets, but the degree of its spread through airborne routes by aerosol is unclear. OBJECTIVE: The aim of this article is to counsel rhinologists on how to modify their conventional practice during the COVID-19 pandemic by prioritising the need of procedures, identifying aerosol- generating procedures and using precise personal protection equipment for various endonasal procedures. METHODS: We did a review of articles indexed for MEDLINE on PubMed, ENT Cochrane, DOAJ and Web of Science databases using the keywords nasal endoscopy, SARS-CoV-2, COVID-19, aerosol generating medical procedures and rhinology to formulate guidelines for the safety of healthcare workers. RESULTS: The review included evidence from 28 articles from the otorhinolaryngology, surgery, infectious disease, head and neck surgery and cancer biology literature. We have provided recommendations and relevant information for rhinologists during the COVID-19 pandemic, based on the available studies and data, to warrant high-quality patient care and requisite levels of infection prevention during rhinology procedures. CONCLUSION: In rhinology, marked care is advised during nasal packing, electrocauterisation and use of high-speed rotating devices in potentially infected tissue as they are considerable aerosol- producing procedures. The choice of personal protective equipment is based on the risk of exposure and possible modes of aerosol generation.