Hyponatremia due to excessive water intake in COVID-19 patients: case series study.

Background: Literatures revealed syndrome of inappropriate antidiuretic hormone (SIADH) as the most common mechanism of hyponatremia in COVID-19. However, it is important to rule out other etiologies of hyponatremia. Methods: This is a case series, retrospective study. Four patients were reviewed from the Mesaieed Hospital, Hamad Medical Corporation, Qatar. The patients were admitted during the second wave of pandemic because of mild to moderate COVID pneumonia. The patients received medications according to the protocol; after few days of treatment, their blood laboratory results showed hyponatremia; as compared to the initial readings, hyponatremia workup excluded SIADH. History revealed that the patients were drinking large amounts of water, around 4-5 L/day, due of certain reasons: one patient had dysgeusia, and the other three patients thought that excessive drinking of water is beneficial for COVID-19 infection. Results: The hyponatremia level was less than 135 mmol/L, other laboratory tests excluded SIADH, and the provisional diagnosis was dilutional hyponatremia. Male/female ratio was 3/1, age from 29- to 45-year-old patients with no associated comorbidities. Fluid restriction up to 1.5 L/day showed dramatic improvement of their sodium blood level. The patients are discharged in a stable condition. Conclusions: In COVID-19 patients, hyponatremia not only is secondary to SIADH but can also be due to other etiologies. Hyponatremia can be induced by excessive water drinking and considered an extremely rare reported cases.

Tracheocutaneous fistula - A surgical challenge.

Tracheocutaneous fistula presents a challenge to the surgeon as different factors affect its formation and healing. A multidisciplinary approach and proper patient counseling, duration of cannulation, and comorbidities help in prognosis and outcome.

COVID-19 and Tinnitus.

Coronavirus disease 2019 (COVID-19) is an infectious respiratory disease caused by the severe acute respiratory syndrome coronavirus 2, brings with it a plethora of health concerns. Although most people have mild symptoms, which are respiratory in nature, some experience neurological symptoms, central nervous system manifestations, peripheral nervous manifestations, and skeletal muscle manifestations. But the damaging impact of COVID-19 virus on the hearing organs in the inner ear is a new finding yet to be explored. Currently, there is little evidence published connecting novel coronavirus and tinnitus directly. But according to the American Tinnitus Association, preexisting behavioral conditions make it more likely for patients to experience tinnitus due to the stress and depression associated with social isolation and infection avoidance. Hearing loss and Tinnitus is a common pathology seen in otolaryngology and there are numerous papers in literature describing its associations with other infections. However, this is the first reported case of hearing loss and tinnitus in a COVID-19 patient, in the State of Qatar, and this case report strives to contribute to the ocean of literature highlighting the need for otorhinolaryngologists to be aware of its correlation with COVID-19 virus.

Internal carotid artery anomaly in oropharynx as a rare cause of sore throat.

BACKGROUND: Anomaly of internal carotid artery (ICA) is a very rare variation. In almost all the cases, the anomaly was on the right side. This right-sided predominance may be attributed to anatomical influences and factors affecting blood pressure. CASE REPORT: A 67-years-old man presented to ear, nose and throat (ENT) outpatient clinic in Al Wakra Hospital complain of sore throat, there was associated medical co-morbidities (diabetic, hypertensive, hyperlipidemia and coronary artery diseases). ENT examination showed a pulsating, bulging mass on the right posterolateral oropharyngeal wall with normal mucosal covering. CT scan with contrast showed aberrant course of the right ICA which is coursing medially in prevertebral space and right posterolateral hypopharyngeal wall over a length of approximately 1.7 cm, making an acute U-turn before resuming the normal course and its distal aspects, only a thin layer of mucosa noted over the aberrant course of ICA. CONCLUSION: Anomaly of ICA must be kept in mind in the evaluation of patients with sore throat associated with oropharyngeal mass especially in old-aged patients with atherosclerotic diseases.

Gradenigo's Syndrome and Labyrinthitis: Conservative versus Surgical Treatment.

BACKGROUND: Extracranial intratemporal complications of chronic suppurative otitis media (CSOM) are extremely rare. Gradenigo's syndrome is defined as a clinical triad of otitis media, severe pain originating from the trigeminal nerve, and ipsilateral sixth cranial nerve palsy. CASE REPORT: A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment. MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex. The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus. CONCLUSION: Although there is little evidence to support the use of conservative treatment in the treatment of Gradenigo's syndrome resulting from chronic ear disease, we here demonstrate successful conservative treatment of Gradenigo's syndrome.

Digital volume tomography (DVT) as a diagnostic modality of the anterior skull base.

CONCLUSION: Because of high resolution and the relatively lower costs in comparison with modern helical CT scanners, digital volume tomography (DVT) can be recommended in the diagnosis of the nasal cavity and paranasal sinuses. OBJECTIVES: DVT is an advancement of panoramic tomography and is based on the principles of rotational tomography. It enables high resolution visualization of osseous structures. The slices can be displayed in three orthogonal planes that can be changed in angle arbitrarily. Data volumes of up to 12×17 cm can be examined with a new generation of the DVT. The aim of this study was to point out the potential of DVT in the anterior skull base. SUBJECTS AND METHODS: DVT scans with a cylindrical size of 10 cm in diameter and 10 cm in height were performed in 23 patients. The identification of surgical key landmarks (uncinate process, middle turbinate, ethmoidal bulla, agger nasi cells, Haller cells, frontal recess, anterior ethmoidal artery in its relationship to the skull base, the cribiform plate of the sphenoidal sinus in relation to the optic nerve, and the internal carotid artery) was evaluated. RESULTS: Display of the essential surgical key landmarks was possible in all patients.