The COVANOS trial - insight into post-COVID olfactory dysfunction and the role of smell training.

BACKGROUND: Olfactory dysfunction is a cardinal symptom of COVID-19 infection, however, studies assessing long-term olfactory dysfunction are limited and no randomised-controlled trials (RCTs) of early olfactory training have been conducted. METHODOLOGY: We conducted a prospective, multi-centre study consisting of baseline psychophysical measurements of smell and taste function. Eligible participants were further recruited into a 12-week RCT of olfactory training versus control (safety information). Patient-reported outcomes were measured using an electronic survey and BSIT at baseline and 12 weeks. An additional 1-year follow-up was open to all participants. RESULTS: 218 individuals with a sudden loss of sense of smell of at least 4-weeks were recruited. Psychophysical smell loss was observed in only 32.1%; 63 participants were recruited into the RCT. The absolute difference in BSIT improvement after 12 weeks was 0.45 higher in the intervention arm. 76 participants completed 1-year follow-up; 10/19 (52.6%) of participants with an abnormal baseline BSIT test scored below the normal threshold at 1-year, and 24/29 (82.8%) had persistent parosmia. CONCLUSIONS: Early olfactory training may be helpful, although our findings are inconclusive. Notably, a number of individuals who completed the 1-year assessment had persistent smell loss and parosmia at 1-year. As such, both should be considered important entities of long-Covid and further studies to improve management are highly warranted.

Defining performance levels in undergraduate otolaryngology education.

OBJECTIVES: This study seeks the opinions of qualified doctors on what they feel medical students should learn about otolaryngology. It aims to identify both the content deemed relevant and the performance levels for medical students in otolaryngology. METHODS: A national survey developed from a content analysis of undergraduate otolaryngology curricula from the UK was undertaken, accompanied by a review of the literature and input from an expert group. Data were collected from a wide range of doctors. RESULTS: Participants felt that graduating students should be able to: recognise, assess and initiate management for common and life-threatening acute conditions; take an appropriate patient history; and perform an appropriate examination for the majority of otolaryngology clinical conditions but manage only a select few. CONCLUSION: This study reports performance levels for otolaryngology topics at an undergraduate level. Participating doctors felt that a higher level of performance should be expected of students treating life-threatening, acute and common otolaryngology conditions.

Supraglottitis and abscess formation.

OBJECTIVE: This case series report aims to raise awareness of the association between supraglottic infection and abscess formation, which has been rarely documented. METHOD: We report a series of four patients who developed cervical abscesses following supraglottic infection. The diagnosis was confirmed by imaging in three patients, and by incision and drainage of pus at direct laryngoscopy in one. RESULTS: All four patients were treated with intravenous antibiotics, steroids and humidification; two also underwent surgical drainage of pus. All made an uneventful recovery. CONCLUSION: The factors that lead to neck abscess formation are poorly understood. Physicians should always be aware of this potential complication. If it is suspected, appropriate neck imaging should be undertaken, after excluding airway copromise; this will aid early diagnosis and treatment.

Extensive metastatic renal cell carcinoma presenting as facial nerve palsy.

Metastatic lesions of the parotid gland are well described in the literature. Metastatic spread to the parotid from renal cell carcinoma is rare. We present the only reported case of facial nerve palsy caused by a metastasis to the parotid from a renal cell carcinoma.

Neurenteric cyst of the cerebellopontine angle: case report.

OBJECTIVE AND IMPORTANCE: We report a case of a neurenteric cyst of the cerebellopontine angle and review the five previously reported cases. The pathology and classification of these cysts are discussed. CLINICAL PRESENTATION: The patient presented with a 1-month history of nausea, vomiting, vertigo, and sudden hearing loss. INTERVENTION: The cyst was decompressed by a retrosigmoid approach. After recurrence of symptoms at 2 months, further decompression was required. CONCLUSION: The patient achieved a good outcome after the second operation, with cessation of her vomiting and vertigo, although she had residual hearing loss. Four of the five previously reported patients experienced satisfactory outcomes after surgery. The definitive diagnosis of these rare lesions is made using immunocytochemical techniques.

Post-tonsillectomy pain: the first ten days.

Forty-one adults were entered into a prospective study to investigate the pattern of pain over 10 days after elective dissection tonsillectomy. The severity of pain was scored by the patient on a visual analogue scale. The results confirm that tonsillectomy is a very painful experience and the provision of adequate analgesia is of paramount importance, especially if day-case tonsillectomy is performed.

Florid reactive mesenchymal proliferation.

Florid reactive mesenchymal proliferation describes a benign soft tissue tumour found in the hand as well as at other sites. The histological appearance and rapid growth of the lesion may lead to an incorrect diagnosis of malignancy. We describe a case in a 79-year-old lady, unusual because of her age at presentation and long history, and review the literature.