Adenoidectomy: Anatomical Versus Clinical Success.

Endoscopic adenoidectomy with powered instruments,a challenge in resource-constraint developing countries, has been on the rise. To evaluate conventional curettage as compared to endoscopic assisted adenoidectomy in the successful management of adenoid enlargement. A randomized controlled double-blinded study among children undergoing adenoidectomywas done. Primary outcomes were assessed by pre- and postoperative evaluation with a symptoms questionnaire and fiberoptic nasal endoscopy. There were 71 children aged 3-15 years, majority having grade III adenoids. Conventional adenoidectomy was done by the surgeon who was blinded to preoperative adenoid status. Patients were randomized to two groups, 35in conventional curettage where no further on-table intervention was done. Check endoscopyof the remaining 36 patients, formingthe second group, revealed residual grade III adenoidsin 5.6%. They underwentcompletion adenoidectomyendoscopically. By the 12th postoperative week, nasal endoscopy noted that 39.3% had grade I/II and 8.8% had grade I in the conventional and endoscopic groups respectively. Thoughstatistically significant, all pre-op symptoms settled except sleep-related ones which persisted in both groups (25% versus 14.7) with no complications in either group. Relief of all symptoms other than sleep-related ones, was achieved despite residual adenoids being up to grade II in both conventional and endoscopic group. This suggests non-obstructive causes in a subset of these patients. Conventional adenoid curettage is comparable to endoscopic adenoidectomy by cold method among children aged three and above. Complete adenoidclearance for achieving 'anatomical success' appears not to be necessary for 'clinical success'.

Abducens Nerve Schwannoma: First Case to Be Treated With an Expanded Endonasal Approach.

Abducens nerve schwannomas are incredibly rare, with very few cases being reported previously. Our patient is the first to have been treated through use of an endoscopic endonasal approach. A 61-year-old woman presented with diplopia over a 1-year period. Magnetic resonance imaging identified a 2.8-cm lesion expanding into her right sphenoid sinus. She underwent an endoscopic endonasal approach for histological diagnosis and clearance of the lesion. Intraoperative exploration found the lesion to be originating from Dorello canal. Histological analysis confirmed a benign schwannoma. Following a multidisciplinary case review, we have followed a conservative approach and she remains well on radiological surveillance. In patients presenting with a sixth nerve palsy/paresis and a concomitant sphenoid lesion, clinicians should consider an abducens schwannoma as a possible diagnosis.

Three-Dimensional printed instruments used in a Septoplasty: A new paradigm in Surgery.

OBJECTIVE: Three-dimensional (3D) printing has been rapidly adopted by different surgical disciplines. It has shown itself to have improved outcomes in education, pre-operative planning, and reconstruction. However, using 3D printing to create surgical instruments is a niche within the literature that has not yet been fully explored. The authors present a study in which it is hypothesized that 3D printing surgical instruments can be utilized successfully within ENT surgery. METHODS: As one of the most common ENT operations worldwide, a septoplasty was chosen as the procedure to provide proof of concept. For the septoplasty, five instruments were printed: a scalpel handle, needle holders, toothed forceps, a Cottle/Freer elevator, and a Killian's speculum. The entire set took 224 minutes on average to print, weighed 36 g, and only used approximately 86 pence ($1.20 USD) worth of polylactic acid plastic to create. RESULTS: All steps in performing a septoplasty on a human cadaver with the 3D printed tools were possible and were undertaken successfully. This yielded a similar outcome to using stainless steel with the added benefit of there being a large reduction in cost and the ability for rapid customization according to the surgeon's preferences. CONCLUSION: As technology and mainstream interest in 3D printing develops, the availability of more precise Computer-Aided Design software will allow for more complex designs of tools to be created. Currently, 3D printing has been shown to be a promising method from which future surgical tools can be fashioned to meet the complex, dynamic demands of surgery. LEVEL OF EVIDENCE: N/A.

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.

Endoscopic transsphenoidal surgery reconstruction using the fibrin sealant patch Tachosil®.

INTRODUCTION: The incidence of CSF leak following endoscopic transsphenoidal surgery remains the most important measure in the success of any repair. The nasoseptal flap (NSF) has played a pivotal role in reconstructing defects. However, morbidity associated with the NSF includes bleeding, septal injury, altered smell and crusting. Tachosil® is an absorbable fibrin sealant patch that promotes haemostasis and wound healing. The purpose of this study was to evaluate the effectiveness of Tachosil® to repair intraoperative defects during an endoscopic transsphenoidal approach. MATERIALS AND METHODS: All patients who underwent an endoscopic transsphenoidal approach with the use of Tachosil® at the Queen Elizabeth Hospital Birmingham, between January 2013 and June 2020 were retrospectively analysed. Tachosil® was used as an overlay patch over of the bony defect, in a multi-layered repair depending on the defect and grade of CSF leak. The primary outcome measure was post-operative CSF leak. RESULTS: A total of 52 primary procedures where Tachosil® was used as the overlay were analysed. There were 23 (44.2%) intraoperative CSF leaks. The overall post-operative CSF leak rate was 7.8% (n = 4), with all cases having had a Tachosil® overlay reconstruction with no NSF. A formal NSF was harvested in only five cases alongside the Tachosil® patch, where a grade 2 or more leak was identified at the time of the primary procedure, none of which developed a post-operative leak. No patient had any post-operative adverse outcomes that were attributed to Tachosil®. CONCLUSIONS: We believe this to be the largest case series evaluating the endoscopic use of Tachosil® in skull base reconstruction. Our data show that in endoscopic transsphenoidal approach, Tachosil® may be used safely in a multi-layered approach as an effective alternative to the NSF in low flow CSF leak cases, or alongside a NSF in higher flow leaks.

A Rare Case of Fungal Rhinosinusitis Caused by Scedosporium apiopermum.

Fungal rhinosinusitis (FRS) is inflammation of the paranasal sinus mucosa due to fungal infections, which can be invasive or non-invasive. The occurrence of a sphenoid mucocele with a fungal ball is rare. We report a case of sphenoid sinus mucocele with a fungal ball caused by Scedosporium apiopermum in a 32-year-old female who presented to the Emergency Department with persistent headache not relieved on medications. The radiological images showed a mucocele with clival osteomyelitis. Urgent endoscopic examination and debridement was undertaken which demonstrated a mucocele with fungal ball. Microbiological examination confirmed it to be Scedosporium apiopermum.

Use of the medial canthal point (MCP) as a reliable anatomical landmark to the frontal sinus.

OBJECTIVES: Frontal sinus surgery is considered one of the more challenging aspects of Functional Endoscopic Sinus Surgery, due to the complex variations in normal sinus anatomy but also increased morbidity due to the close proximity of critical structures such as the anterior cranial fossa and orbits. We aim to investigate the medial canthal point (MCP) as an anatomical landmark for safe frontal sinus access. METHODS: The MCP intranasally is identified during surgery with non-tooth forceps, with one limb just anterior to the medial canthus and the other intranasally in the same coronal plane along the skull base. This point was identified on 100 paranasal sinus computed tomography (CT) scan reconstructions. The distance between the anterior cranial fossa and MCP was measured on imaging-medial canthal point distance (MCPD). The maximal anterior-posterior (AP) distance was measured on all scans. RESULTS: The average MCPD for males was 13.0 mm (8.7-20.4 mm) and for females 12.0 mm (6.8-22.8 mm). Mean AP distance for males was 12.0 mm (4.5-20.2 mm) and for females 10.4 mm (3.8-15.9 mm). Mean distance for all 100 patients was 12.6 mm (range 7.5-22.8 mm). In all cases, the MCP was anterior to the cranial fossa. Mixed effects modelling analysis showed a significant correlation between the MCPD and AP distance (P = .006). CONCLUSION: The MCP is a consistent anatomical landmark that can serve as an adjunct to safe frontal sinus access alongside the first olfactory fiber and CT navigation systems. However, patient selection continues to be very important, with larger well pneumatized frontal sinuses being ideal to tackle earlier in a surgeon's career. LEVEL OF EVIDENCE: NA.

Reliability of Thyroid FNAC as a Single Diagnostic Modality: A Systematic Review.

To determine the reliability of thyroid FNAC as a single diagnostic modality in the case of nodular neoplastic lesions of the thyroid. Multiple databases were searched using the MESH terms thyroid*lesion*nodule*neoplasm*fine needle aspiration*histopathology*correlation. Meta analyses, RCTs, cohort or case control studies and case series were searched. 61 studies were examined to verify the search results after applying the inclusion and exclusion criteria. 422 studies were excluded after the first screening, leaving 61 full text articles. These were further analyzed for outcomes, and ultimately 9 studies were chosen for the final synthesis on the basis of clear recommendations given. FNAC as a single modality for the diagnosis of nodular neoplastic thyroid lesions is highly variable and therefore unreliable. The diagnostic yield may be improved if the Bethesda system of reporting is applied.

Longus Colli Tendinitis: The Lost Twin of Retropharyngeal Abscess.

Longus colli calcific tendinitis is a rare condition which mimics the alarming condition, retropharyngeal abscess. Clinically, the patient presents which acute cervical pain, dysphagia and fever. Since this condition is little known to otorhinolaryngologists, it is usually misdiagnosed as a retropharyngeal abscess which is more common. This is a case report of a 52 year old female who presented with complaints of neck pain and difficulty in swallowing along with fever which were acute in onset. Clinically, the symptoms overlapped with those of a retropharyngeal abscess. The diagnosis was confirmed as longus colli calcific tendinitis. Longus colli calcific tendinitis is a rare entity which can be diagnosed solely based on radiological investigation. The knowledge of this disease is crucial to otorhinolaryngolists as it avoids over treatment, unwarranted chance surgical exposure.

Review Article: Retropharyngeal Abscess-Mimickers and Masqueraders.

To discuss a case of suspected retropharyngeal abscess having important clinical and academic significance. This paper discusses an unusual presentation and evolution of a well known condition such as retropharyngeal abscess. Though the diagnosis in this case was initially a retropharyngeal abscess, several unusual findings were evident, which interfered with the optimal management of the patient. A literature review revealed rare causes and lesions mimicking a retropharyngeal abscess, such as retropharyngeal calcific tendinitis and Kawasaki disease, which are neither familiar to otolaryngologists nor other specialists such as orthopedicians. It is possible that this patient was both over treated and undertreated at the same time. Though the diagnosis in this case could not be established with certainty, several important pieces of information came up, especially unusual causes of retropharyngeal abscess and management of the same. Retropharyngeal abscess is a well-known condition with established modes of management. However, certain variations may occur and may pose challenges in diagnosis and management. These variations are little known and need to be highlighted so that optimal management is ensured.

Erratum to: Review Article: Retropharyngeal Abscess-Mimickers and Masqueraders.

[This corrects the article DOI: 10.1007/s12070-017-1105-6.].