The impact of the COVID-19 pandemic on otolaryngologic emergency department visits at two major NYC hospital systems.

PURPOSE: Since the COVID-19 pandemic began, emergency departments (ED) across the country have seen a significant decrease in patient visits. We aim to evaluate the impact of COVID-19 on ED visits for acute otolaryngologic complaints in New York City, one of the first epicenters of the pandemic in the US. MATERIALS AND METHODS: We conducted a retrospective study of patients who presented to the ED with a primary diagnosis of an acute otolaryngologic complaint between March 1 and May 31 in 2019 and 2020. This was a multicenter study, including two tertiary care hospital systems encompassing Manhattan, Bronx, Queens, and Long Island. RESULTS: A total of 10,162 patients were identified. Significantly fewer patients presented to the ED for acute otolaryngologic complaints in 2020 (7332 vs 2830, p < 0.001). The rate of total otolaryngology-related ED visits was decreased by a factor of 0.635 (95% CI 0.6079 to 0.6634). In a subgroup analysis of each individual diagnosis, there was a significant decrease in rate of ED visits for 13 out of 18 diagnoses, including for life-threatening conditions, such as anaphylaxis. There was no significant difference based on which borough in New York City. Pediatric patients (age 0-17) were more significantly impacted by the pandemic compared to other age groups. CONCLUSION: The COVID-19 pandemic has led to a reduction in the utilization of ED for acute otolaryngologic complaints, including those requiring emergent management, and an even more significant reduction in the pediatric population. Healthcare providers should encourage patients to seek appropriate care, particularly for those illnesses with significant associated morbidity and mortality.

COVID-19 findings revealed via otolaryngological examination: Findings of a Japan Otorhinolaryngologist Association questionnaire.

OBJECTIVE: In Japan, many otolaryngologists provide primary care for patients with coronavirus disease 2019 (COVID-19). The purpose of this study was to analyze the characteristics of otorhinolaryngological findings in order to improve COVID-19 diagnostic systems in a primary care setting. METHODS: A total of 351 patients (mean age, 36.0 ± 15.4 years) diagnosed with COVID-19 by otolaryngologists who belong to the Japan Otorhinolaryngologists Association were included in the study. A web-based questionnaire was used to collect information regarding the timing of positive identification of COVID-19, the route of infection, symptoms, and findings in the tonsils, nasal cavity, pharynx, ear, and neck. A modified Centor score was calculated for cases in which age, symptoms, and tonsil and neck findings were described. RESULTS: Symptoms included fever (56%), olfactory disturbance (46%), and a sore throat (56%). Of the individuals considered, 63% had ordinary rhinoscopic findings, 21% experienced watery rhinorrhea, and 12% had observable mucosal redness. Further, 87% had ordinary tonsillar findings, 13% displayed tonsillar redness, with enlargement and white mucus observe in 2% and 1% of participants, respectively. A total of 193 patients had a calculated Centor score of 3 points in 2%, and scores of the remaining participants were ≤2 points. CONCLUSION: Of all patients considered, 40% had nasal findings and 4% had purulent nasal discharge. In contrast, only 13% of the patients had tonsillar findings, and no patients had Centor scores ≥4 points. Symptom differentiation from that of bacterial infections is difficult. In areas where COVID-19 is prevalent, the disease should be considered in patients presenting with fever, olfactory disturbances, and sore throat with minimal or no clinical findings in the nasal cavity and pharynx.

Otorhinolaryngological manifestations of coronavirus disease 2019: a prospective review of 600 patients.

OBJECTIVES: To evaluate otorhinolaryngological manifestations of coronavirus disease 2019 infection and the time required for their resolution. METHODS: A prospective analysis was conducted of coronavirus disease 2019 patients presenting from 1 April 2020 to 30 July 2020. The otorhinolaryngological manifestations were evaluated based on patient history. The time required for symptom resolution was evaluated separately for intensive care unit and non-intensive care unit patients. RESULTS: A total of 600 patients were included in the study; 13.3 per cent required the intensive care unit and 2.2 per cent expired. The otorhinolaryngological manifestations were: sore throat (88 per cent), fever (78.8 per cent), anosmia or hyposmia (63.6 per cent), ageusia or hypogeusia (63.5 per cent), rhinorrhoea (51.3 per cent), nasal obstruction (33.5 per cent), sneezing (30.3 per cent), and breathing difficulty (18.6 per cent). The time required for symptom resolution was longest for breathing difficulty (23.6 days for intensive care unit and 8.2 days for non-intensive care unit patients). CONCLUSION: Otorhinolaryngological symptoms are one of the main presentations of coronavirus disease 2019 infection. The increased prevalence of medical co-morbidities in patients requiring intensive care unit and in deceased patients is also highlighted.

Consensus statement. Corticosteroid therapy in ENT in the context of the COVID-19 pandemic.

This consensus statement about the indications and modalities of corticosteroid treatment in the context of the COVID-19 pandemic was jointly written by experts from the French Association of Otology and Oto-Neurology (AFON) and from the French Society of Otorhinolaryngology, Head and Neck Surgery (SFORL). There is currently not enough data in favour of danger or benefit from corticosteroids in COVID-19, so until this matter is resolved it is advisable to limit their indications to the most serious clinical pictures for which it is well established that this type of treatment has a positive impact on the progression of symptoms. In Grade V and VI Bell's palsy according to the House-Brackmann grading system, a week's course of oral corticosteroids is recommended. Corticosteroid therapy is also recommended in cases of sudden hearing loss of more than 60dB, either in the form of intratympanic injections or a week's course of oral medication. In rhinology, there is no indication for systemic corticosteroid therapy in the current situation. However, patients are advised to continue with their local corticosteroid therapy in the form of a nasal spray or by inhalation. Treatments with corticosteroid nasal sprays can still be prescribed if there is no alternative. Finally, systemic or local corticosteroid therapy is not indicated for bacterial ENT infections.

Clinical evidence based review and recommendations of aerosol generating medical procedures in otolaryngology - head and neck surgery during the COVID-19 pandemic.

BACKGROUND: Aerosol generating medical procedures (AGMPs) present risks to health care workers (HCW) due to airborne transmission of pathogens. During the COVID-19 pandemic, it is essential for HCWs to recognize which procedures are potentially aerosolizing so that appropriate infection prevention precautions can be taken. The aim of this literature review was to identify potential AGMPs in Otolaryngology - Head and Neck Surgery and provide evidence-based recommendations. METHODS: A literature search was performed on Medline, Embase and Cochrane Review databases up to April 3, 2020. All titles and abstracts of retrieved studies were evaluated and all studies mentioning potential AGMPs were included for formal review. Full text of included studies were assessed by two reviewers and the quality of the studies was evaluated. Ten categories of potential AGMPs were developed and recommendations were provided for each category. RESULTS: Direct evidence indicates that CO2 laser ablation, the use of high-speed rotating devices, electrocautery and endotracheal suctioning are AGMPs. Indirect evidence indicates that tracheostomy should be considered as potential AGMPs. Nasal endoscopy and nasal packing/epistaxis management can result in droplet transmission, but it is unknown if these procedures also carry the risk of airborne transmission. CONCLUSIONS: During the COVID-19 pandemic, special care should be taken when CO2 lasers, electrocautery and high-speed rotating devices are used in potentially infected tissue. Tracheal procedures like tracheostomy and endotracheal suctioning can also result in airborne transmission via small virus containing aerosols.

Pediatric Human Immunodeficiency Virus and Otolaryngologic Manifestations: An Analysis of Hospital Admissions From 1997 to 2012.

OBJECTIVES/HYPOTHESIS: Many human immunodeficiency virus (HIV)-infected pediatric patients develop otolaryngologic disease. We aimed to characterize their otolaryngologic manifestations by type and demographic variation, and model temporal trends. STUDY DESIGN: Retrospective cohort review. METHODS: A retrospective review utilizing the Kids' Inpatient Database (KID) was conducted. International Classification of Diseases, Ninth Revision, Clinical Modification codes for HIV and otolaryngologic diagnoses were used to query data from the triennially published KID files from 1997 to 2012. A subset analysis of infectious versus non-infectious admitting otolaryngologic diagnoses was conducted. RESULTS: A total of 11,150 cases met the inclusion criteria. Of these cases, 21.8% were admitted for otolaryngologic manifestations, with 18.0% presenting with infectious symptomatology, 4.8% with noninfectious disease, and 1.0% with both. On average, patients presenting with infectious disease were younger (8.17 years vs. 9.65 years, P < .001). Patients in the South were significantly more likely to be admitted for infection (54.8% vs. 42.0%, P < .001), with non-infectious predominance in the Northeast and West. HIV-infected children in 1997 were more likely to present with infectious otolaryngologic disease (56.3% vs. 45.8%, P < .001); however, there has been a decrease in the prevalence of infectious head and neck presentations (46.5%, 19.9%, 11.5%, 6.7%, 3.7%, and 1.9% from 1997 to 2012), and a gradual shift toward noninfectious manifestation with notable differences in 2000 and 2012 (19.9% vs. 25.2%; P = .017; and 1.9% vs. 4.8%, P < .001, respectively). CONCLUSIONS: Otolaryngologic disease accounts for nearly one-fifth of hospitalizations in HIV-infected children; however, rates of hospitalization as well as otolaryngologic manifestations have progressively decreased over time. HIV-infected children nowadays are more likely to present with noninfectious rather than infectious disease. LEVEL OF EVIDENCE: NA Laryngoscope, 129:E377-E382, 2019.

[Persistent infections in the children presenting with chronic ENT diseases: the potential of etiotropic therapy].

The objective of the present study that involved 176 children at the age varying from 2 to 12 years presenting with chronic ENT diseases was etiological diagnostics and etiotropic therapy of these pathologies taking into consideration the duration of the disease of less than one year (n=72), from 1 to 2 years (n=54), and over 2 years (n=50). The bacteriological method was employed to identify microflora from the upper respiratory tract and the molecular-biological methods for the detection of Epstein-Barr virus DNA, cytomegalovirus, and 6 types of human herpes virus in the blood and saliva. All the children were treated with the recombinant interferon preparations given for 1-1.5 months. For 41% of the children this treatment was combined with antibacterial therapy followed by immunocorrective therapy with interferon inducers (in 79.4% of the patients) or bacterial lysates (20.6%). The study revealed the predominant role of types 4, 5, and 6 type herpes viruses in the development of chronic ENT pathologies in the children with the gradual lowering of activity of these infections over 2 years. Staphylococcus aureus and Streptococcus pyogenes as well as fungi of the genus Candida were the commonest bacterial and fungal pathogenic agents isolated from the naso- and oropharynx of the children suffering from chronic ENT pathology.The effectiveness of etiotropic therapy was shown to decrease with time, from 78% during 1 year after the onset of the disease to 30% within the next 2 years.

Herpes zoster as a systemic disease.

Herpes zoster (shingles, zona) is a viral infection commonly affliccting the skin and the nervous system with an overall occurring rate of 3 to 5 cases per 1000 persons per year, with higher rates in middle or later life. With the advancement of medicine, more and more case reports have started to emerge showing different incidences of VZV, some new localizations, clinical presentations, and complications, which break the well-known fact that "VZV affects the skin and nervous system." Skin lesions are the most important ones for the early and exact diagnosis of herpes zoster (HZ), due to its visibility and well-defined clinical picture of lesions. The most frequent condition following the acute herpes zoster eruption is postherapeutic neuralgia (PHN). There have been other reports of the disease with otorinolaryngologic complications and ophthalmologic ones, such as ophthalmoparesis/plegia. There have also been reports of delayed contralateral hemiparesis/hemiplegia following the infection, as a manifestation of vaculitis due to a direct VZV invasion of the cerebral arteries. Encephalitis and destructive myelitis is similarly rare, but a serious complication. Some authors found that patients with inflammatory bowel disease are at a significantly increased risk for herpes zoster. As a gastroenterologic complication, there have been several instances of HZV infection with symptoms resembling an acute abdomen. The diagnosis is hard to pinpoint, and a vast array of examinations are required to identify it, sometimes even posthumously. Nephrologic representations and complications have also been reported. With more and more skin diseases being acknowledged as systemic ones, this viral infection is a more likely candidate for the same title.

Creutzfeldt-Jakob disease and ENT.

OBJECTIVE: This review addresses Creutzfeldt-Jakob disease in the context of ENT, and aims to summarise the relevant history, pathophysiology and implications for contemporary practice. OVERVIEW: Creutzfeldt-Jakob disease is a rare, fatal, neurodegenerative disorder. It is a prion disease with four different subtypes that can only be definitively diagnosed post-mortem. The main implications for the ENT surgeon lie in the risk of iatrogenic transmission. The three facets of assessing individual patient risk are: patient history; tissue infectivity; and procedure infectivity. CONCLUSION: This is a controversial area in medicine, and ENT in particular. This review highlights a clinically applicable approach for everyday use.

Otolaryngological, head and neck manifestations in HIV-infected patients seen at Steve Biko Academic Hospital in Pretoria, South Africa.

BACKGROUND: Sub-Saharan Africa has the highest incidence of HIV infection. According to recent census statistics, 5.6 million people in South Africa (SA) are HIV-positive, the highest number of infected individuals worldwide. Over 80% of HIV-infected individuals will present with ear, nose and throat (ENT) manifestations. Previous studies show that oral diseases seem to be the most common ENT-related manifestation, reported in about 40 - 50% of HIV-infected patients. In SA, there is lack of local information regarding the otolaryngological and head and neck manifestations in HIV-infected individuals. OBJECTIVE: To ascertain our local trends of ENT and head and neck manifestations in HIV-infected patients seen at our specialised ENT-HIV Clinic, Steve Biko Academic Hospital, Pretoria, Gauteng Province, SA. METHODS: A 1-year prospective study involving 153 HIV-infected patients was conducted in the clinic from January to December 2011. Patient history was taken and examinations were performed based on the World Health Organization (WHO) HIV/AIDS classification system. Data analysis was performed using Epi Info 7 software. RESULTS: The most common manifestations were adenoid hypertrophy/hyperplasia followed by cervical lymphadenopathy, chronic suppurative otitis media, otitis media with effusion and sensory-neural hearing loss. CONCLUSION: Patients typically presented with early manifestations during symptomatic WHO stages I and II in contrast to results reported in similar developing world studies from Iran, Nigeria and India. A possible explanation may lie in the SA government HIV Counselling and Testing campaign and the antiretroviral rollout programme, the effectiveness of which is becoming evident.

Head, neck and ophthalmologic manifestations of HIV in the emergency department.

Emergency medicine physicians are uniquely positioned to detect manifestations of human immunodeficiency virus (HIV) disease in the head and neck region. Awareness of the myriad of opportunistic infections and malignancies that involve the head, neck, and eyes is paramount to their diagnosis and treatment. On occasion some of these manifestations are a direct result of HIV and represent the initial signs of primary HIV infection. In some cases, prompt diagnosis and therapy will lead to preservation of function and prevention of significant morbidity.

Otolaryngologic manifestations of pediatric immunodeficiency.

Many adults and children with an underlying immunodeficiency can frequently present to ear, nose and throat (ENT) surgeons. This work deals with the presentation, investigation and management of immuno-compromised children in ENT practise. Both primary immunodeficiencies (PID) and secondary or acquired immunodeficiencies such as human immunodeficiency virus (HIV) infection are here discussed. The aim of this work is to give a complete and exhaustive description of ENT manifestations in immunodeficiency, and to outline basic principles to guide clinical practice.

Manifestações otorrinolaringológicas relacionadas à Leishmanisoe Tegumentar Americana: revisão de literatura / Otorhinolaryngologic manifestations relating American Tegumentary Leishmaniasis: literature review

Introdução: A LTA é um problema de Saúde Pública que acomete principalmente as cavidades nasal, oral e mais raramente faringe, laringe e orelha, provocando desfiguração dessas mucosas e levando não só ao acometimento da saúde do indivíduo, mas também a estigmas sociais. Objetivo: Estudo de revisão sobre as Afecções Otorrinolaringológicas relacionadas à Leishmaniose Tegumentar Americana (LTA). Método: Foi realizado por levantamento de dados nas bases SCIELO, MEDLINE, BIREME e livros médicos. Conclusão: O conhecimento a respeito das doenças endêmicas tropicais relacionadas às vias aéreas superiores e a compreensão das suas relações com a otorrinolaringologia são de extrema importância para a resolutividade dessas lesões, bem como para prevenir as deformidades causadas nas estruturas acometidas.

Introduction: American Tegumentary Leishmaniasis is a Public Health problem that most commonly affects nasal and oral cavities and less commonly pharynx, larynx and ears, causing these mucouses' disfiguration and leading not only to one's health loss but also to social stigma. Objective: Review study about Otorhinolaryngological affections relating American Tegumentary Leishmaniasis (ATL). Method: Study made by research from SCIELO, MEDLINE and BIREME databases and from medical books. Conclusion: The Knowledge about tropical endemic diseases relating to the upper respiratory passages and the understanding of their relation with otorhinolaryngology are extremely important for solving these lesions, as well as preventing the deformities caused on the affected structures.

[Piercing--medical problems from otorhinolaryngological point of view]. / Piercing--medizinische Probleme aus HNO-ärztlicher Sicht.

Piercing is defined as puncturing an organ in order to place a jewel in the perforated site. There is hardly any external organ in the human body that has escaped piercing. The origin of piercing traces back to the dawn of human history. Piercing is performed for decorative or symbolic purposes. Many different medical specialists are confronted with the increasingly popular practice of body piercing in their daily practice. Until recently body piercing was mainly confined to the ears and/or nose. In the last few years there has been a significant increase in the prevalence of body piercing. There are a lot of side effects, among them especially infections. The most important bacteria cultivated from such patients are Staphylococcus aureus and group A streptococci and Pseudomonas aeruginosa. Viruses which can be transmitted by piercing are especially hepatitis B virus and hepatitis C virus. Besides local complications also systemic infections (sepsis, endocarditis) occur. The main aspects of diagnostics, therapy and prevention are discussed.

[Observation on HIV-infected patients with otolaryngology surgery].

OBJECTIVE: To discuss the feasibility of otolaryngology surgery on HIV-infected patients. METHOD: Nineteen cases HIV-infected patients whose general examinations were normal were operated. RESULT: Two cases died in the day of operation, 1 case died due to the syndrome of AIDS in the third month after operation, the others are still alive and their symptoms and quality of life improved after operation. CONCLUSION: If general examinations are normal, the otolaryngology surgery can be performed for HIV-infected patients and the assuredness and ratio of survive will be improved.

Otolaryngologic manifestations of human immunodeficiency virus infection.

The otolaryngologist is uniquely positioned to detect and pursue manifestations of HIV in the head and neck. The presentation of problems subsequent to HIV infection is quite varied, but close investigation will often reveal treatable problems.

[Ear, nose and throat pathology in human immunodeficiency virus infection]. / Pathologie de la sphère ORL au cours de l'infection par le virus de i'immunodéficience humaine.

Human immunodeficiency virus (HIV) infection, which is responsible for AIDS, is one of the most widespread in the world. Its clinical manifestations are polymorphous, and are casued by the virus itself (primary lesions) or the resulting immunodepression (secondary lesions). All the body can be affected, and the ORL organs are frequently involved. Our purpose was to describe these manifestations at all stages of the disease, and to illustrate the importance of an early diagnosis, which needs close collaboration between the clinician, the anatomopathologist and the radiologist.

[Unusual manifestation of zoster sine herpete as unilateral caudal cranial nerve syndrome]. / Ungewöhnliche Manifestation eines Zoster sine herpete als unilaterales kaudales Hirnnervensyndrom.

Multiple lower cranial nerve palsies are a rare complication following varicella zoster virus (VZV) reactivation, especially if typical herpetic eruptions are lacking. We report a case of a 45-year-old, immunocompetent male with unilateral involvement of the cranial nerves VIII, IX, X, and XI without skin lesions. Cerebrospinal fluid (CSF) studies revealed mononuclear pleocytosis with intrathecal antibody synthesis against VZV, while polymerase chain reaction (PCR) did not detect VZV or HSV (herpes simplex virus). The patient almost completely recovered after aciclovir administration. VZV reactivation without rash (zoster sine herpete) may lead to multiple cranial nerve palsies. PCR is a useful tool to detect VZV-DNA in CSF, but negative results do not exclude a reactivation. In case of multiple cranial nerve palsies of unknown etiology with mononuclear pleocytosis in CSF tumors of the skull base, meningitis tuberculosis, and meningeosis have to be excluded, and antiviral therapy should be discussed.