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Background: Non-intestinal adenocarcinomas of the sinonasal tract are uncommon neoplasms in adults, and particularly rare in the paediatric population. Case presentation: A 10-year-old male presented to the Paediatric Otolaryngology clinic with symptoms of recurrent epistaxis, persistent clear nasal discharge, and a left-sided polypoidal swelling causing nasal obstruction. An endoscopic biopsy of the polyp under general anaesthesia found a mass arising from the anterior olfactory cleft, and the histology report described the mass as a low-grade non-intestinal adenocarcinoma. CT and MRI of the sinuses post-biopsy demonstrated no bony structure infiltration. The patient underwent a further endoscopic operation for definitive excision of the nasal mass, and the histology findings confirmed a complete resection of the tumour. Conclusion: This case demonstrates the first case of a primary low-grade non-intestinal adenocarcinoma originating from the olfactory cleft.

Abstract Background A rapidly evolving evidence suggests that smell and taste disturbance are common symptoms in COVID-19 infection. As yet there are no reports on duration and recovery rates. We set out to characterise patients reporting new onset smell and taste disturbance during the COVID-19 pandemic and report on early recovery rates. Methods Online Survey of patients reporting self-diagnosed new onset smell and taste disturbance during the COVID-19 pandemic, with 1 week follow-up. Results Three hundred eighty-two patents completed bot an initial and follow-up survey. 86.4% reported complete anosmia and a further 11.5% a very severe loss of smell at the time of completing the first survey. At follow-up 1 week later, there is already significant improvement in self-rating of severity of olfactory loss. 80.1% report lower severity scores at follow-up, 17.6% are unchanged and 1.9% are worse. 11.5% already report compete resolution at follow up, while 17.3% report persistent complete loss of smell, with reported duration being 1 to over 4 weeks. This is reflected in the overall cumulative improvement rate of 79% patients overall in the interval between surveys. Conclusions A review of the growing evidence base supports the likelihood that out cohort have suffered olfactory loss as part of COVID-19 infection. While early recovery rates are encouraging, long term rates will need to be further investigated and there may be an increase in patients with persistent post-viral loss as a result of the pandemic. We further call for loss of sense of smell to be formerly recognised as a marker of COVID-19 infection.

Objectives COVIDTrach is a UK multicentre prospective cohort study project that aims to evaluate the outcomes of tracheostomy in patients with COVID-19 receiving mechanical ventilation and record the incidence of SARS-CoV-2 infection among healthcare workers involved in the procedure.Design Data on patient demographic, clinical history and outcomes were entered prospectively and updated over time via an online database (REDCap). Clinical variables were compared with outcomes, with logistic regression used to develop a model for mortality. Participants recorded whether any operators tested positive for SARS-CoV-2 within 2 weeks of the procedure.Setting UK National Health Service departments involved in treating patients with COVID-19 receiving mechanical ventilation.Participants The cohort comprised 1605 tracheostomy cases from 126 UK hospitals collected between 6 April and 26 August 2020.Main outcome measures Mortality following tracheostomy, successful wean from mechanical ventilation and length of time from tracheostomy to wean, discharge from hospital, complications from tracheostomy, reported SARS-CoV-2 infection among operators.Results The median time from intubation to tracheostomy was 15 days (IQR 11, 21). 285 (18%) patients died following the procedure. 1229 (93%) of the survivors had been successfully weaned from mechanical ventilation at censoring and 1049 (81%) had been discharged from hospital. Age, inspired oxygen concentration, positive end-expiratory pressure setting, fever, number of days of ventilation before tracheostomy, C reactive protein and the use of anticoagulation and inotropic support independently predicted mortality. Six reports were received of operators testing positive for SARS-CoV-2 within 2 weeks of the procedure.Conclusions Tracheostomy appears to be safe in mechanically ventilated patients with COVID-19 and to operators performing the procedure and we identified clinical parameters that are predictive of mortality.Trial registration number The study is registered with ClinicalTrials.Gov (NCT04572438).

Peak sporting performance requires optimal levels of health and fitness. Rhinitis, with its proven detrimental effects on sleep and mood, and its association with asthma, can clearly compromise athletic ability. Nasal health is therefore of key importance to the athlete. While not a limiting factor in a single exercise effort, the effects of nasal dysfunction can have repercussions in the post-exercise recovery period. Furthermore, it is linked with the development of asthma and may increase susceptibility to upper respiratory tract symptoms. This review aims to investigate the physiology of the nose during exercise, examine the relationship between exercise and nasal dysfunction, and consider the impact that dysfunction may have on an athlete. Lastly, the authors describe the diagnosis and treatment of rhinitis in athletes.

Objective: This study examines the effect of preoperative AEN block and SPG nerve block with 0.5 % bupivacaine and 1:200,000 adrenaline (LA) on postoperative pain in patients undergoing endonasal surgery. Study design: This is non-randomised and partly blinded study of 48 patients undergoing ESS. 30 patients underwent pre-operative SPG and AEN local anaesthetic blockade and remaining 18 patients served as controls. Results: The pain score at 1, 2 and 3 hours after the surgery in local anaesthetic vs. control group was 1.1 vs. 2.8 (p

ObjectivesLimited data suggest that swimmers might be affected by poor quality of sleep significantly. The aim was to explore the prevalence of sleep disturbances in swimmers and possible link between rhinitis and sleep disturbance.MethodsStudy 1 was an observational case–control, questionnaire-based study involving 157 elite and non-elite swimmers, 36 non-swimming athletes and 50 controls. In study 2, we measured sleep quality and duration using actigraphy in 20 elite swimmers. We also looked for presence of sleep-disordered breathing using overnight pulse oximetry monitor.ResultsIn study 1, we observed a significant difference in prevalence of excessive daytime sleepiness between groups of elite swimmers and controls. Pittsburgh Sleep Quality Index (PSQI) scores do not suggest that quality of sleep in group of swimmers is impaired. In study 2, we found that prevalence of obstructive sleep apnoea (OSA) in elite swimmers defined as oxygen desaturation index ≥5 was 30%. Analysis of actigraphy data revealed that on nights prior to training days, ‘going to’ bed time was significantly earlier and total sleep time was significantly reduced.ConclusionSwimmers and non-swimming athletes suffer significantly more with excessive daytime sleepiness than healthy controls. In elite swimmers, this is likely linked to high prevalence of OSA. PSQI scores do not suggest that quality of sleep in group of swimmers is impaired, but actigraphy shows great variations between sleep pattern preceding training and rest day. This seems to be associated with early-morning sessions which can be a disruptive element of weekly sleep patterns.

A new method in decision-making of timing of tracheostomy in COVID-19 patients is developed and discussed in this paper. Tracheostomy is performed in critically ill coronavirus disease (COVID-19) patients. The timing of tracheostomy is important for anticipated prolonged ventilatory wean when levels of respiratory support were favorable. The analysis of this timing has been implemented based on classification method. One of principal conditions for the developed classifiers in decision-making of timing of tracheostomy in COVID-19 patients was a good interpretation of result. Therefore, the proposed classifiers have been developed as decision tree based because these classifiers have very good interpretability of result. The possible uncertainty of initial data has been considered by the application of fuzzy classifiers. Two fuzzy classifiers as Fuzzy Decision Tree (FDT) and Fuzzy Random Forest (FRF) have been developed for the decision-making in tracheostomy timing. The evaluation of proposed classifiers and their comparison with other show the efficiency of the proposed classifiers. FDT has best characteristics in comparison with other classifiers.

Biochar has been studied extensively in terms of its influence on soil hydrophysical properties, but only small part of results was obtained from the field experiments. In this study, the soil water content was measured in 5-10 cm depth at experimental plots which received 20 t/ha and 0 t/ha (control) of biochar amendment at the Malanta area (Slovakia). The experimental area was cultivated with maize in 2015 and spring wheat in 2016. Our field measurements show that the positive effect of biochar amendment (20 t/ha) on soil water content is strongly related to the type of the crop grown and not straightforward. Unexpectedly, during the monitoring campaign in 2015 the soil water content of the biochar-amended soil was lower than control. In 2016, negligible differences were observed in soil water contents at both experimental plots, especially during the dry spells. However, higher soil water content was measured at the plot with biochar amendment after the series of precipitation events during the physiological maturity of the spring wheat. Moreover, the biochar amendment did not increase the biomass production and yields of maize in 2015, but it significantly increased the biomass production and yields of spring wheat in 2016.

Objective: This study aimed to investigate the presence of implicit bias among ENT surgeons and explore the impact of the results of the Implicit Association Test on the surgeons' behaviour towards patients. Method: Seven ENT surgeons who were not black, Asian or minority ethnic were asked to complete the Race Implicit Association Test. The surgeons also completed a survey about their perceptions of their implicit biases and the impact of the Race Implicit Association Test results on their behaviour towards patients. Results: The mean Race Implicit Association Test score for the ENT surgeons suggested a slight bias that favoured white over black people. Furthermore, 42 per cent of the surgeons thought that they had hidden or unconscious racial bias, 42 per cent said they would change their behaviour towards patients after receiving these results and 85 per cent thought that the Race Implicit Association Test was helpful for appraisal purposes. Conclusion: The results suggest that ENT surgeons who are not black, Asian or minority ethnic may have implicit biases towards black patients. These findings highlight the need for interventions to reduce implicit bias among ENT surgeons and improve healthcare outcomes for marginalised populations. [ABSTRACT FROM AUTHOR]

Introduction:Aspergillus can cause different allergic diseases including allergic bronchopulmonary aspergillosis (ABPA) and allergic fungal rhinosinusitis (AFRS). ABPA is allergic pulmonary disease against Aspergillus antigens. AFRS is a type of chronic rhinosinusitis (CRS) presented as hypersensitivity reactions to the fungal presence in sinuses. The aim of the present study was to clarify if ABPA and AFRS could be considered as a common disease entity.Methodology: The prospective cohort study included 75 patients with ABPA. Patients were divided into two groups and compared with each other: (i) patients with CT confirmation of rhinosinusitis and presence of fungi in sinuses (ABPA+AFRS group) and (ii) patients without CT or without mycological evidence of AFRS (ABPA group).Results: Findings of this study were: (i) AFRS was confirmed in 80% of patients with ABPA; (ii) all ABPA+AFRS patients had allergic mucin while fungal hyphae were present in 60% sinonasal aspirate; (iii) ABPA+AFRS patients had more often complicated CRS with (nasal polyps) NP (p < 0.001) and more severe forms of CRS; (iv) culture of sinonasal aspirate revealed fungal presence in 97% patients with ABPA+AFRS; (v) patients with ABPA+AFRS had more common positive skin prick test (SPT) for A. fumigatus (p = 0.037), while patients without AFRS had more common positive SPT for Alternaria alternata and Penicillium notatum (p = 0.04 and p = 0.03, respectively); (vi) 67% of ABPA patients had Aspergillus induced AFRS; (vii) larger number of fungi was isolated from the air-samples obtained from homes of patients with ABPA+AFRS than from the homes of patients without AFRS, while the most predominant species were A. fumigatus and A. niger isolated from almost 50% of the air-samples.Conclusion: The pathogenesis of ABPA and AFRS is similar, and AFRS can be considered as the upper airway counterpart of ABPA. Fungi-induced upper and lower respiratory tract allergic diseases present common entity. Next studies should clarify the mechanism by which fungi turn from “normal flora” into trigger of immunological reactions, resulting in ABPA or AFRS as well as to find new approaches for its' diagnosis and treatment.

Background. Prevalence of rhinitis in athletes has frequently been studied and varies widely from 27% to 74%. The aim of this systematic review was to examine the prevalence of rhinitis in athletes, to specifically compare the evidence of rhinitis in land-based and aquatic athletes. Methods. Systematic search of MEDLINE, EMBASE, and the non-MEDLINE subset of PubMed was performed from inception to March 8, 2016, to identify studies on rhinitis in athletes. Results. Of the 373 identified unique articles, a total of 13 studies satisfied the criteria for this review. The final group contained 9 cohort and 4 case-control studies. We found 10 studies that reported the prevalence of allergic rhinitis (21%–56.5%). In contrast, nonallergic rhinitis was identified by only 1 author (6%). We have also evaluated the prevalence of rhinitis in the separate subgroups (land, water, and cold air) where swimmers seem to be the most affected (40%–74%), followed by cross-country skiers (46%) and track and field athletes (21 to 49%). Conclusion. We did not reveal any convincing trend of a higher prevalence in land-based athletes compared to general population. By contrast, aquatic and cold air athletes demonstrate increased prevalence reflecting the irritant effects of their environment on the nasal mucosa.

Heterogeneity in outcomes used in clinical trials prevents meta-analysis and contributes to research waste. Core outcome sets aim to address this by defining a small number of essential outcomes that should be measured in all effectiveness trials. Adoption in routine clinical practice can further improve outcomes for patients. There has been a rapid growth in therapeutic options available for patients with chronic rhinosinusitis with nasal polyps, but difficulty comparing results leads to uncertainty into optimum management, and there is a need to define a core outcome set. We consider whether work already undertaken needs to be modified for patients with nasal polyps. We recommend that a core outcome set should include assessment of disease specific quality of life, nasal polyp score, evaluation of sense of smell, alongside need for OCS and surgical treatment and complications from the disease or treatment. Further work is required to achieve international consensus regarding the choice of nasal polyp scoring system. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to perform a systematic review and meta-analysis of existing evidence on the role of hot saline irrigation in patients undergoing functional endoscopic sinus surgery and its impact on the visibility of the surgical field. Method: A search of PubMed, Cochrane, Ovid databases and Google Scholar was performed. Results: Three randomised controlled trials were included. Pooled meta-analysis demonstrated a statistically significant better visibility of the surgical field, and a reduction in total blood loss and operating time during functional endoscopic sinus surgery in the hot saline irrigation group compared with the room temperature irrigation group. Subgroup analysis of studies that did not use vasoconstrictors showed a significant reduction in total blood loss and operating time. Conclusion: This is the first systematic review that addresses hot saline irrigation for haemostasis in functional endoscopic sinus surgery. The results suggest that hot saline irrigation in functional endoscopic sinus surgery for chronic rhinosinusitis may significantly improve visibility of the surgical field, reduce total blood loss by 20 per cent and decrease operating time by 9 minutes. However, there are limitations of the study because of the significant heterogeneity of the methods, quality and size of the studies. [ABSTRACT FROM AUTHOR]