Vassilios A. Lachanas

Background: Deep neck infections represent a common but heterogeneous medical condition, as clinical manifestations and outcomes vary, depending, among others, on the infection site. The pharyngeal mucosal space (PMS) represents the most superficial neck space, confined between the pharyngeal mucosa and the pharyngeal constrictor muscles. The collection of pus in the PMS (pharyngeal mucosal abscess (PMA)) is considered rare and is rarely reported in the literature. This study focuses on infections of the pharyngeal mucosal space, aiming to provide an elaborate description of the clinical behavior of this category and reporting its differences from other categories of deep neck infections (DNIs). Methods: A retrospective study of 743 cases of deep neck infections was conducted in a single tertiary center. Cases of abscesses, confined in the pharyngomucosal space (PMAs), were studied, reporting demographics, clinical features, imaging, bacteriology, and treatment data, and comparisons with other DNIs were made. Results: A total of 106 cases of pharyngomucosal space abscesses (PMAs) were reported, representing 14.3% of deep neck infections (DNIs). Dysphagia, odynophagia, and fever were the most common symptoms. Hospitalization with non-surgical drainage was the treatment of choice, resulting in complete recovery with no complications. Conclusions: In conclusion, the frequency of PMAs in our series suggests that they may not be as rare as they are considered to be. Symptoms and clinical findings can be similar to those of other DNIs, especially parapharyngeal abscesses, but, overall, PMAs seem to have a milder clinical behavior, highlighting the need for diagnosis and reporting as a separate, recognizable category.

Glomus tympanicum are benign tumors of vascular origin, arising from the neural crest cells and located on promontory. The treatment of choice is surgical excision of the lesion. Traditionally, it is performed under microscopic observation. With the introduction of endoscopes in the field of ear surgeries, an endoscopic approach has also evolved. Herein, we present case reports of three patients diagnosed with glomus tympanicum tumors who were operated on using an endoscopic approach. A review of the literature is also performed. The mass was completely excised in all patients, and there were no signs of recurrence at the follow-up at least a year later. Endoscopic ear surgery is a safe and effective method of managing glomus tympanicum tumors. Its main limitation is the tumor size; however, in most cases, tumors of stages I to II as per the Glasscock-Jackson classification and types A1 to B1 according to the modified Fisch-Mattox classification can be completely removed endoscopically. Careful preoperative selection of patients warrants the best outcomes.

Sinonasal lobular capillary hemangiomas (LCH) are rare benign vascular lesions commonly arising from the nasal septum. Nasopharyngeal, nasal mid-turbinate, and anterior nasal swabbing is the preferred method of screening for coronavirus disease-2019 (COVID-19). Herein, we present a case of a sinonasal LCH in a child after continuous self-tests for COVID-19, with an anterior nasal swab. The child presented with a well-defined red mass in the anterior part of the nasal septum, which was removed endoscopically. Histopathology revealed a LCH. This is the first report of a complication other than epistaxis with the use of an anterior nasal swab. Our literature review identified 32 studies reporting complications of COVID-19 screening. Cerebrospinal fluid leaks and foreign body retention are the most common ones. A proper specimen collection technique and a quick patient history with an emphasis on risk factors are the best practices to prevent complications from COVID-19 screening.

Keypoints: • The presence of a pharyngeal mucosal space abscesses (PMA), being confined between the pharyngeal mucosa and the pharyngeal constrictor muscle, is considered rare. However, in our series represented 14,3% of deep neck infections (DNIs), suggesting that they may not be so rare as they are considered to be. • PMAs’ symptoms and clinical findings are similar to those of other DNIs, but trismus and neck swelling seem to be significant lower in PMAs. • Imaging studies will set PMA diagnosis, while CT with contrast is the modality of choice. • PMAs seems to be less dangerous than their deep-seated counterparts, since its superficial location renders them amenable to spontaneous drainage, aspiration, incision and drainage intraorally obviating spread to deeper structures.

Aims: In this particular study, we report our experience of eight doctors infected with SARS-CoV-2 and discuss the probability of in-hospital virus transmission to patients or the rest of the hospital personnel. The importance of PPEs is highlighted.

Objectives Endoscopic approaches constitute a newly introduced and promising technique in the field of stapes surgery, presenting favorable outcomes, so far. This study aims to compare endoscopic and microscopic stapes surgery based on current literature evidence, in terms of their efficacy and safety characteristics. Design We conducted a systematic literature search of three medical databases (Pubmed, Cochrane Library, and Scopus). We focused on randomized controlled studies or observational studies comparing microscopic to endoscopic stapes surgery. Data related to the efficacy and safety of each technique were extracted. Outcome data were summarized using the pooled mean differences or pooled odds ratio along with their 95% confidence intervals, according to the available data. The quality of evidence was assessed according to the GRADE recommendations. Results Thirteen studies with 705 patients were included in the meta-analysis. Success rate was evaluated by estimating air-bone gap improvement, resulting in comparable outcomes for the two techniques (mean difference: -0.20; 95% CI: -0.53, 0.14). No statistically significant difference was detected concerning postoperative complications, except for dysgeusia that was in favor of the endoscopic approach (OR: -1.46; 95% CI: -2.45, -.047). The overall quality of evidence was assessed to range from “Low” to “Very Low”. Conclusion Endoscopic stapes surgery is an innovative alternative to the microscopic technique, resulting in commensurate outcomes in terms of success rate and complications. Further high-quality studies are needed, to adequately compare the two approaches, particularly in terms of operation time, learning curve, cost-effectiveness, and otology surgical skills acquisition.

Key point: • Being one of the commonest presenting emergencies, epistaxis can increase the pressure on the health service; in times similar to COVID-19 pandemic such pressure can be crucial and challenging to deal with. • Non-absorbable nasal packing and home discharge for selected patients can be a safe and efficient alternative treatment method with low readmission rates (5.3 %); such management can be of tremendous help when the hospital capacity is overwhelmed. • Although such protocols can be challenging to generalize, the presented protocol seems safe, easily adoptable without any significant complications.