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Cancer diagnosis and anosmia recovery in the pandemic update, cholesteatoma diagnosis, otosclerosis in pregnancy, and no renaissance of maxillary sinus irrigation

Published online by Cambridge University Press:  14 March 2022

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Abstract

Type
Editorial
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

The latest coronavirus disease 2019 (Covid-19) related articles in The Journal of Laryngology & Otology include an update on head and neck cancer referrals and diagnosis during the pandemic from Wolverhampton.Reference Bhamra, Gorman, Arnold, Rajah, Jolly and Nieto1 We have covered the topic previously in The Journal,Reference Warner, Scholfield, Adams, Richards, Ali and Ahmed2,Reference Banerjee, Voliotidis, Parvin and Rama3 and have articles from before the pandemic for comparison.Reference Williams, Byrne, Holden, Sherman and Srinivasan4 The 62 per cent reduction in fast-track referrals in early 2020 (compared to 2019) during the study period is of the same order of magnitude that has been experienced elsewhere. The authors highlight that this major change in patient illness related behaviour forms part of the hidden cost of the pandemic. A similar detection rate in the two time periods suggests that there is a cohort of undiagnosed patients in the community, which is worrying, despite the acknowledged limitations of the ‘two-week wait’ system of cancer diagnosis.Reference Bethell and Leftwick5

The anosmia story during the pandemic is updated this month by a study from Italy,Reference Fernandez, Molinari, Federici, Silvestri, De Corso and Presutti6 which found that over one-third of anosmic Covid-19 patients still had symptoms after over five months, and those who had a complete recovery tended to have a shorter duration of symptoms. A long duration of symptomatic anosmia predicted incomplete recovery.Reference Fernandez, Molinari, Federici, Silvestri, De Corso and Presutti6 An earlier (small) study from Milan found that 91 per cent of patients had some degree of recovery, with 53 per cent showing total recovery at eight months.Reference Capelli and Gatti7

Cholesteatoma diagnosis by special sequences of magnetic resonance imaging (MRI) has allowed many patients to avoid costly and inconvenient second- or third-look tympanoplasty operations,Reference Crowson, Ramprasad, Chapurin, Cunningham and Kaylie8,Reference Kasbekar, Scoffings, Kenway, Cross, Donnelly and Lloyd9 as the technique has a high predictive value. Equivocal cases might lead to a negative exploration. This issue's study of MRI diagnosis of cholesteatoma, from Newcastle upon Tyne, found that, in equivocal cases, when the lesion in the middle-ear cleft has higher signal intensity compared with the ipsilateral temporal lobe, there is high statistical probability of cholesteatoma diagnosis.Reference Al Zuhir, Zammit-Maempel, Yates and Dixon10

Human papilloma virus (HPV) and its relevance to head and neck tumours continue to stimulate interest; previous work has investigated the prevalence in paediatric tonsils, which has been low.Reference Wojtera, Paradis, Husein, Nichols, Barrett and Salvadori11 The paper in this issue, from London, Ontario (Canada), examined paediatric tonsillectomy specimens in 102 children aged 0–18 years, and found that none contained relevant viral subtypes as determined by a quantitative polymerase chain reaction test.Reference Wojtera, Barrett, Strychowsky, Dzioba, Paradis and Husein12 This suggests no vertical transmission of the virus in this population, unless the virus is latent, as would be expected from a primarily sexually-transmitted disease, and strengthens the push for HPV vaccination prior to the age of sexual activity.

The growing interest in biofilms in inflammatory disorders, and the efficacy of saline douches in the management of chronic rhinosinusitis,Reference Ragab, Lund and Scadding13 has made many rhinologists wonder if the old-fashioned maxillary sinus washout (‘antral lavage’) had some merit and might reappear. This issue has a study from Haifa, Israel, in which patients with chronic rhinosinusitis were treated medically, with or without maxillary sinus irrigation.Reference Ronen, Marshak, Uri, Gruber, Haberfeld and Paz14 The irrigation added nothing, as judged by a careful outcomes assessment, so it seems that the Tilley Lichtwitz trocar and cannula will not experience a manufacturing renaissance just yet.

Otosclerosis has a female bias in presentation and its association with pregnancy has been known for a long time,Reference Crompton, Cadge, Ziff, Mowat, Nash and Lavy15 but how real is the association? This issue's study from Verona, Italy, reviews the topic, but finds that hard and fast answers are hard to come by.Reference Fabbris, Molteni, Tommasi and Marchioni16 The authors conclude that a fair proportion of women (probably over 40 per cent) with a definite diagnosis of otosclerosis experience a deterioration in hearing during or after pregnancy.

References

Bhamra, N, Gorman, B, Arnold, W, Rajah, A, Jolly, K, Nieto, H et al. The impact of coronavirus disease 2019 on suspected head and neck cancer two-week-wait referrals. J Laryngol Otol 2022;136:248–51Google Scholar
Warner, E, Scholfield, DW, Adams, A, Richards, P, Ali, S, Ahmed, J et al. North East London coronavirus disease 2019 protocol for diagnostics in two-week wait head and neck cancer patients. J Laryngol Otol 2020;134:680–3CrossRefGoogle ScholarPubMed
Banerjee, S, Voliotidis, D, Parvin, L, Rama, SPK. Telephone triage of suspected head and neck cancer patients during the coronavirus disease 2019 pandemic using the Head and Neck Cancer Risk Calculator version 2. J Laryngol Otol 2021;135:241–5CrossRefGoogle ScholarPubMed
Williams, C, Byrne, R, Holden, D, Sherman, I, Srinivasan, VR. Two-week referrals for suspected head and neck cancer: two cycles of audit, 10 years apart, in a district general hospital. J Laryngol Otol 2014;128:720–4CrossRefGoogle Scholar
Bethell, GS, Leftwick, P. Views of general practitioners and head and neck surgeons on the referral system for suspected cancer: a survey. J Laryngol Otol 2015;129:893–7CrossRefGoogle ScholarPubMed
Fernandez, IJ, Molinari, G, Federici, G, Silvestri, M, De Corso, E, Presutti, L et al. Delayed recovery from severe acute respiratory syndrome coronavirus-2 related anosmia predicts incomplete olfactory restoration. J Laryngol Otol 2022;136:237–42Google Scholar
Capelli, M, Gatti, P. Anosmia in the first coronavirus disease 2019 outbreak in Europe: functional recovery after eight months. J Laryngol Otol 2021;135:224–8CrossRefGoogle ScholarPubMed
Crowson, MG, Ramprasad, VH, Chapurin, N, Cunningham, CD 3rd, Kaylie, DM. Cost analysis and outcomes of a second-look tympanoplasty-mastoidectomy strategy for cholesteatoma. Laryngoscope 2016;126:2574–9CrossRefGoogle ScholarPubMed
Kasbekar, AV, Scoffings, DJ, Kenway, B, Cross, J, Donnelly, N, Lloyd, SWK et al. Non echo planar, diffusion-weighted magnetic resonance imaging (periodically rotated overlapping parallel lines with enhanced reconstruction sequence) compared with echo planar imaging for the detection of middle-ear cholesteatoma. J Laryngol Otol 2011;125:376–80CrossRefGoogle ScholarPubMed
Al Zuhir, N, Zammit-Maempel, I, Yates, P, Dixon, J. Magnetic resonance non-echo planar diffusion-weighted imaging accuracy in detecting cholesteatoma in comparison with clinical and surgical findings. J Laryngol Otol 2022;136:208–14Google Scholar
Wojtera, M, Paradis, J, Husein, M, Nichols, AC, Barrett, JW, Salvadori, MI et al. The prevalence of human papillomavirus in pediatric tonsils: a systematic review of the literature. J Otolaryngol Head Neck Surg 2018;47:8CrossRefGoogle ScholarPubMed
Wojtera, M, Barrett, JW, Strychowsky, JE, Dzioba, A, Paradis, J, Husein, M et al. The prevalence of human papillomavirus in paediatric tonsils in Southwestern Ontario. J Laryngol Otol 2022;136:243–47Google Scholar
Ragab, SM, Lund, VJ, Scadding, G. Evaluation of the medical and surgical treatment of chronic rhinosinusitis: a prospective, randomised, controlled trial. Laryngoscope 2004;114:923–30CrossRefGoogle ScholarPubMed
Ronen, O, Marshak, T, Uri, N, Gruber, M, Haberfeld, O, Paz, D et al. Direct maxillary irrigation therapy in non-operated chronic sinusitis: a prospective randomised controlled trial. J Laryngol Otol 2022;136:229–36Google Scholar
Crompton, M, Cadge, BA, Ziff, JL, Mowat, AJ, Nash, R, Lavy, JA et al. The epidemiology of otosclerosis in a British cohort. Otol Neurotol 2019;40:2230CrossRefGoogle Scholar
Fabbris, C, Molteni, G, Tommasi, N, Marchioni, D. Does pregnancy have an influence on otosclerosis? J Laryngol Otol 2022;136:191–96Google Scholar
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Cancer diagnosis and anosmia recovery in the pandemic update, cholesteatoma diagnosis, otosclerosis in pregnancy, and no renaissance of maxillary sinus irrigation
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