To document changes in evaluation protocols for acute invasive fungal sinusitis during the coronavirus disease 2019 pandemic, and to analyse concordance between clinical and histopathological diagnoses based on new practice guidelines.

Protocols for the evaluation of patients with suspected acute invasive fungal sinusitis both prior and during the coronavirus disease 2019 period are described. A retrospective analysis of patients presenting with suspected acute invasive fungal sinusitis from 1 May to 30 June 2021 was conducted, with assessment of the concordance between clinical and final diagnoses.

Among 171 patients with high clinical suspicion, 160 (93.6 per cent) had a final histopathological diagnosis of invasive fungal sinusitis, concordant with the clinical diagnosis, with sensitivity of 100 per cent, positive predictive value of 93.6 per cent and negative predictive value of 100 per cent.

The study highlights a valuable screening tool with good accuracy, involving emphasis on ‘red flag’ signs in high-risk populations. This could be valuable in situations demanding the avoidance of aerosol-generating procedures and in resource-limited settings facilitating early referral to higher level care centres.

To determine risk factors affecting mortality in acute invasive fungal sinusitis.

This observational cohort study was conducted over a five-year period.

Of 109 recruited patients, 90 (82.6 per cent) had diabetes mellitus. Predominant fungi were zygomycetes (72.6 per cent) with Rhizopus arrhizus being most common. Of the patients, 12.8 per cent showed a positive biopsy report from radiologically normal sinuses. Factors affecting mortality on multivariate analysis were: female sex (p = 0.022), less than two weeks between symptoms and first intervention (p = 0.01), and intracranial involvement (p = 0.034). Other factors significant on univariate analysis were: peri-orbital swelling (p = 0.016), restricted ocular movements (p = 0.053), intracranial symptoms (p = 0.008), posterior disease (p = 0.058), imaging showing ocular involvement (p = 0.041), fungus being zygomycetes (p = 0.050) and post-operative cavity infection (p = 0.032). Bilateral, palatal and retromaxillary involvement were not associated with poor prognosis.

Diagnosis of acute invasive fungal sinusitis requires a high index of clinical suspicion. Recognition of factors associated with poor prognosis can help when counselling patients, and can help initiate urgent intervention by debridement and antifungal therapy. Post-operative nasal and sinus cavity care is important to reduce mortality.

Chronic rhinosinusitis is associated with altered mucociliary clearance and olfaction. The study aimed to analyse the reversibility of impairment and endoscopic factors predicting changes in mucociliary clearance and olfactory parameters.

This prospective study included patients undergoing functional endoscopic sinus surgery for medically refractory chronic rhinosinusitis. Pre- and post-operative measurements of mucociliary clearance, olfactory thresholds, and identification scores were recorded.

Of the 96 patients, 65.6 per cent had polyposis and 80.2 per cent underwent primary surgery. Improvements in mucociliary clearance and olfaction scores were seen in all patients, with greater reversibility of impairment in patients with polyposis and in those who underwent revision surgery. The presence of polyps correlated significantly with changes in mucociliary clearance and olfaction.

The study highlights improvements in mucociliary clearance, olfactory thresholds and identification scores after functional endoscopic sinus surgery in chronic rhinosinusitis with or without nasal polyposis, as well as for primary and revision surgeries. Adequate post-operative care and prevention of polyps recurrence help to improve mucociliary clearance and olfaction scores.

To investigate the long-term outcomes of pulmonary nodules detected on chest computed tomography in a consecutive cohort of patients with newly diagnosed or recurrent head and neck squamous cell cancer staged between 2001 and 2003.

The study included 222 patients, 148 patients with newly diagnosed head and neck cancer (group 1) and 74 patients with recurrent cancer (group 2). Abnormalities were identified in 101 patients (45.4 per cent); these were predominantly benign in group 1 (61.7 per cent) as compared to predominantly malignant in group 2 (64.3 per cent) (Fisher's exact test; p = 0.0009). Only four patients (7.4 per cent) with an initially benign-looking pulmonary nodule went on to develop malignancy over time, conferring a negative predictive value of 93 per cent for the whole cohort.

Chest computed tomography abnormalities in patients with recurrent head and neck cancer are statistically more likely to be malignant. Very few patients with an initially benign-appearing nodule develop chest malignancy over time.

To assess the role of video endoscopy in evaluating velopharyngeal incompetence and investigate a possible relationship between velopharyngeal incompetence type and speech defect in cleft palate patients.

A prospective study of 28 pre- or post-operative cleft palate patients with speech defects who attended Plastic Surgery–Cleft Palate and ENT out-patient clinics was performed. The velar defect type was determined using a flexible endoscope and findings were video recorded. Speech pathology was assessed using the cleft palate audit protocol for speech.

A significant, clinically relevant relationship was noted between the perceived characteristics of hypernasality and velopharyngeal insufficiency type. Hypernasal speech was a definite clinical indicator of velopharyngeal incompetence, and the type 1 velopharyngeal defect was most common. Type 1 velopharyngeal coronal-type dysfunction was strongly associated with hypernasality (p < 0.05). When speech substitution was noted, type 2 velopharyngeal (or sagittal) incompetence could be predicted (p < 0.05).

In the management of cleft palate patients, it is important that surgical correction of the defect and achieving velopharyngeal competency for speech are performed simultaneously. Pre-operative velopharyngeal endoscopy with speech assessment will define the anatomical and functional bases for velopharyngeal correction and assist in planning and tailoring the pharyngeal flap.

In an emergency, the non-availability of a conventional paediatric tracheostomy tube is a therapeutic challenge for the attending surgeon.

To describe a simple alternative to a paediatric tracheostomy tube for use in an emergency situation.

Case report of a 14-year-old boy who developed tracheomalacia following partial cricotracheal resection for subglottic stenosis. As a suitably sized tracheostomy tube (with a long narrow segment) was not available, an endotracheal tube was modified and used successfully. Details of the modification, and a relevant literature review, are also discussed.

In the paediatric age group, when an appropriately sized tracheostomy tube is not available, a modified endotracheal tube is a simple temporary alternative; this may be especially useful in an emergency.

To highlight the clinical presentation and management of a rare case of oncogenic osteomalacia due to an ethmoid sinus tumour.

We examined the case records of a 55-year-old man who presented with progressive fatigue, weakness and bone pain, and noted the clinical presentation, laboratory investigations, computed tomography findings, operative notes and follow-up details.

Oncogenic osteomalacia secondary to a paranasal sinus neoplasm is a rare entity. The causative tumour is often occult and may be missed by routine clinical examination. This case report illustrates the appropriate pattern of evaluation and management to ensure a successful outcome.