ENT Regions Research Articles

ENT manifestations of Sjogren’s syndrome: A narrative review

Sjogren's syndrome (SS) is an autoimmune condition marked by dryness of the mouth and eyes, frequently manifesting as a range of ENT symptoms that have a major negative impact on the quality of life of patients. Dryness and discomfort in the mouth and eyes, brought on by lacrimal and salivary gland dysfunction are ENT symptoms in SS. However, ENT regions are involved in more areas than just the ocular surface and mouth cavity. Due to laryngopharyngeal involvement, patients may experience hoarseness, dysphagia, and the sensation that something foreign is in their throat. Common nasal symptoms include nasal dryness, congestion, and recurrent sinusitis, while Eustachian tube dysfunction can lead to middle ear infections and hearing problems. To improve the quality of life in SS patients, clinicians and healthcare professionals should be careful in identifying and treating these symptoms. More investigations and clinical trials are required to create tailored medicines that can reduce ENT symptoms and enhance long-term outcomes for SS patients.

Covid associated orbital apex syndrome: Madras ENT Research Foundation experience

<p class="abstract">The second wave of corona virus pandemic is currently raging through India since last few weeks. Since last year, COVID-19 has brought in a multitude of challenging manifestations in the ENT regions. One such rare and complex entity is OAS (orbital apex syndrome). This case series highlighted our experience in 2020 with managing two such cases of OAS associated with COVID-19 infection. Their clinical and radiological presentation was discussed and their management protocol was explained with references from relevant literature. Although elderly patients with co-morbidities were considered to have highest risk for COVID-19 associated neurologic and ophthalmic complications earlier, now it was found to affect younger healthy individuals as noted in our cases. Knowledge about such virulent complications of COVID-19 is essential for otolaryngologists, to manage this life-threatening entity in a timely manner.</p>

Pulmonary tuberculosis with rhinosinusal and otic manifestations - diagnostic challenge

Abstract BACKGROUND. Unfortunately, tuberculosis is still being diagnosed among patients, independent of their age, gender, provenance or social category. The etiologic agent of tuberculosis is Mycobacterium tuberculosis, which is known to have a period of latency between the initial infection and the clinical manifestation. The most common localization is pulmonary, but it can affect, secondarily, other organs, especially in the ENT regions, mimicking other systemic diseases. MATERIAL AND METHODS. We are presenting a case of a 51-year-old female patient, who was referred to our ENT Clinic with the suspicion of Behcet’s disease with rhinosinusal manifestations. She had a pulmonary assessment in another hospital, as she was known with left lung bronchiectasis, but the sputum samples were negative. The clinical otorhinolaryngologic examination together with the rheumato-logical assessment and the result of the nasal mucosa biopsy were suggestive for Behcet’s disease and the patient received 6 weeks of Prednisolone. The specific immunologic tests (cANCA, pANCA, HLA B51) were negative. The patient returned to our clinic after 2 months, accusing symptomatology reacutization with right otorrhea and bilateral hearing loss aggravation. Nasal and rhinopharyngeal mucosa biopsies were repeated and the anatomopathological result was specific for tuberculosis. RESULTS. She was referred to the Pneumology Service where she received the diagnosis of pulmonary tuberculosis with rhinosinusal and otic manifestations. Currently, the patient is under tuberculostatic treatment. CONCLUSION. Extrapulmonary tuberculosis symptoms might be confused with other systemic diseases with rhinosinusal manifestations. Thorough examination and multidisciplinary approach are mandatory in order to establish a correct diagnosis followed by an appropriate treatment.

Foreign bodies in the ear, nose, and throat in Japan: association with sociocultural and geographical conditions

ObjectiveForeign bodies (FBs) in ear, nose, and throat (ENT) are common ENT emergencies but are sometimes life-threatening. However, FBs could be avoidable by the efficient announcement about the risk of these occurrence to the public. Fish bones are commonly found as throat FBs, and small toys are commonly found as pediatric ear and nose FBs. We hypothesized that there were relationships between the occurrence of FBs and sociocultural/geographical conditions. The purpose of this study is to clarify the risk factors of FBs in ENT regions related to eating customs and weather conditions. MethodsFrom April 2009 to March 2014, 94,479 patients visited the Chuo Emergency Clinic (CEC) in Osaka, which is a local emergency center for Osaka prefecture in Japan. Among them, 3229 patients with throat FBs, 577 children (0–15 years of age) with ear FBs, and 1999 children (0–15 years of age) with nose FBs were enrolled into the present study. Monthly trends in the number of throat FBs were examined in relation to fish eating customs. The monthly average of the daily ratio of pediatric patients with ear or nose FBs to the total number of patients were examined in relation to weather parameters using a database of the Japan Meteorological Agency. ResultsThe incidence of throat FBs was significantly higher in July and January (p<0.05, analyzed by ANOVA and Tukey–Kramer test), presumably because Japanese people have more chances to eat fish in these months due to the traditional fish-eating customs. There was also a significant correlation between the number of pediatric patients with ear and nose FBs and the bad weather parameters including daily rainfall (r=0.76, p=0.0043; r=0.57, p=0.050, respectively, analyzed by the Pearson product-moment correlation coefficient). This is because children would spend longer time inside on rainy days, which increases the chance of putting a small toy part in the ear and nose. ConclusionsFBs in throat and ear/nose occurred more frequently in the specific periods to eat fish and rainy days, respectively. Therefore, public announcement on the risk of occurrence of FBs based on sociocultural and geographical data is helpful to prevent FBs.

Orbital complications of ENT diseases

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Orbital complications are fairly common in Otorhinolaryngology practice because of close proximity of orbit to adjacent ENT regions. Orbital complications must be suspected whenever ENT patients present with complaints of proptosis, diplopia, vision loss and epiphora. Early diagnosis and treatment is necessary to prevent morbidity and mortality in these patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study was conducted in the ENT department for a period of 1 year from August 2016 to July 2017 and comprised of 38 cases. This study was conducted to see the incidence, etiology, clinical, radiological and histopathological profile in relation to ophthalmic complications in ENT diseases. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Male to female ratio was 1.71:1. Patients mean age at presentation in present study was 39.71±19.86 (SD) years and maximum number of cases 10 (26.32%) were between 41-50 years of age. Among 38 patients of our series, most common clinical presentation was proptosis followed by nasal obstruction. Commonest ENT diseases responsible for orbital complications were the different sinonasal tumours comprising 18 cases, in which carcinoma maxilla constituted 6 cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In conclusion, correct diagnosis, adequate antibiotic therapy, and surgical intervention are important for management of orbital and ophthalmic complications. Cooperation between Ophthalmologist and the Otolaryngologist is clearly desirable for proper management of these cases.&lt;/p&gt;

The velocity structure of the upper mantle beneath Central Asia

Data on the deep structure of the Earth's crust and upper mantle are necessary for understanding and explaining the tectonic processes occurring in differ� ent regions of the world. The obtained information can be used for constructing geodynamical models that enable both explanation and prediction of further evolution of these processes. Therefore, of special interest are regions where riftogenesis and intensive orogenesis are currently observed. It was shown earlier (1-3) that the upper mantle beneath Central Asia is of an inhomogeneous struc� ture, and in both the lateral and vertical directions, at that. Such an inhomogeneous structure indicates the complex geodynamical regime of this region. The aim of the present communication is to investigate the deep structure of the discussed region in more detail and in a greater depth interval. The investigation of the Earth's crust and upper mantle velocity structure was carried out by the sur� facewave tomography for the case of a spherical sur� face (4). The materials for our study were records of surface waves from distant earthquakes of M > 5.5 (1991-2009), made in the "DRYa" channels of digital broadband seismic stations of the IRIS network. The range of epicentral distances was 1500-16 000 km. The dispersion curves of the group velocity for the main mode of the Rayleigh wave were calculated uti� lizing the spectralandtemporal analysis procedure (5) for more than 3200 seismic paths crossing the study region in different directions. In calculations, wave periods of 10 to 250 s were used, which, according to (6), corresponds to a depth extent of 650-700 km. Use of the representative sampling of dispersion curves has allowed us to calculate maps of distributions of the group velocities of the Rayleigh wave for the periods mentioned and to estimate the resolution of the map� ping results by calculation of the effective smoothing radius (4), which was 250-350 km in the lateral direc� tion. Based on these maps, local dispersion curves in particular points of the study region were calculated, and then these curves were turned into Swave velocity sections. The main tendencies of the mantle structure are illustrated by two 2D Swave velocity sections (Fig. 1). The A-B profile crosses the structures of the Mon� gol-Okhotsk Fold Belt in the territories of NE China and Transbaikalia, the Baikal Rift Zone, and the adja� cent areas of the Siberian Craton. The C-D profile starts in the Sayan Mountains, crosses the Khangai Arch and part of the Gobi desert, ending in China, near the Chinese-Mongolian boundary. The characteristic peculiarity of the discussed velocity sections is the presence of a clearly expressed asthenospheric layer possessing Swave velocities of 4.3-4.4 km/s. Beneath the Baikal Rift Zone, the top of this layer lies at about 120 km depth, while beneath other tectonically active structures it is located in the vicinity of the crustal base. The maximal thickness (150 km) of the asthenosphere is reached beneath the Khangai Arch, while in other parts of the profiles it is about 70 km thick.

Differences in Schistosomiasis Knowledge among Irrigation Rice Farming Communities in Different Irrigation Schemes in Tanzania

Aim: To assess differences in schistosomiasis knowledge in farmers working in traditional, improved traditional and modern irrigation schemes in Tanzania. Study Design:A cross-sectional survey among farmers practicing irrigation rice farming, in 2 differ ent regions and 6 different irrigation systems. Place and Duration of Study:The study was carried out between November and

Synchronous ENT Lymphoepitheliomas. Controversies on Their Diagnosis and Treatment

Lymphoepithelial carcinomas are characterized by proliferation of undifferentiated malignant epithelial cells together with an infiltrate of mature lymphocytes. They mainly appear in the nasopharynx but can also be encountered in other upper and lower aerodigestive sites such as oropharynx, stomach, trachea, and others. When they occur in the larynx they usually do so in the laryngeal ventricle and are characterized by protrusion of the laryngeal band, visible in laryngoscopy. They mainly metastasize to cervical lymph nodes no matter what size the tumour is and distant non-nodal metastases are not infrequent. Cases of 2 synchronous lymphoepithelial tumours in ENT regions without nodal involvement, albeit theoretically possible, are very uncommonly encountered. The very scant reports of primary laryngeal lymphoepitheliomas or only-laryngeal metastatic tumours make 2 simultaneous ENT lymphoepitheliomas an exceedingly rare form of presentation that may lead to important controversies regarding their diagnosis, staging and treatment. A case of 2 synchronous neoplasms in the larynx and cavum is reported and the most significant aspects of this uncommon feature are discussed.

Larval development rate predicts range expansion of an introduced crab

Introduced populations can cause ecologi- cal and economic damage and are diYcult to eradicate once they have established. It is therefore important to be able to predict both where species may become established and their capacity to spread within recipi- ent regions. Here, we use a new method to assess potential for intraregional spread of a marine crab introduced to North America, Carcinus maenas. We determined survivorship and development rates throughout a range of temperatures in the laboratory for C. maenas larvae from non-native populations on the Atlantic and PaciWc coasts of North America. The larvae exhibited narrower physiological tolerances than adults, and no lab-cultured larvae completed lar- val development below 10.0°C or above 22.5°C. Survi- vorship peaked at intermediate water temperatures of 12.5-20.0°C, and development time decreased with increasing temperatures within this range. Based upon these laboratory development rates, we used nearshore sea-surface temperature data from both coasts of North America to predict development times required for larvae at diVerent months and sites. Taken together, survivorship and development data indicate that C. maenas has the capacity to continue its north- ward spread and establish populations at numerous additional sites in North America. Moreover, decadal temperature data at two Alaskan sites predicted little variability in development duration across years, sug- gesting that development duration predictions are robust to interannual water temperature diVerences.

Syndrome de Garcin révélant un lymphome malin non hodgkinien

R Garcin described progressive unilateral cranial nerve palsy in 1926. Garcin syndrome is characterized by progressive involvement of the cranial nerves culminating in total unilateral paralysis of all cranial nerves. Carcinoma of the skull base or ENT regions is the most common etiology. A 74-year-old man developed signs involving the left Vth (V2 and V3) cranial nerve then the VIth, VIIth and VIIIth cranial nerves and finally the IXth and Xth. MRI showed involvement of these cranial nerves with gadolinium uptake and involvement of the pons at the terminal phase. Careful ENT explorations failed to reveal a cause. The lymphocyte count was elevated in the cerebrospinal fluid. The patient died one year after diagnosis and the general autopsy was normal. The neuropathological studies led to the post-mortem diagnosis of type B non-Hodgkin lymphoma. In patients with Garcin syndrome, lymphoma is a possible diagnosis when carcinoma of the ENT regions or of the skull bases are not present.

Thalamic innervation of striatal and subthalamic neurons projecting to the rat entopeduncular nucleus.

The present study analyses the anatomical arrangement of the projections linking the Wistar rat parafascicular thalamic nucleus (PF) and basal ganglia structures, such as the striatum and the subthalamic nucleus (STN), by using neuroanatomical tract-tracing techniques. Both the thalamostriatal and the striato-entopeduncular projections were topographically organized, and several areas of overlap between identified circuits were noticed, sustaining the existence of up to three separated channels within the Nauta-Mehler loop. Thalamic afferents arising from dorsolateral PF territories are in register with striatofugal neurons located in dorsolateral striatal areas, which in turn project to dorsolateral regions of the entopeduncular nucleus (ENT). Medial ENT regions are innervated by striatal neurons located within medial striatal territories, these neurons being the target for thalamic afferents coming from medial PF areas. Finally, afferents from neurons located in ventrolateral PF areas approached striatal neurons in ventral and lateral striatal territories, which in turn project towards ventral and lateral ENT regions. Efferent STN neurons projecting to ENT were found to be the apparent postsynaptic target for thalamo-subthalamic axons. The thalamo-subthalamic projection was also topographically organized. Medial, central and lateral STN territories are innervated by thalamic neurons located within medial, ventrolateral and dorsolateral PF areas, respectively. Thus, each individual PF subregion projects in a segregated fashion to specific parts of the striato-entopeduncular and subthalamo-entopeduncular systems. These circuits enabled the caudal intralaminar nuclei to modulate basal ganglia output.

Mitochondrial DNA polymorphisms in honey bee subspecies from Kenya

Thirty-nine samples of Apis mellifera monticolaand A. m. scutellata from three differ- ent regions of Kenya were analyzed for mitochondrial DNA (mtDNA) variation using 6-base and 4-base restriction enzymes. Restriction with HpaII and AluI resulted in distinct patterns that together produced three different haplotypes. While haplotypes 2 and 3 were restricted to samples from the mountain forest, haplotype 1 was found in A. m. scutellata and in all samples from the Ngong Hills. No introgression of A. m. scutellata mtDNA was detected in bees collected in mountain environments, but a few samples from the savanna had A. m. monticola morphology, or mtDNA, or both. These results support the hypothesis that A. m. monticola is a distinct subspecies and not an ecotype of A. m. scutellata. The polymorphic restriction sites were mapped. Ten samples of A. m. litorea from the coast of Kenya were analyzed using polymerase chain reaction (PCR) amplification and subse- quent restriction analysis. All samples of A. m. litorea shared the A. m. scutellata haplotype. Apis mellifera monticola / A. m. scutellata / A. m. litorea / mtDNA polymorphism / Kenya

Targeted integration of human herpesvirus 6 in the p arm of chromosome 17 of human peripheral blood mononuclear cells in vivo.

Out of 64 cases of non-Hodgkin's lymphomas (NHL), 55 cases of Hodgkin's disease (HD) and 31 cases of multiple sclerosis (MS), 2 NHL, 7 HD and 1 MS cases were found positive by polymerase chain reaction (PCR) for the presence of HHV-6 sequences in pathologic lymph nodes of the lymphomas and in peripheral blood mononuclear cells (PBMCs) of MS. A further analysis of the PBMCs of the PCR positive cases by standard Southern blot technique revealed only 2 NHL, 3 HD and 1 MS cases as positive, indicating that these six patients have an unusually high viral copy number in the PBMCs. Restriction analysis, carried out using probes representative of different regions of the virus, showed that three cases retain only a deleted portion of the viral genome. In the remaining three cases a complete viral genome was present, containing the right end sequences in which the rep-like gene, possibly crucial to the viral and cellular life cycle, is located. The analysis by pulsed field gel electrophoresis (PFGE) of the total DNA of the PBMCs obtained directly, without culture from PBMCs of these last three cases (1 NHL, 1 HD, and 1 MS), using the same probes, showed the absence of free viral molecules and the association of viral sequences with high molecular weight DNA. These results are consistent with in vivo integration of the entire virus in the cellular genome. A further study of the same patients with chromosome fluorescence in situ hybridization (FISH) showed in all the three cases the presence of a specific hybridization site, located at the telomeric extremity of the short arm of chromosome 17 (17p13), suggesting that this location is at least a preferred site of an infrequent, but possibly biologically important, integration phenomenon.

Kernspintomographie in der Diagnostik von Kopf-Hals-Tumoren*

36 patients with carcinomas of different ENT regions were investigated by means of MRI, CT and B-mode ultrasonography (US). The images were evaluated by parameters of clinical importance: tumour detectability marginal appearance, internal architecture, regional extension, and artifact degradation. The results were compared with the clinical tumour staging in accordance with the TNM system. In MRI, a multiplanar imaging of tumour extension with horizontal, frontal and sagittal sections is possible. Together with a good contrasting of the tumour against the surrounding structures, these are major advantages over CT in the imaging of carcinomas of the tonsils, the hypopharynx and the larynx. For both methods, tumours of the tongue base and the floor of the mouth are a real challenge. Lymph node metastases can be visualised with MRI, but US is the method of choice for the evaluation of cervical lymph nodes.

Eight Cases of Extracutaneous Malignant Melanoma of ENT Regions

Eight Cases of Extracutaneous Malignant Melanoma of ENT Regions