Nasal Trauma Research Articles

One year on: assessing the impact of coronavirus disease 2019 on demand for semi-urgent ENT services.

This study investigated how the coronavirus disease 2019 pandemic has impacted on presentations to ENT first-on-call services. All appointments to a rapid access triage clinic from 1 June to 31 August in 2019 and 2020 were reviewed retrospectively and their reasons for consultation classified. A binomial proportion test was used to determine whether the proportions of consultations per presentation differed significantly between years. This analysis was repeated with the number of unique patients per presenting complaint. The proportions of nine reasons for consultation differed significantly between 2019 and 2020, including an increase in otitis media and nasal trauma presentations, and a decrease in otitis externa and tonsillitis presentations. Reattendances caused some variation in the frequency of certain diagnoses. Our data suggest a shift in the presentations to first-on-call services, which may be a result of changes in patient behaviour and access to healthcare services.

The Use of Modified High Flow Nasal Cannula (HFNC) In Preterm Infants With Neonatal Respiratory Distress Syndrome (NRSD) In Primary ICU Services

Introduction: NRSD (Neonatal Respiratory Distress Syndrome) is one of the most frequent causes of newborns in intensive care (NICU). Several NICU centers are now using the High Flow Nasal Cannula (HFNC) in recent years. With the use of HFNC as a breath aid in preterm infants, HFNC had the same efficacy ratio as nasal Continuous Positive Airway Pressure (CPAP) (continuous or intermittent). Case Report: A three-day-old baby boy was admitted to anesthesia with respiratory failure due to grade II HMD with suspicion of congenital heart failure. The initial condition showed that a respiratory rate of 70-80x / minute, breathing of the nostrils and retractions in the intercostals and abdomen with 85% post ductal SpO2 with the help of a CPAP mask (Pinsp 10, Fio2 70%). There was a Ronchi sound in the right and left basal lungs, and hemodynamics obtained a pulse of 180-195x / minute, non-invasive blood pressure 95/34 mmHg (54), heart murmurs were not found. During day 1 - day three, the patient uses a CPAP mask until the patient vomits and being consulted to an Anesthesiologist. On day 3 - day seven, the patient uses HFNC; after day seven until day 10, the patient uses neonatal nasal canularis oxygen. Until day 10, the patient is still being treated at the NICU by administering oxygen 0.5 liters/minute with SpO2 ranging from 93-96% with stable conditions but still needing oxygen. Conclusion: The use of Modified High Flow Nasal Cannula (HFNC) in preterm infants with Neonatal Respiratory Distress Syndrome (NRSD) is more effective and efficient than CPAP. The use of HFNC was associated with a lower incidence of nasal trauma and pneumothorax than nasal CPAP.

Prevalence of the anatomical variations of concha bullosa and its relation with sinusitis among Saudi population: a computed tomography scan study.

Concha bullosa (CB) is a pneumatic cavitation inside a concha in the nasal cavity. It is one of the most widely recognized nasal variations and is mostly found in the middle concha. CB is divided according to its site into three types; lamellar, bulbous and extensive. The goal of our study was to estimate the prevalence of CB among Saudi adult population and its association with sinusitis by using multidetector computed tomography (MDCT). This was a retrospective study carried out over a three-year period on 879 adult Saudi patients aged 18 years or older, referred for MDCT assessment of paranasal sinuses. Males were 540 and females were 339. Patients with facial congenital anomalies or nasal trauma were excluded from our study. CB was prevalent in both males and females among Saudi population (55.4%, 55.7%) respectively. Bilateral CB (55.5%) was more frequent than unilateral (44.5%). Extensive CB (44.0%) was the most frequent type. Sinusitis was associated more in patients with CB (48.0%) versus those who have no CB (5.9%). In conclusion, CB was prevalent among Saudi population and the most frequently recorded is the extensive type. Furthermore, the most common type associated with sinusitis was extensive CB (49.6%).

Experiences with implementation of continuous positive airway pressure for neonates and infants in low-resource settings: A scoping review.

Continuous positive airway pressure (CPAP) is the gold standard of care in providing non-invasive positive pressure support to neonates in respiratory distress in high-resource settings. While safety has been demonstrated in low-resource settings, there is a lack of knowledge on the barriers and facilitators to proper implementation. To identify and describe the barriers, facilitators, and priorities for future implementation of CPAP for neonates and infants in low-resource settings. A systematic search (database inception to March 6, 2020) was performed on MEDLINE, Embase, Web of Science, CINAHL, Global Health, and the WHO Global Index Medicus using PRISMA-ScR guidelines. Original research articles pertaining to implementation of CPAP devices in low-resource settings, provider or parent perspectives and experiences with CPAP, cost-benefit analyses, and cost-effectiveness studies were included. Inductive content analysis was conducted. 1385 article were screened and 54 studies across 19 countries met inclusion criteria. Six major themes emerged: device attributes, patient experiences, parent experiences, provider experiences, barriers, and facilitators. Nasal trauma was the most commonly reported complication. Barriers included unreliable electricity and lack of bioengineering support. Facilitators included training, mentorship and empowerment of healthcare providers. Device design, supply chain infrastructure, and training models were imperative to the adoption and sustainability of CPAP. Sustainable implementation of CPAP in low resource settings requires easy-to-use devices, ready access to consumables, and holistic, user-driven training. Further research is necessary on standardizing metrics, interventions that support optimal provider performance, and conditions needed for successful long-term health system integration.

Management of Nasal Trauma.

Facial trauma can have long-lasting physical and mental consequences. Trauma to the nose is commonly seen in the emergency department. Nasal lacerations account for 7% of all facial lacerations. Thorough examination and documentation including photographs is important for documentation and creating a reconstruction plan. Underlying damage to cartilage or bone must be reconstructed initially or in a delayed fashion to recreate the pretrauma anatomy and function. There are several options for soft tissue nasal reconstruction, including local flaps, skin grafts, pedicle flaps, and free flaps. At present there is no standard of care for postoperative facial trauma wound care.

Alar Cartilage Hematoma: Case Report and Literature Review.

Nasal hematomas can occur after nasal trauma. It can involve the septal, alar, or all levels, with the septum being the most commonly affected site. We present a case of alar hematoma in a five-year-old boy after nasal trauma. The patient came to the emergency room complaining of nasal pain, epistaxis, and nasal deformity. A complete ear, nose, and throat examination was performed, and X-ray and computed tomography imaging of the facial bone were done to confirm the presence of a nasal alar hematoma. The alar hematoma was successfully treated via surgical evacuation. Alar cartilage hematoma is a rare entity that can lead to undesirable complications when missed.

Systematic review of high-flow nasal cannula versus continuous positive airway pressure for primary support in preterm infants

IntroductionWe conducted a meta-analysis of trials that compared efficacy and safety of high-flow nasal cannula (HFNC) with continuous positive airway pressure (CPAP) as primary respiratory support in preterm infants and...

Complex nasal reconstruction for skin cancer and posttraumatic deformity using a modified frontonasal flap - Case report.

Introduction and importanceReconstruction of the nasal tip is challenging, especially when large defects are associated with compromised nasal soft tissues and framework. The frontonasal flap is an axial-pattern myocutaneous flap from the glabella and nasal dorsum that allows for various modifications in flap design to cover medium sized defects of the nasal tip.Case presentationA 66-year-old male patient presented with a large and ulcerated squamous cell carcinoma of the nasal tip that was associated with substantial posttraumatic damage of the nasal soft tissue envelope and cartilaginous vault of the dorsum. Considering patient comorbidity, risk factors, and specific nasal condition, a single-stage tumor resection and reconstruction using a modified frontonasal flap was intended. While tumor excision resulting in a tip defect of 1.5 × 1.5 cm and flap coverage were initially achieved in a single stage, histologically incomplete tumor resection and individual patient requests mandated further surgery, including re-excision, cartilage grafting, and soft tissue contouring.Clinical discussionThe frontonasal flap allows for single-stage reconstruction of moderate size tip defects. Even in the case of prior soft tissue damage and scarring, the flap may be used safely pending individual adjustments in flap design. However, additional measures may be employed as needed to optimize the functional and aesthetic outcome in cases of complex nasal pathology.ConclusionIn a case with a combined tumor and posttraumatic nasal deformity, an individualized surgical concept incorporating a modified frontonasal flap with adjunct cartilage grafting and soft tissue contouring achieved an excellent functional and cosmetic outcome.

Management and Complications of Nasal Septal Collections

Background: Nasal septum collections (hematoma and abscess) can lead to structural and functional abnormalities. Our objective was to assess the clinical characteristics, management and complications of nasal septal collections, and document factors associated withtheir complications. Methods: This was a retrospective study of patients managed for nasal septal collections. Socio-demographic and clinical information was recorded, and the main investigations and results noted. Follow-up and complications of septal collections were documented and the clinical factors associated with the complications explored. Results: Twenty-four patients records were studied: male: female ratio=2:1, mean age 40.1±13.1years,62.5% presented with complaints of nasal obstruction, 66.7% had antecedent nasal trauma, presentation was from 2 to 13 days,25%had co-morbid disease(s). All patients had incision and drainage of the septal collection within 1–7 h; 41.2% of the aspirated collections cultured microorganisms, 20.8% developed complications. Increased age above 45 years, co-morbidity, delayed presentation, culture-positive aspirate was all significantly associated with development of complications. Conclusion: Nasal septal collections were more common in adult males with antecedent nasal trauma; 20% developedcomplications associated with the presence of culturepositive abscesses, increased age, and duration of septal collection.
 Keywords: Nasal trauma, Septal hematoma, Septal abscess, Complications

Utilización de las cánulas nasales de alto flujo en las unidades neonatales españolas

IntroductionThe use of high-flow cannula therapy (HFNC) in neonatal units has increased in recent years, but there are no consensus guidelines on its indications and application strategies. Our aim was to know the rate of use of HFNC, their indications and the management variability among Spanish neonatal units. Material and methodsTwenty-five-question survey for medical and nursing staff. Level II and III units were contacted by phone and sent in Google forms between September 2016 and December 2018. ResultsNinety-seven responses (63.9% medical, 36.1% nursing), from 69 neonatal units representing 15 autonomous communities (87% level of care III; 13% level II). All units except one have HFNC with a humidified and heated system. Their most frequent indications are: non-invasive ventilation weaning (79.4%), bronchiolitis (69.1%), respiratory distress of the term newborn (58.8%), after extubation (50.5%). Minimum flow (1–5 L/min) and maximum flow (5–15 L/min) are variable between units. 22.7% have experienced some adverse effect from its use (9 air leak, 12 nasal trauma).Less than half have an employment protocol, but all the answers agree on the usefulness of national recommendations. ConclusionsHFNC therapy is widely used in Spanish units, but there is great variability in its indications and strategies of use. National recommendations would be applicable in most units and would allow unifying its use.

High-flow nasal cannulae for respiratory support in adult intensive care patients.

High-flow nasal cannulae (HFNC) deliver high flows of blended humidified air and oxygen via wide-bore nasal cannulae and may be useful in providing respiratory support for adults experiencing acute respiratory failure, or at risk of acute respiratory failure, in the intensive care unit (ICU). This is an update of an earlier version of the review. To assess the effectiveness of HFNC compared to standard oxygen therapy, or non-invasive ventilation (NIV) or non-invasive positive pressure ventilation (NIPPV), for respiratory support in adults in the ICU. We searched CENTRAL, MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane COVID-19 Register (17 April 2020), clinical trial registers (6 April 2020) and conducted forward and backward citation searches. We included randomized controlled studies (RCTs) with a parallel-group or cross-over design comparing HFNC use versus other types of non-invasive respiratory support (standard oxygen therapy via nasal cannulae or mask; or NIV or NIPPV which included continuous positive airway pressure and bilevel positive airway pressure) in adults admitted to the ICU. We used standard methodological procedures as expected by Cochrane. We included 31 studies (22 parallel-group and nine cross-over designs) with 5136 participants; this update included 20 new studies. Twenty-one studies compared HFNC with standard oxygen therapy, and 13 compared HFNC with NIV or NIPPV; three studies included both comparisons. We found 51 ongoing studies (estimated 12,807 participants), and 19 studies awaiting classification for which we could not ascertain study eligibility information. In 18 studies, treatment was initiated after extubation. In the remaining studies, participants were not previously mechanically ventilated. HFNC versus standard oxygen therapy HFNC may lead to less treatment failure as indicated by escalation to alternative types of oxygen therapy (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.45 to 0.86; 15 studies, 3044 participants; low-certainty evidence). HFNC probably makes little or no difference in mortality when compared with standard oxygen therapy (RR 0.96, 95% CI 0.82 to 1.11; 11 studies, 2673 participants; moderate-certainty evidence). HFNC probably results in little or no difference to cases of pneumonia (RR 0.72, 95% CI 0.48 to 1.09; 4 studies, 1057 participants; moderate-certainty evidence), and we were uncertain of its effect on nasal mucosa or skin trauma (RR 3.66, 95% CI 0.43 to 31.48; 2 studies, 617 participants; very low-certainty evidence). We found low-certainty evidence that HFNC may make little or no difference to the length of ICU stay according to the type of respiratory support used (MD 0.12 days, 95% CI -0.03 to 0.27; 7 studies, 1014 participants). We are uncertain whether HFNC made any difference to the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) within 24 hours of treatment (MD 10.34 mmHg, 95% CI -17.31 to 38; 5 studies, 600 participants; very low-certainty evidence). We are uncertain whether HFNC made any difference to short-term comfort (MD 0.31, 95% CI -0.60 to 1.22; 4 studies, 662 participants, very low-certainty evidence), or to long-term comfort (MD 0.59, 95% CI -2.29 to 3.47; 2 studies, 445 participants, very low-certainty evidence). HFNC versus NIV or NIPPV We found no evidence of a difference between groups in treatment failure when HFNC were used post-extubation or without prior use of mechanical ventilation (RR 0.98, 95% CI 0.78 to 1.22; 5 studies, 1758 participants; low-certainty evidence), or in-hospital mortality (RR 0.92, 95% CI 0.64 to 1.31; 5 studies, 1758 participants; low-certainty evidence). We are very uncertain about the effect of using HFNC on incidence of pneumonia (RR 0.51, 95% CI 0.17 to 1.52; 3 studies, 1750 participants; very low-certainty evidence), and HFNC may result in little or no difference to barotrauma (RR 1.15, 95% CI 0.42 to 3.14; 1 study, 830 participants; low-certainty evidence). HFNC may make little or no difference to the length of ICU stay (MD -0.72 days, 95% CI -2.85 to 1.42; 2 studies, 246 participants; low-certainty evidence). The ratio of PaO2/FiO2 may be lower up to 24 hours with HFNC use (MD -58.10 mmHg, 95% CI -71.68 to -44.51; 3 studies, 1086 participants; low-certainty evidence). We are uncertain whether HFNC improved short-term comfort when measured using comfort scores (MD 1.33, 95% CI 0.74 to 1.92; 2 studies, 258 participants) and responses to questionnaires (RR 1.30, 95% CI 1.10 to 1.53; 1 study, 168 participants); evidence for short-term comfort was very low certainty. No studies reported on nasal mucosa or skin trauma. HFNC may lead to less treatment failure when compared to standard oxygen therapy, but probably makes little or no difference to treatment failure when compared to NIV or NIPPV. For most other review outcomes, we found no evidence of a difference in effect. However, the evidence was often of low or very low certainty. We found a large number of ongoing studies; including these in future updates could increase the certainty or may alter the direction of these effects.

Experience With Autologous Nasal Septum Cartilage Combined With Conchal Cartilage in Nasal Tip Reconstruction.

There has been an increase in use of autologous costal cartilage for nasal tip shaping material. However, there are deficiencies in using this plastic material, such as a hard nasal tip, poor nasal tip elasticity and mobility postoperatively, and some nasal tip skin thinning that allows the shape of the cartilage grafts to be felt on the surface of the nasal tip skin. To address these problems, we have combined autologous nasal septum cartilage and conchal cartilage as nasal tip graft materials, which achieve a natural shape and realistic touch postoperatively. From January 2017 to September 2019, a total of 47 patients with nasal septal cartilage combined with conchal cartilage transplantation for nasal tip plasty were screened for a retrospective study. They were followed up and evaluated for 6 to 25 months postoperatively. The operation was performed through an incision in the nose. During the operation, a piece of septal cartilage was cut to make a columella strut. Using one side of the cavitas conchae and cymba conchae cartilage as the graft material, 2 long strips of cartilage were excised for the septum extension graft, and a piece of cap cartilage was transplanted to the top of the nasal tip cartilage scaffold. The time between the operation and follow-up was greater than 6 months, with the range of follow-up and evaluation being from 6 to 25 months. Forty-six patients were satisfied with the shape of the nose. One patient complained that the nasal tip was round and large after 1 month postoperatively, but after 6 months, he was satisfied with the shape of the nasal tip after daily use of a nasal clip. In one male case, the implant was removed more than 7 months postoperatively because of hematoma and infection secondary to nasal trauma. There were 2 cases of nasal tip numbness, both of which recovered spontaneously after 12 months. After the operation, the shape of the nasal tip was round, no cartilage contour was seen on the surface, no collapse of upper nasal tip, no obvious deviation of the nasal dorsum and columella, and no deformation and displacement of the nasal tip cartilage scaffold. At the 6-month follow-up visit, each patient palpated the nasal tip for evaluation. Most patients felt their nose felt realistic and that they had good nasal tip motion. Only 1 patient felt that the nasal tip and the nasal dorsum were moving together when the tip of the nose was being pushed. Nasal septum cartilage and conchal cartilage can be combined as a graft material for reconstruction of the nasal tip. This technique uses different characteristics of each of the 2 cartilages to achieve a more realistic and esthetic outcome.

Computer-Aided Rhinoplasty Using a Novel “navigated” Nasal Osteotomy Technique: A Pilot Study

To describe the surgical technique of navigation-guided nasal osteotomies and assess feasibility of this technique for treating complex nasal bone deformities in reconstructive rhinoplasty. A retrospective chart review was performed in order to identify patients who underwent computer-aided rhinoplasty from August 2014 to February 2017. Inclusion criteria were nasal bone deformities on computed-tomography (CT) that correlated with specific nasal complaints. All patients underwent computer-aided rhinoplasty with navigation-guided nasal osteotomies using a standard navigation system. Osteotomies were performed using real-time visualization on the navigation screen. Additional soft tissue procedures were performed as needed. Medical records were reviewed for presenting symptoms, radiologic and operative findings, and postoperative course. Cosmetic outcomes were subjectively based on patients' standard 6-view photo-documentation from pre- and post-operative timepoints. Twenty-one patients were included in the study; 8 were revision cases and 3 had mild-to-moderate hemifacial microsomia. Fifteen were completely closed procedures. No cases were opened because of inadequate visualization or difficulty accessing bony pathology. Mean (range) follow up was 98.6 (6-559) days. There were no intra-operative complications, unplanned admissions or re-admissions, or iatrogenic cosmetic complications (ie, "inverted V" or "saddle nose" deformities). Two patients required revision. One was after suffering nasal trauma within 4 weeks of initial rhinoplasty. The second underwent further correction of a deformity that required a costochondral graft. Both experienced good final results. Computer-aided rhinoplasty is safe and feasible for treating complex nasal deformities using standard navigation systems.

English

A 26-year-old male presented to general medicine department on 16th March 2020 with complaints of 3 episodes of epistaxis for 2 days. The epistaxis was spontaneous, sudden in onset, recurring in nature, copious in amount, not relieved on its own. No history of nasal trauma, head injury, fever, joint pain, cough, breathlessness, difficulty in swallowing, pain abdomen, haematuria, rashes. No history of bleeding diathesis from any other site. Past history revealed similar complaints of nasal bleeding for past 2 - 3 months for which he used to get admitted and administered platelets transfusions after which the symptoms used to subside. No history of any bleeding disorders or other comorbidities. Family history revealed that the younger brother is a known case of Bernard-Soulier syndrome diagnosed at the age of 15 years. Drug history was insignificant. Based on patient’s presentation and family history, a congenital bleeding disorder was considered as provisional diagnosis. On clinical examination pallor was observed in lower palpebral conjunctiva and dorsum of tongue and crusts were present in nose. Moderate splenomegaly was also observed. His laboratory data revealed presence of microcytic hypo-chromic anaemia with hyponatremia, with prolonged bleeding time, normal clotting time and coagulation time. Complete blood count revealed severe microcytic hypochromic anaemia (haemoglobin - 5.8 gram / decilitre) (Figure 1) and giant platelets (Figure 2). Bleeding time was 12 minutes and clotting time was 8 minutes. Factor VIII levels were normal in the patient. Prothrombin time was prolonged with 13.9 seconds. Liver function test revealed only hypoalbuminemia with no derangement of liver enzymes. Renal function tests were normal. Serum electrolytes revealed hyponatremia with 130 millimole / litre. Ultrasound abdomen and pelvis revealed a heterogeneous focus which was noted in spleen with peripheral colour uptake and necrotic areas within it suggesting of splenic abscess / splenic haematoma / infarct. Contrast enhanced computed tomography of abdomen and pelvis revealed mild splenomegaly with heterogeneous foci with peripheral colour uptake and necrotic areas within it measuring 6.4 * 4.8 centimeters, areas were hypo dense and few enlarged retroperitoneal lymph nodes noted in para-aortic region. Computed tomography of brain plain was normal. Contrast enhanced computed tomography of thorax was normal. Platelet function tests revealed normal aggregation with adenosine diphosphate, collagen and arachidonic acid and markedly reduced with ristocetin. Flow cytometry could not be assessed. His clinical examination revealed findings suggestive of anaemia and splenomegaly was also present with vital parameters within normal limits. He underwent thorough work-up with working diagnosis of bleeding disorder under evaluation.

An Unusual Case of Nasal Septal Hematoma Caused by Local Dental Anesthesia in a 15-Year-Old Girl

Introduction: Nasal septal hematoma (NSH) is a complication of nasal trauma, which its emergency treatment is drainage of hematoma. Delayed treatment may result in necrosis of the nasal cartilage and saddle nose deformity. Case Presentation: Here, we reported a 15-year-old girl presented with NSH associated with a dental local anesthetic injection, which led to nasal septum necrosis. Conclusions: Computerized tomography (CT) scanning was performed to determine the hematoma size and existence of other complications.

Tubed Temporalis Fascia for Nasal Dorsal Contouring: A Novel Technique

Introduction: Nasal dorsum irregularities may occur after nasal trauma or as a postrhinoplasty complication. Here, we present a novel technique using temporalis fascia (TF) grafting for primary and revision rhinoplasty to repair the nasal dorsum, hide nasal irregularities, and improve nasal contouring. Methods: This prospective cohort study was conducted from January 2019 to June 2019 and evaluated nasal dorsal contouring using the TF in a tubed form. The outcome variables were patient satisfaction, dorsal irregularity, and contour definition. The predictor variable was the use of tubed TF for dorsal augmentation. Other associated variables were age, sex, indication for surgery, surgery type, and graft size. Patient satisfaction was evaluated using the Rhinoplasty Outcome Evaluation questionnaire. A rhinoplasty specialist other than the surgeon who performed the procedure evaluated the dorsal augmentation outcomes by inspection and palpation of the dorsum. All statistical analyses were performed using the SPSS software. Results: Seventy-four patients (21.6% men and 78.4% women) were treated with the tubed TF. The mean age was 28.97 years. Thin skin was the most common indication (48.6%) for using TF. The graft size was 2–5 cm; inspection and palpation revealed no irregularities. No reception site complications occurred. One patient had a mild hematoma at the donor site. The mean patient satisfaction score was 10.14 preoperatively and 19.95 postoperatively (p = 0.001). Discussion/Conclusions: Our novel technique of using the TF graft in a tubed form was easy to perform. Furthermore, the tubed TF covers all irregularities, is good for dorsal augmentation, and improves dorsal contouring and definition.

Topical nasal xylometazoline for flexible bronchoscopy (VAIN): A randomized, double-blind, placebo-controlled trial.

The role of topical nasal vasoconstrictor administration during flexible bronchoscopy is unclear. Consecutive subjects undergoing flexible bronchoscopy were randomized to receive either topical xylometazoline (0.1%) or placebo (saline nasal spray, 0.74% w/v isotonic solution) before bronchoscopy. Background topical anesthesia included 2% nasal lignocaine gel, pharyngeal spray of 10% lignocaine, and 1% lignocaine solution for spray-as-you-go administration. The primary outcome was the operator rated ease of nasal negotiation of the bronchoscope on the visual analog scale (Negotiation VAS). Secondary objectives included assistant rated facial pain scale score, patient-rated nasal pain score (Pain VAS), time to reach the vocal cords after bronchoscope insertion, operator rated nasal mucosal trauma score (Trauma VAS), hemodynamic changes, and complications between the groups. In all, 148 subjects were recruited and randomized to the placebo (73) and xylometazoline groups (75). Operator rated ease of nasal bronchoscope negotiation (Negotiation VAS) was similar in both the groups [Median (IQR), 1 (1-2) in both groups, p=0.79]. There were no differences in the other outcomes including assistant rated score of facial pain [(Median (IQR), 2 (2-4) placebo and 2 (2-4) xylometazoline, p=0.36], Pain VAS [Median (IQR), placebo 2 (1-2) and xylometazoline 2 (1-3), p=0.28], Trauma VAS, [Median (IQR), placebo 1 (0-2) and xylometazoline 1 (0-1), p=0.28], hemodynamic changes, or complications between the two groups. The findings of this study do not support the administration of topical nasal xylometazoline in flexible bronchoscopy. Trial registered on Clinicaltrials.gov, www.clinicaltrials.govNCT03424889, on January 02, 2018.

A Comparative Study between Postextubation of Preterm Neonates into High-Flow Nasal Cannula versus Nasal Continuous Positive Airway Pressure

Background: For respiratory support in premature newborns, there has been a trend toward less trachealintubation, less mechanical ventilation, and more nasal respiratory support which can result in the improvement ofsuccessful extubation rate. The two commonly known types of nasal respiratory support after extubation are thenasal continuous positive airway pressure (CPAP) and high flow nasal cannula (HFNC). The current study aimed toinvestigate and compare successful extubation using HFNC and conventional nasal CPAP after a period ofendotracheal positive pressure ventilation and detect which of these two methods is better for successfulextubation with fewer side effects.Methods: This randomized controlled study was conducted on 210 preterm newborns in the neonatal intensive careunit (NICU) of Gynecology and Obstetrics Department of Qasr El Eyni Hospital. Post extubation failure rates werecompared between the two groups, namely (HFNC) and (nasal CPAP). The collected data were analyzed in SPSSsoftware (version 20).Results: Neonates who needed re-intubation within 72 h after initial extubation were higher in the HFNC group(72.7%) versus (27.3%) in the CPAP group (P-value=0.063). Moreover, 45.8% of neonates in the HFNC group neededre-intubation within 1 week of initial extubation versus 54.2% in CPAP (P-value=0.970). The mean duration ofrespiratory support using HFNC was 3.7 days, compared to 6.5 days using CPAP (P-value= 0.001). Among neonateswho suffered from nasal trauma, 90.6% of neonates belonged to the CPAP group, while 9.4% of cases belonged to theHFNC group (P-value= 0.001). Conclusion: The use of CPAP and HFNC after the extubation of preterm mechanically ventilated neonates wasstatistically equal regarding extubation failure.

Inadvertent esophageal migration of endotracheal tube used to guide orogastric tube: An unfortunate complication in an intubated patient

In patients undergoing ambulatory laparoscopic surgeries, Ryles tubes are required only for the purpose of intraoperative gastric decompression. Insertion of nasogastric tubes can lead to nasal trauma, and hence, oral tubes provide a feasible alternative. In contrast to the nasopharyngeal cavity, whose anatomical orientation allows ease of insertion into the esophagus, oral insertion of Ryles tube is difficult on account of a larger cavity and potential for coiling. Various aids are often used to ease the insertion of these orogastric tubes. One such aid is the use of an oral endotracheal tube (ETT). This case report aims to bring to light, and the inadvertent complications may occur with the improper use of these aids, which in our case, was the misplacement of the said oral ETT.

What still presents urgently to ENT during a pandemic? Experience of an ENT rapid access clinic during the coronavirus disease 2019 pandemic.

This study sought to determine the conditions that still present to ENT despite government advice to avoid unnecessary travel. It also assessed the impact of social distancing on pathologies presenting to ENT and reviewed the usefulness of telephone consultations in semi-urgent presentations. A retrospective review was conducted of 97 instances of patient care carried out in the rapid access ENT clinic at a large district general hospital. Otitis externa and foreign bodies represented 25 per cent and 13 per cent of consultations respectively. Tonsillitis and peritonsillar abscess were uncommon, representing 6 per cent of total consultations. Telephone appointments represented only 28 per cent of total consultations; however, they appeared to reduce the number of physical appointments required. Otitis externa and foreign bodies continue to be common during the pandemic. Social distancing measures reduced the number of tonsillitis and quinsy presentations. Telephone consultations are effective for certain urgent presentations to ENT, most noticeably nasal trauma and follow up of non-serious pathologies.