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Background: Acute neurological sequela in patients with COVID-19 infection include acute thromboembolic infarcts related to cytokine storm and post infectious immune activation resulting in a prothrombotic state. Radiologic imaging studies of the sinonasal tract and mastoid cavity in patients with COVID-19 infection are sparse and limited to case series. In this report, we investigate the radiologic involvement of nasal cavity, nasopharynx, paranasal sinuses, and mastoid cavity in patients with SARS-CoV-2 infection who presented with acute neurological symptoms. Methods: Retrospective review of medical records and neuroradiologic imaging in patients diagnosed with acute COVID-19 infection who presented with acute neurological symptoms to assess radiologic prevalence of sinus and mastoid disease and its correlation to upper respiratory tract symptoms. Results: Of the 55 patients, 23 (42%) had partial sinus opacification, with no evidence for complete sinus opacification. The ethmoid sinus was the most commonly affected (16/55 or 29%). An air fluid level was noted in 6/55 (11%) patients, most commonly in the maxillary sinus. Olfactory recess and mastoid opacification were uncommon. There was no evidence of bony destruction in any of the studies, Cough, nasal congestion, rhinorrhea, and sore throat were not significantly associated with any radiological findings. Conclusion: In patients who present with acute neurological symptoms, COVID-19 infection is characterized by limited and mild mucosal disease within the sinuses, nasopharynx and mastoid cavity. Level of Evidence: 4

SMARCB1-deficient sinonasal tract carcinomas are an emerging subset of rare tumors recently described in the literature, with less than 100 reported cases. Given the aggressive nature of this tumor, timely diagnosis is especially important. We present a case report of a SMARCB1-deficient carcinoma of the sinonasal tract.Case report with review of the literature.The patient was a 53-year-old male with computed tomography (CT)-proven mass of the right ethmoid and sphenoid sinuses. Rigid nasal endoscopy revealed a purple mass completely obstructing the right nasal cavity that extended inferiorly from the posterior ethmoids and sphenoid sinuses. Initial biopsy in the emergency room was nondiagnostic due to extensive tumor necrosis. Magnetic resonance imaging (MRI) revealed T2 hypointense enhancing mass centered in the right posterior ethmoids with invasion into the right orbital apex, classifying it as a T4b tumor. The patient underwent repeat biopsy with frozen section and tumor debulking. Immunohistochemical analysis of subsequent biopsy revealed complete loss of INI-1 and negative staining for other pertinent markers, alluding to the diagnosis of SMARCB1-deficient sinonasal tract carcinoma.Tumor necrosis may be problematic in obtaining a diagnosis for SMARCB1-deficient sinonasal carcinomas. Thus, sampling various regions of the tumor during initial biopsy can prevent delays in diagnosis and treatment.

Allergic fungal sinusitis (AFS) is a condition that has an allergic basis caused by exposure to fungi in the sinonasal tract leading to chronic inflammation. Despite standard treatment modalities, which typically include surgery and medical management of allergies, patients still have a high rate of recurrence. Subcutaneous immunotherapy (SCIT) has been used as adjuvant treatment for AFS. Evidence exists to support the use of sublingual immunotherapy (SLIT) as a safe and efficacious method of treating allergies, but no studies have assessed the utility of SLIT in the management of allergic fungal sinusitis. A record review of cases of AFS that are currently or previously treated with sublingual immunotherapy from 2007 to 2011 was performed. Parameters of interest included serum IgE levels, changes in symptoms, Lund-McKay scores, decreased sensitization to fungal allergens associated with AFS, and serum IgE levels. Ten patients with diagnosed AFS were treated with SLIT. No adverse effects related to the use of SLIT therapy were identified. Decreases in subjective complaints, exam findings, Lund-McKay scores, and serum IgE levels were observed. Thus, sublingual immunotherapy appears to be a safe adjunct to the management of AFS that may improve patient outcomes.

Background: Sinonasal schwannoma (SNS) is a rare sinonasal tract tumor whose presentation is similar to that of other benign nasal tumors. Very few case series appear in the literature. This study aims to describe the presentation, treatment, and outcome of 10 SNS cases from 3 referral centers. Methods: All SNS cases were analyzed retrospectively. Patient demographics, tumor data, surgical procedures, and outcome were recorded. Results: Five males and 5 females (mean age, 49.1 ± 21.4 years) were included in the study. The tumor was on the left side in 9 patients and on the right side in 1. It originated in the middle turbinate in 4 cases, the ethmoid and sphenoid sinuses in 2 cases, and the nasal septum and infratemporal fossa in 1 case each. Tumor resection was done endoscopically in all cases, and there was no need for an external procedure, and 5 patients did not require a sinusotomy. All 10 patients remained disease-free after a mean follow-up of 65.3 months (range, 2-120 months). Conclusion: Safe and effective endoscopic resection of SNS is feasible. If the tumor is contained within the nasal cavity, simple tumor excision without sinusotomy can be enough to resect the tumor. In more extensive disease, a wider endoscopic approach may be needed, but an external approach was not necessary in this series.

The great majority of teratomas of the head and neck present in the neonate or infant and are biologically benign and yet with a high mortality because of their space-occupying and obstructive character. Teratomas in the adult neck and sinonasal tract are histologically and biologically malignant, with an often unpredictable response to therapy.

Salivary-type neoplasms of the nasal cavity and paranasal sinuses are numerically dominated by adenoid cystic carcinomas and pleomorphic adenomas. All others, benign or malignant, are rarely encountered and are usually biologically and histologically low-grade. Sites of origin in the sinonasal tract conform to the density and distribution of the seromucous glands and hence are most often nasal (septum and turbinates) or ostial

Inverted papilloma is a benign neoplasm confined almost exclusively to the sinonasal tract. We present the first known case report of an inverted papilloma arising from the middle ear. In this paper we discuss the pathophysiology and review the literature of this interesting clinical entity.

Choanal and angiomatous polyps can be distinguished from ordinary sinonasal polyps by either a distinctive clinical presentation (choanal) or the histopathologic appearance (angiomatous). Nearly all choanal polyps arise within paranasal sinuses, with the antrochoanal polyp the most common. The angiomatous polyp is most often a secondary change in a choanal polyp and can be mistaken for vascular neoplasms, eg, angiofibroma