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Objectives: Defining how pregnant women respond to SARS-CoV-2 infection and vaccination is critical to optimize vaccination strategies that protect mother and infant at the epidemic. This study aimed to compare Anti-SARS-CoV-2-spike IgG of vaccinated vs. infected women and to determine the optimal timing of maternal vaccination during pregnancy at the time of epidemic. Study design: We collected maternal/cord blood at delivery (October 2021-March 2022) and measured Anti-SARS-CoV-2-spike-IgG geometric mean concentrations (IgG-GMC), using a quantitative immunoassay. We compared groups according to timing and number of doses and correlated maternal and fetal IgG levels. We described the proportion of women with IgG-levels above the 150 AU/ml positivity threshold according to the timing of infection/vaccination and performed a sub-analysis for maternal IgG-GMC levels pre and during the Omicron wave. Results: We included 238 vaccinated women, 125 who received two doses and 113 three; and 48 unvaccinated infected women. All groups infected/vaccinated in the second or third-trimester had an IgG-GMC above the positivity threshold. Third-trimester vaccination (second/third dose) resulted in higher maternal and cord-blood IgG-GMC compared to the second-trimester (maternal-IgG:10232 vs. 4325 AU/mL,ptwo doses and their newborns had IgG-levels above the positivity threshold at all time points. In vaccinated-women, there were higher maternal IgG-GMC levels during the Omicron wave than pre-Omicron. Conclusions: At the time of epidemic, receiving an additional COVID-19 vaccine dose in the third-trimester resulted in a higher IgG-GMC compared to the second-trimester. Relatively higher levels of maternal and cord IgG-GMC were achieved following vaccination than infection. Women infected during or before the first-trimester might benefit from an additional third-trimester dose to prevent peripartum infection and to passively immunize their newborn. The higher levels of maternal IgG-GMC in the Omicron period are suggestive of hybrid immunity.

Objective Posttonsillectomy bleeding is a dreadful complication that may be life-threatening. Preoperative coagulation tests have not been shown to be effective in predicting this complication. The Pediatric Bleeding Questionnaire (PBQ) is a validated and sensitive tool in diagnosing children with abnormal hemostatic functions, and the objective of our study was to assess its utility as a preoperative screening tool for predicting posttonsillectomy bleeding. Study design Prospective single-blinded cohort study. Setting Tertiary care hospital system. Methods All children scheduled for tonsil surgery between 2017 and 2019 in the Galilee Medical Center were included. The PBQ was completed by the caregivers prior to surgery, and all children underwent coagulation tests. Each PBQ item is scored on a scale of -1 to 4, and the total score per candidate is based on summation of all items. Results An overall 272 patients were included in the study with a mean age of 5.2 years; 57.7% were boys. The main finding was that in a multivariable model adjusted to age, a PBQ score of 2 is correlated with increased postoperative bleeding risk (odds ratio, 10.018 [95% CI, 1.20-82.74]; P = .046). The results of the PBQ demonstrated better predictive ability when compared with abnormal coagulation test results (odds ratio, 1.76 [95% CI, 0.63-4.80]; P = .279). Sex was not found to be significant (odds ratio, 1.45 [95% CI, 0.70-3.18]; P = .343). Conclusions This study demonstrated that a PBQ score ≥2 has a higher yield for detecting children at risk for posttonsil surgery bleeding as compared with coagulation studies.

Objectives In the midst of the coronavirus disease 2019 (COVID-19) outbreak, chest X-ray (CXR) imaging is playing an important role in diagnosis and monitoring of patients with COVID-19. We propose a deep learning model for detection of COVID-19 from CXRs, as well as a tool for retrieving similar patients according to the model’s results on their CXRs. For training and evaluating our model, we collected CXRs from inpatients hospitalized in four different hospitals. Methods In this retrospective study, 1384 frontal CXRs, of COVID-19 confirmed patients imaged between March and August 2020, and 1024 matching CXRs of non-COVID patients imaged before the pandemic, were collected and used to build a deep learning classifier for detecting patients positive for COVID-19. The classifier consists of an ensemble of pre-trained deep neural networks (DNNS), specifically, ReNet34, ReNet50¸ ReNet152, and vgg16, and is enhanced by data augmentation and lung segmentation. We further implemented a nearest-neighbors algorithm that uses DNN-based image embeddings to retrieve the images most similar to a given image. Results Our model achieved accuracy of 90.3%, (95% CI: 86.3–93.7%) specificity of 90% (95% CI: 84.3–94%), and sensitivity of 90.5% (95% CI: 85–94%) on a test dataset comprising 15% (350/2326) of the original images. The AUC of the ROC curve is 0.96 (95% CI: 0.93–0.97). Conclusion We provide deep learning models, trained and evaluated on CXRs that can assist medical efforts and reduce medical staff workload in handling COVID-19. Key Points • A machine learning model was able to detect chest X-ray (CXR) images of patients tested positive for COVID-19 with accuracy and detection rate above 90%. • A tool was created for finding existing CXR images with imaging characteristics most similar to a given CXR, according to the model’s image embeddings. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08050-1.

Objective: While COVID-19 symptoms impact rhinology (anosmia) and laryngology (airways), two major disciplines of the otolaryngology armamentarium, the virus has seemed to spare the auditory system. A recent study, however, reported changes in otoacoustic emission (OAE) signals measured in SARS-COV-2 positive patients. We sought to assess the effect of COVID-19 infection on auditory performance in a cohort of recovered SARS-COV-2 patients and controls. To avoid a potential bias of previous audiological dysfunction not related to SARS-COV-2 infection, the study encompasses patients with normal auditory history. We hypothesized that if SARS-COV-2 infection predisposes to hearing loss, we would observe subtle and early audiometric deficits in our cohort in the form of subclinical auditory changes. Study Design: Cross-sectional study. Setting: Tertiary referral center. Patients: The Institutional Review Board approved the study and we recruited participants who had been positive for SARS-COV-2 infection, according to an Reverse Transcription Polymerase Chain Reaction (RT-PCR) test on two nasopharyngeal swabs. The patients included in this study were asymptomatic for the SARS-COV-2 infection and were evaluated following recovery, confirmed by repeated swab testing. The control group comprised healthy individuals matched for age and sex, and with a normal auditory and otologic history. Intervention(s): The eligibility to participate in this study included a normal audiogram, no previous auditory symptoms, normal otoscopy examination with an intact tympanic membrane, and bilateral tympanometry type A. None of our volunteers reported any new auditory symptoms following SARS-COV-2 infection. Ototacoustic emissions (OAE) and auditory brainstem response (ABR) measurements were used to evaluate the auditory function. Main Outcome Measure(s): OAE and ABR measurements. Results: We have found no significant differences between recovered asymptomatic SARS-COV-2 patients and controls in any of transitory evoked otoacoustic emission (TEOAE), distortion product otoacoustic emissions (DPOAE), or ABR responses. Conclusions: There is no cochlear dysfunction represented by ABR, TEOAE, and DPOAE responses in recovered COVID-19 asymptomatic patients. Retrocochlear function was also preserved as evident by the ABR responses. A long-term evaluation of a larger cohort of SARS-COV-2 patients will help to identify a possible contribution of SARS-COV-2 infection to recently published anecdotal auditory symptoms associated with COVID-19.

Vaccine hesitancy remains a barrier to full population inoculation against highly infectious diseases. With rapid developments in a potential COVID-19 vaccine by scientists across the globe, public concerns over the safety and side effects of such a vaccine may contribute to vaccine hesitancy. We analyzed anonymous questionnaire answers regarding acceptance of a potential COVID-19 vaccine posed to healthcare workers and the general population throughout Israel with a total respondent count of 1941. Our results demonstrate higher rates of COVID-19 vaccine hesitancy among various groups: parents, nurses, and medical workers not caring for SARS-CoV-2 positive patients. Healthcare staff involved in the care of COVID-19 positive patients and individuals who consider themselves at higher risk of disease were more likely to self-report acquiescence to obtain a COVID-19 vaccine if and when it becomes available. Interventional educational campaigns targeted towards populations at risk of vaccine hesitancy, therefore, are urgently needed to combat misinformation and resultant low inoculation rates.

This study was performed to test a protocol for trans-implant treatment of chronic recurrent maxillary sinusitis (CRS), via implants with an internal removable sealing screw. The appropriate indications for treatment, optimal number of treatment sessions, and general schedule of treatment and follow-up were assessed. This was a retrospective study of 31 patients with CRS who were managed with trans-implant lavage. Of these patients, 28 (referred for a sinus elevation procedure) underwent a simultaneous implantation procedure and treatment of the sinusitis. Three patients received treatment for sinusitis via an already existing implant. The suggested sinusitis treatment protocol includes the drainage of pus through the punctured sinus floor and three sessions of antral irrigation/lavage, four cone beam computed tomography scans, and four transnasal endoscopic observations. The suggested combined protocol includes the simultaneous evaluation of the implant status and the sinusitis treatment results on days 30 and 60 after surgery. Of the 31 patients, 28 (90%) had complete relief of most of their symptoms (nasal obstruction/discharge, anosmia/hyposmia) up to day 30 postoperative. Follow-up nasal endoscopy demonstrated no evidence of active sinus disease. Twenty-seven implants were well-osseointegrated and were still in use for prosthetic purposes. In one case, the implantation failed because of poor bone quality. For the remaining 30 cases, both clinical and radiological results showed stability of the implants and no CRS recurrence during the whole follow-up period. The dental implant with an internal central port and an integral sealing screw may be used for drainage, irrigation, observation, and further treatment of the maxillary sinus in cases of CRS.

Objectives The accuracy of a cytological diagnosis obtained by fine needle aspiration is influenced by several factors including the technique used and the experience of both the aspirator as well as the cytologist. In this project we planned to evaluate the interobserver differences of thyroid nodule cytopathology in our medical centre. Methods The study was conducted using retrospective pathology reports from a single academic centre from August 2013 to September 2017. We compared the sensitivity, specificity, negative and positive predictive values, malignancy rates, and accuracy of two cytopathologists who evaluated thyroid nodules. Results We included 287 fine needle aspirations of thyroid nodules in the study. Approximately one fifth (18.5%) of patients had surgery and the rate of malignancy was 40%. There was a similar frequency of use of all thyroid Bethesda system (TBS) categories with the exception of TBS 3 (8.0% and 21.2%, P = .01). As a consequence, the malignancy rate was different in TBS 3 category (40% vs 17%, P = .545). Conclusions There are interobserver differences in the evaluation of thyroid nodules. Clinicians should be aware of such differences because they affect the malignancy rate in each TBS category.

Left untreated, obstructive sleep-disordered breathing (OSDB) are associated with adverse effects on growth and development. History and physical examination alone are used for diagnosing children with OSDB, as polysomnography is not always feasible. Our objective was to develop and validate a Hebrew version of the Pediatric Sleep Questionnaire (PSQ) to help to diagnose and follow-up children before and after adenotonsillectomy surgery for OSDB. We conducted a prospective, nonrandomized, controlled trial in an academic medical center. We enrolled parents of children younger than 5 years of age planned for tonsillectomy with or without adenoidectomy due to obstructive airway indication. The parents completed the validated Hebrew version of PSQ questionnaire before and after surgery. We translated the questionnaire through forward–backward translation method. Our main outcome measures were reliability, validity, and responsiveness of the Hebrew version of PSQ. Overall, 45 parents of children with OSDB and 34 controls filled out the questionnaires. We found significant differences between the PSQ scores before and after surgery (p

ObjectivePost-surgical bleeding after tonsillectomy occurs in 2–7 per cent of cases. This study examined whether heart rate and haematocrit changes are associated with the amount of bleeding.MethodIn this retrospective analytical study, data were collected from the medical charts of patients admitted with post-surgical bleeding.ResultsOver the course of 10 years, there were 218 cases of post-operative bleeding in children aged under 18 years. There was a significant increase in heart rate after the bleeding had started, and a significant decrease in both haemoglobin and haematocrit levels (p < 0.05). There was no significant correlation between the differences in haemoglobin and haematocrit and changes in heart rate.ConclusionNo correlation was found between the differences in haemoglobin and haematocrit levels and the changes in heart rate from before the surgery to after the bleeding had started. The monitoring of paediatric patients’ heart rate after tonsillectomy surgery solely for the purpose of predicting acute blood loss is therefore discouraged.

upper airway complications are common sequelae of endotracheal tube (ETT) intubation, and systemic corticosteroids are considered a mainstay treatment for this problem. Drug-eluting ETT may present an attractive option for topical steroid delivery while avoiding systemic side effects and improving the therapeutic outcome. The objective of the present study is to evaluate the reduction of tube-related tracheal morbiditysteroid-eluting ETTs were coated by poly(lactic-the blank-ETT group exhibited a significant increase in tracheal mucosal thickness compared to the loaded-ETT and control groups. Average tracheal mucosal thickness was 112 ± 34, 242 ± 49, and 113 ± 43 μm in the control, blank-ETT, and loaded-ETT groups, respectively. The blank-ETT group exhibited a significant increase in tracheal fibrosis compared to the loaded-ETT and control groups. Relative fibrosis values were 0.07 ± 0.05, 0.154 ± 0.1, and 0.0984 ± 0.084% for the control, blank-ETT, and loaded-ETT groups, respectively. While SEM imaging showed normal surface structures in the control group, intubated blank-ETT rats showed severe surface structural damage, whereas only mild damage was observed in the loaded-ETT group.local sustained release of MF

ObjectivePost-operative bleeding is one of the most common and severe complications of turbinate surgery. This study compared post-operative bleeding following partial turbinectomy, submucosal turbinate reduction and endoscopic turbinoplasty.MethodsPost-operative bleeding was assessed in patients who underwent inferior turbinate intervention by partial turbinectomy, submucosal turbinate reduction or endoscopic turbinoplasty between January 2016 and November 2017 and had completed at least one month of follow up.ResultsOf 1035 patients who underwent inferior turbinate surgery during the study period, 751 were included. Of these, 56 (7.5 per cent) presented to the emergency room with post-operative bleeding; 31 (8.4 per cent) had undergone partial turbinectomy, 19 (10.7 per cent) had undergone submucosal turbinate reduction and 6 (3.0 per cent) had undergone endoscopic turbinoplasty. The odds ratio of requiring an intervention to control bleeding was significantly lower in the endoscopic turbinoplasty group than in the submucosal turbinate reduction group (odds ratio = 3.26, 95 per cent confidence interval = 1.02–10.43).ConclusionEndoscopic turbinoplasty had the lowest rate of post-operative bleeding and the lowest rate of patients requiring intervention.

Objective Studies have demonstrated a potential correlation between low vitamin D status and both an increased risk of infection with SARS-CoV-2 and poorer clinical outcomes. This retrospective study examines if, and to what degree, a relationship exists between pre-infection serum 25-hydroxyvitamin D (25(OH)D) level and disease severity and mortality due to SARS-CoV-2. Participants The records of individuals admitted between April 7th, 2020 and February 4th, 2021 to the Galilee Medical Center (GMC) in Nahariya, Israel, with positive polymerase chain reaction (PCR) tests for SARS-CoV-2 (COVID-19) were searched for historical 25(OH)D levels measured 14 to 730 days prior to the positive PCR test. Design Patients admitted to GMC with COVID-19 were categorized according to disease severity and level of 25(OH)D. An association between pre-infection 25(OH)D levels, divided between four categories (deficient, insufficient, adequate, and high-normal), and COVID-19 severity was ascertained utilizing a multivariable regression analysis. To isolate the possible influence of the sinusoidal pattern of seasonal 25(OH)D changes throughout the year, a cosinor model was used. Results Of 1176 patients admitted, 253 had records of a 25(OH)D level prior to COVID-19 infection. A lower vitamin D status was more common in patients with the severe or critical disease (p < 0.001). Patients with vitamin D deficiency (p < 0.001). Conclusions Among hospitalized COVID-19 patients, pre-infection deficiency of vitamin D was associated with increased disease severity and mortality.

Early detection of COVID-19 is key in containing the pandemic. Disease detection and evaluation based on imaging is fast and cheap and therefore plays an important role in COVID-19 handling. COVID-19 is easier to detect in chest CT, however, it is expensive, non-portable, and difficult to dis-infect, making it unfit as a point-of-care (POC) modality. On the other hand, chest X-ray (CXR) and lung ultrasound (LUS) are widely used, yet, COVID-19 findings in these modalities are not always very clear. Here we train deep neural networks to significantly enhance the capability to detect, grade and monitor COVID-19 patients using CXRs and LUS. Collaborating with several hospitals in Israel we collect a large dataset of CXRs and use this dataset to train a neural network obtaining above 90% detection rate for COVID-19. In addition, in collaboration with ULTRa (Ultrasound Laboratory Trento, Italy) and hospitals in Italy we obtained POC ultrasound data with annotations of the severity of disease and trained a deep network for automatic severity grading.

Objective The COVID-19 pandemic-related restrictions on the public have led to changes in occupation status and societal behavior which may be linked with adverse effects on mental health. We hypothesized that elevated personal stress induced by COVID-19 may underlie pain exacerbation among individuals with chronic myofascial pain. Methods Comprehensive myofascial pain questionnaire among 319 patients registered in our pain clinic. In total, 78 patients with TMD-associated pain responded and 113 patients with pain in other orofacial regions responded. Results Patients with chronic TMD pain reported a higher self-rated stress level, which correlated with significantly increased pain intensity, and analgesic consumption. In contrast, patients experiencing non-TMD pain did not report of any increase pain, regardless of their stress levels. Conclusion Significant correlation between self-perceived psychosocial stress levels and chronic myofascial pain exacerbation. Patients may benefit from early education and conservative intervention, and avoid uncontrolled increases in consumption of pain relief medication.

Vaccine hesitancy is a global health threat which may hinder the widespread acceptance of several COVID-19 vaccines. Following the collection of 2470 responses from an anonymous questionnaire distributed between October and November 2020 across Israel, we analyzed the responses of physicians, life science graduates (biology, virology, chemistry, etc.), and the general public to whether they would obtain a COVID-19 vaccine with particular vaccine characteristics such as vaccine country of origin, technology, side effect profile, efficacy, and other attributes. Physicians and life science graduates were least likely to accept a vaccine based on mRNA technology (30%) while the general population seemed to adopt any vaccine technology if the declared efficacy is above 90% and the country of manufacturing is the USA/UK rather than China or Russia. However, current inoculation rates in Israel far outpace our predicted rate. Our results highlight the importance of tailored vaccine educational campaigns based on population demographic details and specific vaccine concerns.

With the onset of the COVID-19 pandemic, social distancing guidelines have reshaped the way that we live our lives. Perhaps the most common and strictly adopted measure has been mask wearing. Mask wearing, whether it be cloth, surgical, or N95, has quickly become the new norm in the ongoing struggle against this pandemic and has been proven to be effective in curbing its high infection rate. There has, however, been growing opposition to these policies by a substantial part of the general population who claims that masks are ineffective and can worsen breathing. To some, the choice to use or not use a mask has morphed into a point of political contention, rather than a choice rooted in concerns for public health. This commentary attempts to investigate the validity of these claims and explore how clinicians can encourage the usage of masks despite the fears and confusion against them.

In the midst of the coronavirus disease 2019 (COVID-19) outbreak, chest X-ray (CXR) imaging is playing an important role in the diagnosis and monitoring of patients with COVID-19. Machine learning solutions have been shown to be useful for X-ray analysis and classification in a range of medical contexts. The purpose of this study is to create and evaluate a machine learning model for diagnosis of COVID-19, and to provide a tool for searching for similar patients according to their X-ray scans. In this retrospective study, a classifier was built using a pre-trained deep learning model (ReNet50) and enhanced by data augmentation and lung segmentation to detect COVID-19 in frontal CXR images collected between January 2018 and July 2020 in four hospitals in Israel. A nearest-neighbors algorithm was implemented based on the network results that identifies the images most similar to a given image. The model was evaluated using accuracy, sensitivity, area under the curve (AUC) of receiver operating characteristic (ROC) curve and of the precision-recall (P-R) curve. The dataset sourced for this study includes 2362 CXRs, balanced for positive and negative COVID-19, from 1384 patients (63 +/- 18 years, 552 men). Our model achieved 89.7% (314/350) accuracy and 87.1% (156/179) sensitivity in classification of COVID-19 on a test dataset comprising 15% (350 of 2326) of the original data, with AUC of ROC 0.95 and AUC of the P-R curve 0.94. For each image we retrieve images with the most similar DNN-based image embeddings; these can be used to compare with previous cases., Elisha Goldstein, Daphna Keidar, and Daniel Yaron have made an equal contribution and are equal first authors, listed alphabetically

Many government websites and mobile content are inaccessible for people with vision, hearing, and cognitive disabilities. The COVID-19 pandemic highlighted these disparities when health authority website information, critical in providing resources for curbing the spread of the virus, remained inaccessible for disabled populations. The Web Content Accessibility Guidelines provide comparatively universally accepted guidelines for website accessibility. We utilized these parameters to examine the number of countries with or without accessible health authority websites. The resulting data indicate a dearth of countries with websites accessible for persons with disabilities. Methods of information dissemination must take into consideration individuals with disabilities, particularly in times of global health crises.

Background: Over 3200 Syrian patients were admitted and treated at Galilee Medical Center (GMC) over a five-year period (May 2013 - May 2018) since the beginning of the Syrian civil war in 2011. This study compares the number of postoperative complications of patients admitted to the GMC immediately after injury or two to three weeks after initial high-velocity maxillofacial injuries and the potential mechanisms for the variation in complication rates. We describe our experiences, strategies, and resultant treatment approach.Methods: Retrospective case studies in which the incidence of complications including infection, rejection of hardware, bone or soft tissue grafts, tissue dehiscence, oroantral fistula formation, excessive scarring, and unplanned return to the operating theater were investigated. Patients arriving at the GMC within 24 hours following maxillofacial injury were considered “early” while patients arriving to the GMC within 14-28 days following initial trauma without treatment prior to arrival were considered “late” or “delayed.” Both groups of patients received definitive surgical treatment within 48 hours of admission to our hospital. Results: Sixty patients suffering from "high-velocity" maxillofacial Syrian civil war-related battlefield injuries were included in this study. The mean age was 26±8 years (range: 9-50) and all except one were male. Post-operative complications in the early group were found to be significantly higher compared to the delayed group (p = 0.006).Conclusions: We discovered that the delayed group of patients, characterized by progressive neovascularization of injured tissue, had better surgical success from rich blood supply that enhances tissue survival. Sustained tissue perfusion to the tissue supports efficient systemic antibiotic delivery, a favorable condition in lowering infection rate and complication. We found that the unintendedly delayed treatment contributed to a critical revascularization period resulting in improved healing and decreased postoperative morbidity and complications.

Background Epiphora due to refractory bicanalicular obstructions is typically managed by conjunctivodacryocystorhinostomy (CDCR) with or without the assistance of nasal endoscopy. However, the evidence for its benefit is unclear. Methods A systematic review of the literature on the treatment of epiphora by CDCR was performed (March 1, 2018). All studies reporting original data on patients suffering from epiphora treated with CDCR surgery were included. Primary outcomes were success and satisfaction rates. Secondary outcomes were CDCR complications. A comparison was made between the results obtained in patients undergoing CDCR with vs without assistance of nasal endoscopy. Results Fifty-four studies representing information on 2555 CDCR procedures were included in the systematic review. All the studies are case series, most of them retrospective. Lester Jones tube (LJT) is the most commonly used in CDCR (66.7%). The overall success rate with all studies included (n = 2555) was 88.9%; 90.8% (n = 890) in CDCR with assistance of nasal endoscope and 87.7% (n = 1575) in the non-endoscopic approach. The overall "tube displacement" rate, the most common complication, was 24.5% (n = 2522), 20.8% (n = 1575) tube displacement in CDCR with assistance of nasal endoscope vs 26.7% (n = 1575) in the non-endoscopic approach. Only 3 studies (5.5%) used patient-reported outcome measures (PROMs) to evaluate epiphora improvement. Due to the low level of evidence and the high bias of the studies, a meta-analysis was not performed. Conclusion Based on the data available in the literature, CDCR is considered an effective procedure for treating epiphora due to proximal obstruction. Controlled and qualitative studies are needed to clarify the significance of the endoscope's contribution to CDCR.

Resume Introduction La thrombose veineuse profonde du membre superieur (ueDVT) est souvent causee par un traumatisme de la veine sous-claviere, un catheter veineux central et des troubles d’hypercoagulation. Cas clinique Nous presentons le cas d’une ueDVT due a un goitre retrosternal comprimant le tronc brachiocephalique (TVBC) droit. L’administration d’un traitement a base d’heparine de faible poids moleculaire par voie sous-cutanee et une aspiration du liquide du kyste thyroidien entrainait une amelioration immediate. La cytologie ne detectait aucune malignite. Apres huit mois de suivi, on notait une resolution complete de ses symptomes. Discussion D’une facon generale, le traitement optimal devrait consister dans de tels cas en une ablation du tissu thyroidien a l’origine de la compression. Chez des patients fragiles en presence d’un kyste thyroidien, l’aspiration du kyste peut s’averer suffisante.

Abnormal formation of otoconia, the biominerals of the inner ear, results in balance disorders. The inertial mass of otoconia activates the underlying mechanosensory hair cells in response to change in head position primarily during linear and rotational acceleration. Otoconia associate exclusively with the two gravity receptors, the utricle and saccule. The cristae sensory epithelium is associated with an extracellular gelatinous matrix known as cupula, equivalent to otoconia. During head rotation, the inertia of endolymphatic fluids within the semicircular canals deflect the cupula of the corresponding crista and activates the underlying mechanosensory hair cells. It is believed that detached free floating otoconia particles travel ectopically to the semicircular canal and cristae and are the culprit for benign paroxysmal positional vertigo (BPPV). The Slc26a4 mouse mutant harbors a missense mutation in pendrin. This mutation leads to impaired transport activity of pendrin and to defects in otoconia composition and distribution. All Slc26a4(loop/loop) homozygous mutant mice are profoundly deaf but show inconsistent vestibular deficiency. A panel of behavioral tests was utilized in order to generate a scoring method for vestibular function. A pathological finding of displaced otoconia was identified consistently in the inner ears of mutant mice with severe vestibular dysfunction. In this work, we present a mouse model with a genetic predisposition for ectopic otoconia with a clinical correlation to BPPV. This unique mouse model can serve as a platform for further investigation of BPPV pathophysiology, and for developing novel treatment approaches in a live animal model.

Background: Many government websites and mobile content are inaccessible for people with vision, hearing, and cognitive disabilities. The COVID-19 pandemic highlighted these disparities when health authority website information, critical in providing resources for curbing the spread of the virus, remained inaccessible for disabled populations. Methods: The Web Content Accessibility Guidelines (WCAG) provide comparatively universally accepted guidelines for website accessibility. We utilized these parameters to examine the number of countries with or without accessible health authority websites. Findings:The resulting data indicate a dearth of countries with websites accessible for persons with disabilities. Fewer than 5% of all countries had health authority websites fully accessible according to the WCAG. Interpretation: Methods of information dissemination must take into consideration individuals with disabilities, particularly in times of global health crises. Government health websites can be considered the most trustworthy sources of preventative healthcare information and therefore must be accessible to all, regardless of ability. Nations should seek to improve website compliance with the WCAG. Funding Statement: The authors report no funding sources. Declaration of Interests: The authors have no other competing interests to declare.

BACKGROUND Chronic rhinosinusitis (CRS) is a relatively common disease, which significantly affects the patient's quality of life (QoL). Sino-Nasal Outcome Test-22 (SNOT-22) is a QoL questionnaire, which allows quantifying patients' complaints. Our aim was to translate and validated the SNOT-22 into the Russian language. METHODS Translation and validation of SNOT-22 questionnaire was performed through forward-backward translation technique. After proper translation, the translated questionnaire was completed by CRS patients before and after endoscopic sinus surgery (ESS) and by healthy individuals as controls. RESULTS Thirty-four native Russian-speaking CRS patients completed the Russian version of the SNOT-22 questionnaire before and after ESS. The internal consistency for reliability assessment was very good (mean Cronbach's alpha = 0.816 for CRS patients). Mean scores for the preoperative, postoperative and control groups were 67.6, 18.1 and 9.2, respectively (P

The currently accepted treatment for idiopathic sudden sensorineural hearing loss (ISSHL) is systemic steroids as first-line and intratympanic steroids as salvage therapy. Intratympanic (IT) treatment is applied worldwide in many different ways with no universally accepted protocol.To present the current disparity in ISSHL management and to discuss the necessity for establishing a common national protocol.In 2014 we conducted a national survey by sending questionnaires on ISSHL management to otologists in every otolaryngology department in the country.The majority of otolaryngology departments (56%) admit patients with sudden sensorineural hearing. Almost two-thirds (61%) of departments recommend supplementary initial treatment in addition to systemic steroids. None of the medical centers offer intratympanic steroid treatment as primary therapy, but 94% offer this treatment as a salvage therapy. Fewer than half the medical centers (44%) consider the maximal period for intratympanic therapy to be 4 weeks since hearing loss appears. Almost half (48%) the departments use intratympanic steroids once every 5-7 days, usually in an ambulatory setting. Almost half (44%) the medical centers tend to use not more than four courses of IT steroids. In 44% of departments an audiogram is performed at the beginning and at the end of the intratympanic course.Our results demonstrate a variability among Israeli medical centers in many aspects of intratympanic treatment. We believe this reinforces the need for a comparative international study in order to establish a standard protocol.

Objectives Medication errors in hospitalized children represent a serious health problem; these include dosing errors, administration route errors, errors in identifying the patient and more. The rates of medication errors are considered higher in children compared to adults because, among other reasons, the pediatric dose is calculated according to the child's weight or body surface. This study aims to examine the incidence of pediatric medication dosing errors and the impact of an intervention program in reducing these errors and related adverse effects in a cohort of hospitalized children at an otolaryngology department. Methods We reviewed 100 computerized medical reports of hospitalized children from 2017 to 2018, including 50 inpatient admissions prior to the implementation of an intervention program and 50 inpatient admissions following its implementation. Data includes demographic variables, number of hospitalization days, rates and types of medication errors and adverse effects. We have analyzed the rates of medication errors before and after implementation of an interventional program. Results The average patient age was 5.26 and the demographic features of the two groups were similar. We identified 23.2% medication dosing errors in medications prescribed to the patients (n = 33) and 17.6% medication dosing errors in total medications administered to the patients (n = 64) in the pre-intervention group (PREG). In the post-intervention group (POSG) we identified 10.6% medication dosing errors in prescriptions prescribed to the patients (n = 12) and 7% medication dosing errors in the total drugs administered to the patients (n = 21). The intervention program resulted in 46% reduction of prescription errors; No adverse effects were recorded. Conclusions Medication dosing errors among hospitalized children are common, although rates of adverse events are low. The suggested intervention program demonstrates a significant reduction in the rates of these errors, thus improving the safety of hospitalized children.

Objective Laryngotracheal damage is a well-described complication of endotracheal intubation and animal models are essential for studying the underlying cellular injury cascade. This novel rat model is based on transoral intubation and aims to simulate the common clinical scenario of tube-related airway damage. Methods Prospective randomized control pilot study. 28 male Sprague-Dawley were randomly assigned into three groups: control, 3-h' intubation and 6-h' intubation. The animals were then euthanized and their laryngotracheal complexes sent for histological analysis. Epithelial damage, mucosal thickness and mucosal gland hypertrophy were reviewed. Results Total of 13 control animals and 15 intubated animals. 10 intubated animals survived the study protocol. Loss of epithelial surface architecture including damage to the microscopic ciliary mechanism was a common feature amongst all intubated animals. Average mucosal thickness of the larynx (including vocal cords and subglottic area) was 143 ± 88 μm for control rats, 315 ± 101 μm for rats intubated 3 h and 574 ± 174 μm for rats intubated 6 h .This was a statistically significant difference. Average mucosal gland hypertrophy in the laryngeal subsite was 0.41 ± 0.5 in control rats, 1.4 ± 0.5 in rats intubated 3 h and 2.0 ± 0.0 for rats intubated 6 h (statistically significant difference). There was a clear difference between three and 6 h of intubation with poorer mucosal injury parameters for longer intubation. Conclusions We describe a novel rat-based animal model for simulating airway mucosal damage following transoral intubation. This animal model is easy to carry out, reproducible and involves containable animal mortality rates.

Objectives To establish clinical criteria for performing computed tomography scan for suspected upper digestive tract fishbone. Methods This is a prospective study of all adult patients referred to the otolaryngology emergency department at our medical center for suspected fishbone in the upper digestive tract after no fishbone was seen on physical examination. The patients were divided into two groups: 1) The first was a high clinical suspicion group, which included patients with at least one of the following criteria: drooling, accumulation of saliva in the sinus piriformis, fever, referral 24 hours after the ingestion with worsening/continuing symptoms, and readmission. These patients underwent nonenhanced CT scan (NECT) of the neck. 2) The second was a low clinical suspicion group, which included patients discharged with no NECT performed. These patients were followed at 1 week and 3 months. Results One hundred and fourteen patients were included in the study; the median age was 41 years. Half of the patients arrived at the emergency department within 7 hours. There were no false negatives. The negative predictive value and sensitivity were 100%. Positive predictive value and specificity were 28.5% and 65%, respectively. Referral to the emergency department 24 hours after the ingestion with continuing symptoms had the highest false positive rate. Conclusions Our clinical criteria score for excluding foreign body fishbone in the upper aerodigestive tract was established. According to this score, a NECT can be spared in about 75% of all cases, thus reducing unnecessary ionizing radiation, stay at the emergency department, and costs with a very high NPV of almost 99%. Level of evidence 4. Laryngoscope, 2467-2472, 2018.

For two years the State of Israel has been treating casualties from the Syrian civil war. The Galilee Medical Center in Nahariya is the main hospital for this humanitarian mission. Objectives: To evaluate the demographic and clinical characteristics of the casualties that were treated in our department.Information from medical records of all Syrian casualties evacuated to the Galilee Medical Center were evaluated.Between March 2013 and December 2014, 450 casualties were evacuated to the Galilee Medical Center. Of those, 45 were treated in the Department of Otolaryngology - Head and Neck Surgery. Of the 45 cases, 43 were male (95.5%) and the mean age was 30.4 years (range 1-79 years). There was a significant difference in terms of gender (p0.0001). The majority of cases (42.1%) were aged 21-27 years. The most common cause of injury was a gunshot wound. Thirty five patients (77.7%) suffered from multiple trauma, and complex injuries of the maxillofacial bones and upper respiratory tract. Eight (18%) of the cases arrived at the medical center with a tracheotomy. The average length of hospital stay was 15 days (range: 1-141). Of the 450 cases, 97.3% were discharged back to Syria, and 12 died.Of all Syrian injured treated in the ENT department, the vast majority were young men. The main cause of injury was gunshot wounds.It is likely that the lack of protective gear that exist in western armies is a factor in the complex injuries treated at the Galilee Medical Center.