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Testing for coronavirus disease 2019 is critical in controlling the pandemic all over the world. Diagnosis of severe acute respiratory syndrome coronavirus-2 infection is based on real-time polymerase chain reaction performed on nasopharyngeal swab. If not adequately performed, the viral specimen collection can be painful and lead to complications. We present a complication occurred during a nasopharyngeal swab collection performed in a noncooperative patient where the plastic shaft of the swab fractured during the procedure, resulting in swab tip retention deep into the nasal cavity. The foreign body was found endoscopically, stuck between the nasal septum and the superior turbinate tail at the upper level of the left choana and removed under general anesthesia in a negative pressure operating room with the health care personnel wearing personal protective equipment. Unpleasant complications like the one described can happen when the swab is collected without the necessary knowledge of nasal anatomy or conducted inappropriately, especially in noncooperative patients. Moreover, the design of currently used viral swabs may expose to accidental rupture, with risk of foreign body retention in the nasal cavities. In such cases, diagnosis and treatment are endoscopy-guided procedures performed in an adequate setting to minimize the risk of spreading of the pandemic. [ABSTRACT FROM AUTHOR]

Objectives: Impaired cochlear perfusion seems to be an important event in sudden sensorineural hearing loss. Prothrombotic gene mutations have been related to vascular disorders and sudden hearing loss. We assessed the prothrombotic risk in 10 patients with sudden sensorineural hearing loss who had previously experienced cardiovascular events to support its vascular pathogenesis. Methods: Ten patients underwent hematologic tests (MTHFR C677T/A1298C, prothrombin G20210A, platelet GlyIIIaA1/A2, and V Leiden G1691A genotyping; fibrinogenemia; cholesterolemia; homocysteinemia; folatemia).The results were compared with those of 100 previously investigated patients with sudden hearing loss alone and those of 200 healthy controls. DNA was isolated from peripheral blood leukocytes, and the gene mutations were investigated by polymerase chain reaction and a LightCycler DNA analyzer. Results: Two patients had 2 mutant alleles, 6 had 3, and 2 had 4. The mean homocysteine, cholesterol, and fibrinogen levels were above the upper limit of normal; the mean folate levels were slightly above the lower limit of normal. Multiple mutations were more frequent in the patient group than in the previously analyzed patients and healthy controls. Conclusions: The association between inherited and acquired prothrombotic factors in patients with sudden sensorineural hearing loss and thrombotic diseases in other sites suggests that a multifactorial mechanism may underlie microvascular cochlear impairment. Hematologic investigation, including MTHFR, prothrombin, platelet, and V Leiden genotyping, may help to detect patients at potential risk of recurrent hearing loss and multiple microvascular diseases, and could be usefully performed in otherwise idiopathic sudden sensorineural hearing loss. [ABSTRACT FROM AUTHOR]

Objectives: Salivary duct disorders are the second most common cause of obstruction after calculi. Magnetic resonance sialography has been recently proposed as a means of diagnosing a heterogeneous group of salivary disorders, and so we compared it with sialoendoscopy in evaluating stenoses and sialectasia in 24 patients with obstructive symptoms and ultrasonographic results negative for calculi or masses. Methods: All of the patients (19 of whom had recurrent unilateral or bilateral swollen parotid glands and 5 of whom also had recurrent swollen submandibular glands) underwent dynamic color Doppler ultrasonography and dynamic magnetic resonance sialography with lemon juice stimulation of saliva; 18 patients also underwent diagnostic sialoendoscopy. Results: Ultrasonography and color Doppler ultrasonography showed duct dilatation in all patients (bilateral in 5 with parotid stenosis). Magnetic resonance sialography confirmed duct dilatation and stenosis in all of the patients, and revealed the simultaneous presence of calculi in 4 cases. A parotid sialocele was found in 4 cases. The magnetic resonance sialographic findings were confirmed in the patients who underwent sialoendoscopy. No side effects were observed. Conclusions: Magnetic resonance sialography following prediagnostic ultrasonography allows an adequate diagnosis of salivary duct disorders such as stenosis and sialectasia, as confirmed by objective sialoendoscopic assessment. Magnetic resonance sialography also makes it possible to visualize the salivary duct system up to its tertiary branches and, in this regard, may be considered a valid, noninvasive method for the evaluation of salivary duct disorders. [ABSTRACT FROM AUTHOR]

Objective: The most widely used diagnostic technique for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is real-time reverse transcriptase-polymerase chain reaction (RT-PCR). It can be done on different samples: nasopharyngeal swabs (NPS) or oropharyngeal swabs (OPS), and self-collected saliva. However, negative findings do not rule out infection. Methods: A review was conceived to discuss advantages and limitations of the available diagnostic modalities for nonserologic diagnosis of SARS-CoV-2 based on RT-PCR; the article also proposes some practical suggestions to improve diagnostic reliability. Results: A total of 16 papers (corresponding to 452 patients) of the 56 initially identified were included. Most of the papers describe findings from different samples obtained in limited case series; comparative studies are missing. Conclusions: Diagnostic accuracy of NPS and OPS is suboptimal and the risk of contaminated aerosol dispersal is not negligible. The SARS-CoV-2 RNA can be found in self-collected saliva specimens of many infected patients within 7 to 10 days after symptom onset. There is an urgent need for comparative trials to define the diagnostic modality of choice. Adequate education and training of health care personnel is mandatory. [ABSTRACT FROM AUTHOR]

Merkel cell carcinomas are uncommon malignant tumors thought to originate from the neuroendocrine cells of the skin that mainly affects sun-exposed body areas, particularly the head and neck. In approximately 10% of cases, they present with localized lymphadenopathy without any clinical evidence or history of a primary lesion, but a truly primary lymph node Merkel cell carcinoma may occur, possibly originating from epithelial inclusions or an anomalous neuroendocrine differentiation of hematopoietic stem cells. It has been observed that Merkel cell carcinoma is more likely to affect patients whose immune status is impaired as a result of iatrogenic immunosuppression, human immunodeficiency virus infection, or hematological malignancies. This study reports the case of a bona fide primary Merkel cell carcinoma arising in an intraparotid lymph node of a patient infected by HIV that had a particularly unfavorable clinical course. [ABSTRACT FROM PUBLISHER]

Salivary gland sialoceles are relatively common and may be a complication of trauma with a penetrating salivary gland injury or may be a complication of salivary gland surgery. The development of new diagnostic tools such as magnetic resonance sialography and endoscopic techniques has led to further improvements in the clinical and diagnostic assessment of this condition, and botulinum toxin therapy has recently been described in the management of parotid sialoceles. We here report the case of a 41-year-old patient with an unusually complicated parotid sialocele following an unsuccessful attempt to remove a stone located in the distal third of Stensen's duct. Magnetic resonance sialography and sialoendoscopy were used in order to obtain an adequate diagnostic assessment. The patient underwent extracorporeal lithotripsy that led to partial symptom regression. After the development of a parotid abscess, he received antibiotics and a botulinum toxin type A injection that induced spontaneous drainage and disappearance of the symptoms. Magnetic resonance sialography and sialoendoscopy are promising new diagnostic techniques for better noninvasive management of iatrogenic sialoceles. [ABSTRACT FROM AUTHOR]

Crohn's disease is a chronic inflammation that may involve the entire gastrointestinal tract, from the mouth to the anus. The most widely accepted etiologic theory involves an immunologic aberration leading to local tissue destruction. Cell-mediated immunity with increased tumor necrosis factor (TNF) production may play a role in mucosal damage. Oral and laryngeal involvement are rare manifestations of Crohn's disease that are usually treated successfully by steroids. We here report a rare case of extra-intestinal Crohn's disease resistant to steroid therapy, which was successfully treated with infliximab, a chimeric antibody directed against TNF-α that is the only registered agent for the treatment of Crohn's disease. The relative safety, efficacy, and efficiency of infliximab make it an alternative treatment of which otolaryngologists should be aware. [ABSTRACT FROM AUTHOR]