The ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and the associated coronavirus disease 2019 have had a profound global and individual burden, with 1,610,909 confirmed cases and 99,690 confirmed deaths across 213 countries, areas, and territories at the time of writing (1).The highly transmissible nature of the novel coronavirus, its potential for asymptomatic transmission, and the lack of a curative treatment, has necessitated the enforcement of stringent social distancing and quarantine measures in order to limit the rate of infection-thereby reducing morbidity and mortality whilst also reducing the strain on rapidly saturating healthcare systems (2).Recent literature has identified that medical professionals account for COVID-19 patients due to their increased and repeated exposure to the virus (3). This unhappy truth, combined with a lack of testing and personal protective equipment for key workers, has, in some areas, seen a diminishment of the workforce and a reduction of our ability to combat the disease on both a local and international level (4).Multidisciplinary team meetings (MDTs) are defined by the United Kingdom's National Health Service as 'a group of professionals from one or more clinical disciplines who together make decisions regarding recommended treatment of individual patients' (5). They have become the clinical mainstay and gold-standard for the care of complex patients, in particular those with oncological malignancies. As such, their efficacy and cost-effectiveness is well documented in the literature (6)(7)(8).In this light, as MDTs in their current format necessitate face-to-face contact between multiple clinical teams, they have the potential to act as potent accelerators of viral transmission. This article evaluates the efficacy of virtual MDTs in the light of the SARS-CoV-2 pandemic as a means of reviewing patient care at a physical distance, thereby maintaining the safety of clinicians by minimizing the risk of infection.We conducted a survey of 50 practicing physicians who have been using virtual MDTs since mid-March of the SARS-CoV-2 pandemic (1 month at the time of writing). This evaluated their thoughts on whether or not virtual MDTs are a safe alternative to in-person MDTs and on how the shift to a virtual space may have affected the standard of patient care. This was achieved through comparison of opinions of virtual MDTs to in-person MDTs across eleven core criteria: accessibility; clinical decision process and consensus; clinical governance; communication; continuity

Background Puberphonia is the perseverance of high pitched voice after the pubertal age in males which causes a huge psychosocial impact. Voice therapy is one modality of management of Puberphonia. Aim The Objective of our study was to evaluate the efficacy of voice therapy in patients as the sole treatment to improve the pitch and quality of voice, the psychosocial impact and patient's satisfaction. Methods A retrospective study was carried out on 71 patients who were presented to ENT unit at the National hospital of Sri Lanka for fifteen years from 2002. Pre and post voice therapy subjective assessment was done by the speech therapist for pitch and quality and patient's perceptual assessment using an analog scale (0-extremely poor to 10normal voice) and a psychosocial impact assessment was also done. Results The time duration of voice therapy ranged from 1 to 10 months (average-3.6 months). Pitch and quality of the voice became normal in 78.9% and 35.2% of patients respectively. Pre-therapy perceptual score range(PSR) was 0 to 6 (mean-3.0). Post-therapy PSR was 5 to 10 (mean-7.7). 95.8% patients had improved psychosocial impact and patient satisfaction after voice therapy. Remaining opted for surgical management. Conclusion Voice therapy significantly improves the pitch, patient's satisfaction and psychosocial impact and can be used as an effective modality of treatment for Puberphonia.

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The Covid 19 infection which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is found to be associated with a wide range of bacterial and fungal co-infections. We report the first post COVID-19 Sino-orbital Mucormycosis infection in a patient with diabetes mellitus in Sri Lanka. A 57 years old female with a history of long standing uncontrolled diabetes presented with left facial pain and swelling. She has had a positive reverse-transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2 one month back. On Rigid nasal endoscopy(RNE) blackish crusting was noted on the nasal septum. The Contrast enhanced CT scan (CECT) demonstrated fat stranding in premaxillary, infratemporal and pterygopalatine regions. Presence of mucormycosis was confirmed from biopsies following a functional endoscopic sinus procedure. Patient was treated with IV liposomal amphotericin B and with local nasal packs with amphotericin. Sinonasal biopsies after completion of 5g of Liposomal amphotericin B were negative and the patient was asymptomatic and discharged after 27 days of Amphotericin. ConclusionA good prognosis can be achieved with an early diagnosis and debridement along with prompt conservative treatment of Amphotericin B .

Objective Lesions involving nasal cavity(NC), paranasal sinuses(PNS) and nasopharynx consists of a wide variety of inflammatory, non-neoplastic and neoplastic lesions. Even though they are common in Sri Lanka proper data is scarce. The aim of this study is to determine various histopathological patterns of NC, PNS and nasopharyngeal lesions, their relative distribution with regard to age and sex in our setting. Methodology A retrospective analytical study was carried out in all patients who underwent biopsies of the above lesions presented to ENT unit at National Hospital of Sri Lanka from 1.1.2015 to 31.12.2017. Results From 238 patients who underwent biopsies, the commonest site was the NC (51.06%) followed by the PNS (43.9%). Male to female ratio was 1.38:1. 79.8% were non-neoplastic, from which 88.9% were inflammatory and 7.3% were fungal, where mucormycosis and rhinosporidiosis being the commonest. Out of the neoplastic conditions (20.8%), 54.1% were benign, with inverted papilloma being the commonest (42.3%), commonly seen in 6th and 7th decades with a male predominance, followed by angiofibroma (15.3%). Squamous cell carcinoma is the commonest malignancy (40.9%), common in 7th and 8th decades with a male predominance, followed by adenocarcinoma (18.18%), adenoid cystic carcinoma (9%) and non-Hodgkin's B cell lymphoma (9%). Conclusion Internationally benign and malignant neoplasms are more common in 4 to 5th decades and 5-6th decades respectively. But in our study both benign and malignant neoplasms were found approximately two decades later in life. This may be due to the late presentation hence we recommend a thorough ENT examination at the earliest presentation of nasal symptoms.