Purpose: COVID-19 pandemic transformed the health system response worldwide. The aim of this study is to report changes about numbers and reason for ENT consultations in emergency department (ED) during COVID-19 pandemic comparing with those occurred the previous year (2019). Methods: Data about patients admitted to adult and pediatric ED were collected from March 1 to May 31, 2019 and 2020. Patients referred for urgency from general practitioners were excluded from the study. Results: Global ED admission (except for dyspnea or COVID-19–related symptoms) dramatically decreased during pandemic (−50.9% among adults and −71.4% among pediatrics). At the same time, ENT consultancy significantly reduced too, by 71.5% ( P < .01) among adults and 45.1% ( P < .01) for pediatrics. Among adults, it was reported a statistically significant decrease in consultation for ear problems (−88.5%, P = .0146). Reduction in ENT referral for bone fracture (−40%, P = .059), vertigo (−77.8%, P = .637), and tonsillitis (−87.5%, P = .688) was consistent, but not significant. Among pediatric patients, it was observed an increase by 25% about foreign bodies (12 vs 15, P < .01). A reduction in numbers of consults for ear problem (−90.8%; P = .045), epistaxis (−80%; P = .196), and nasal fracture (−70%; P = .36) was also observed. Conclusion: Fear of infection and the forced lock down caused a significant decrease in the number of ED accesses and in ENT consultancy. These data may suggest that some ED referral usually could be deferred, but on the other hand, pandemic will cause a great diagnostic delay.
Papillary carcinoma is the most frequently encountered differentiated thyroid carcinoma. Usually, metastasis occurs along lymphatic pathways in the central compartment and along the jugular chain. Nevertheless, lymph node metastasis in the parapharyngeal space (PS) is a rare but possible event. In fact, a lymphatic pathway has been identified that connects the upper pole of the thyroid and the PS. We describe the case of a 45-year-old man with a two-month history of a right neck mass. He underwent a complete diagnostic path that highlighted the presence of a parapharyngeal mass associated with the presence of a thyroid nodule suspected to be malignant. The patient underwent surgery (thyroidectomy and removal of the PS mass that was found to be a metastatic node of papillary thyroid carcinoma). The aim of this case is to underline the importance of detecting these kinds of lesions. Nodal metastasis in PS from thyroid cancer is a rare occurrence that is not easily detectable by a clinical examination until the metastasis reaches a considerable dimension. Computed tomography (CT) and magnetic resonance imaging (MRI) permit early identification, but unfortunately, these are not usually employed as a first-level imaging technique in patients with thyroid cancer. The treatment of choice is surgery with a transcervical approach that allows for better control of the disease and of the anatomical structures. Non-surgical treatments are usually reserved for patients with advanced disease, with satisfactory results.
Paragangliomas of the thyroid gland are rare and usually they originate from the inferior laryngeal paraganglia. In this case report, we describe the case of a 78-year-old woman who presented with an incidental finding of thyroid nodule dislocating the trachea. After a systemic and radiological evaluation, right lobo-isthmectomy was performed, and the definitive diagnosis of paraganglioma was reached. Diagnosis of these thyroidal lesions could be difficult due to their rarity, to their specific radiological aspects and the need of employing specific histological staining techniques. Once the definitive diagnosis is reached, patients should undergo a systemic and genetic evaluation. Surgery is the gold standard treatment; radiotherapy should be considered when aggressive behavior is suspected. Regular long-lasting follow-up should be proposed to these patients considering the unpredictable behavior of these lesions.
TheCOVID-19 pandemic has rapidly spread worldwide. Individual prevention approaches include FFP2/N95 mask use. Healthcare (HC) workers wear face masks for a long time during their work shifts and often complain of nasal symptoms. Current data on mask-associated symptoms or upper airway epithelium transformations are limited. Nasal cytology (NC) is a useful, non-invasive diagnostic method to assess cellular alterations. The aim of this study is to compare NC in HC workers before and after the continuous wearing of FFP2 face masks. We conducted a pilot observational study on 10 volunteer HC workers, who continuously used FFP2 masks during the work shift. All subjects underwent NC at the beginning (T0) and at the end of their workshift (T1) and the cytological findings were compared. Moreover, nasal symptoms were collected. Rare inflammatory cells were detected at T0 and, comparing cytological data about T0 and T1, no significant differences were observed. The most reported nasal symptoms were itching (70%) and a dry nose (60%). Difficulty of breathing and nasal blockage were not relevant. These preliminary data seem to suggest that wearing an FFP2 mask does not determine observable alterations in NC in daily work. However, further studies on a larger population for a longer period are needed.
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