Objective: To investigate the prevalence of olfactory and gustatory dysfunction among patients with COVID-19 infection and the recovery rate. Methods: Adult patients (≥18 years) tested positive for COVID-19 via reverse transcription-polymerase chain reaction (RT-PCR) and admitted in Hospital Tuanku Ja’afar Seremban, Malaysia, were recruited in this study. Patients completed a questionnaire via telephone interview comprising the following details: age, sex, ethnicity, comorbidities, general and otorhinolaryngological symptoms, onset and duration of olfactory and gustatory dysfunction. Patients with persistent olfactory and gustatory dysfunction at the time of the initial interview were followed-up every 3 to 5 days till resolution. Results: A total of 145 patients were included in our study. The mean age of patients was 43.0 ± 17.7 (range: 18-86). Fever (44.1%) and cough (39.3%) were the most prevalent general symptoms. Thirty-one patients (21.4%) reported olfactory dysfunction and 34 (23.4%) reported dysgeusia. There was a significant association between both olfactory and gustatory dysfunction ( P < .001). Altered sense of smell or taste occurred before other symptoms in 7 (15.9%); concomitant in 16 (36.4%) and after in 15 (34.1%). Six patients (13.6%) reported isolated sudden-onset anosmia. The median duration of olfactory and gustatory dysfunctions was 7 days. Complete recovery was achieved for 70.5% of the patients within 7 days of symptom onset. Only 6 (19.4%) of the 31 patients with olfactory dysfunction experienced nasal obstruction or rhinorrhea. Olfactory dysfunction was not significantly associated with nasal obstruction or rhinorrhea. Olfactory dysfunction was significantly associated with younger age ( P = .002), female ( P = .011), and hyperlipidemia ( P = .012). Gustatory dysfunction was significantly associated with fever ( P = .019) and cough ( P = .039). Conclusion: Olfactory and gustatory dysfunction is a pertinent manifestation of COVID-19. Most of the affected patients achieve rapid and complete recovery. Sudden onset of olfactory and gustatory dysfunction should be recognized as a major symptom of COVID-19 as we implore to contain this pandemic.
Cochlear implant (CI) surgery is relatively safe, however reports of complications and failure following cochlear implant surgery are higher nowadays due to the increasing number of patients with CI. Herein, we report a case of infected cochlear implant 10 months after surgery. A three-year-six-month-old girl underwent right cochlear implantation for bilateral profound sensorineural hearing loss. From day one until six months after the surgery, it was uneventful and the wound healed well. However, at 10 months postsurgery, she presented with a chronic discharging wound over the previous surgical site. Despite being on IV antibiotics for six weeks and daily dressing, the wound over the implant site keep discharging and eventually the implant was removed two months later. She was later re-implanted with a cochlear implant on the same side at the age of five years 10 months old. Currently, she is showing good speech improvement with the right CI. Her aided hearing threshold is at 30-40 dB at all frequencies.Early diagnosis is crucial, and the proper course of action should be taken as soon as possible if implant failure is suspected. Prior to implant surgery, any potential risk factors that could lead to implant failure should be identified and addressed appropriately to reduce the risk of an infected cochlear implant.
Aim: To highlight the challenges involved in the diagnosis and management of synchronous tumours. A synchronous head and neck lesion brings the attending physician into a quandary, as there is no gold standard for managing such patients. Failure to respond to treatment should provoke physicians into considering other possible diagnoses, as often a secondary lesion may be the hidden culprit. Case report: Herein, we present a case of a synchronous cervical mass: Kimura disease and nasopharyngeal carcinoma in a 48-year-old woman. She was initially treated for Kimura disease based on fine-needle aspiration cytology evidence, and later found out to have a synchronous malignancy in the fossa of Rosenmüller. Failure of Kimura disease to respond to steroid treatment led to a repeated examination, which resulted in the diagnosis of nasopharyngeal carcinoma. The patient was treated with concurrent chemoradiotherapy. Conclusion: Kimura disease, a rare benign head and neck tumour, is treated successfully with steroids. Persistent swelling coupled with treatment failure should alert physicians to repeat patient assessment, as improper disease management leads to severe complications.
Aim of the study: The aim of this case report is to emphasise the importance of meticulous history-taking and examination, and to raise the awareness of various possibilities of diagnosis and management. Unilateral peritonsillar abscess is a common complication of acute bacterial tonsillitis. However, bilateral peritonsillar abscess is considered rare, and only a meagre number of cases has been reported to date in the English medical literature. The challenging part involved in the diagnosis of bilateral peritonsillar abscess is the absence of common physical findings of unilateral peritonsillar abscess. Case report: We present a case of a teenage girl who presented with a history of worsening sore throat, odynophagia and muffled voice, which turned out to be bilateral peritonsillar abscess. Oropharyngeal examination revealed bilateral peritonsillar fullness, and pus was aspirated bilaterally. The patient underwent bilateral peritonsillar incision and drainage, and was discharged well after a few days, with no recurrence. Bilateral peritonsillar abscess can present with usual symptoms, but physical findings may vary. Conclusion: Proper history-taking and meticulous physical examination may direct the physician towards correct diagnosis, and an imaging evaluation is warranted if in doubt, so as to avoid unwanted perilous complications.
To emphasize the importance of meticulous history and examination as well as the awareness of various possibilities of diagnosis and management. Case study: Warthin's tumour is a benign tumour which mostly arises from the parotid gland and rarely involves minor salivary glands. Extraparotid or ectopic Warthin's tumour most commonly involves the submandibular gland. We report a rare case of nasopharyngeal Warthin's tumour with an unusual presentation. A 59-year-old man presented with left submandibular swelling with right-sided nasopharyngeal fullness. Biopsy of the nasopharyngeal mass along with imaging was suggestive of Warthin's tumour. Conclusion: We would like to highlight the challenge in diagnosing this entity and discuss its management.
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