BACKGROUND AND OBJECTIVES

The global pandemic caused by Coronavirus Disease 2019 (COVID-19) has affected millions, with growing evidence of the potential role of ocular tissues in viral transmission. At the time of writing, local data regarding the phenomenon was limited. This study investigated external ocular manifestations in patients with COVID-19 at a referral center in the Philippines, examined correlations between demographics, systemic manifestations, and laboratory results with ocular manifestations, and determined their timing relative to systemic symptoms.

METHODS

This single-center, descriptive cross-sectional study was carried out from December 8 to 18, 2020 at the adult COVID-19 wards of the Philippine General Hospital involving 72 participants. Data collection involved relevant clinical history taking and performing gross eye examination. The prevalence of ocular manifestations was described with 95% confidence intervals. Correlations between ocular manifestations and quantitative variables were analyzed with point-biserial correlation, and associations with qualitative variables were tested using chi-square or Fisher’s exact tests.

RESULTS

Among participants, 31.9% presented with ocular manifestations with foreign body sensation as the most prevalent ocular symptom (11.1%) and conjunctival hyperemia as the most prevalent ocular finding (19.4%). The median age of patients with ocular manifestations was 41 years old with a higher prevalence in the male population (73.9%, CI=95%, p=0.001). No significant correlation was observed between presence of external ocular manifestations and the different systemic and ocular co-morbidities as well as with COVID-19 clinical classification. Among those who experienced symptoms, majority (29.2%) of the patients experienced systemic symptoms prior to the onset of ocular symptoms. Ocular complaints may present as the sole manifestation (13.9%). Several laboratory parameters were measured and only temperature and AST levels showed a low positive correlation with the presence of ocular manifestations. 

CONCLUSION

Ocular manifestations occur in roughly one third of patients with COVID-19 based on this study population. With some individuals presenting with ocular signs or symptoms as the initial and sole manifestation, healthcare practitioners must exercise caution and remain vigilant in managing patients who present as such. At the time of writing, this is the first local study investigating the different external ocular manifestations in patients with COVID-19. There is a need to pursue more robust studies and conduct more local investigations which will guide both ophthalmologists and other practitioners in strengthening existing guidelines regarding precautionary practices, clinical diagnosis, and management of COVID-19 patients.

Human ; Sars-cov-2 ; Covid-19 ; Philippines ; Adult ; Association ; Classification ; Collection ; Confidence Intervals ; Coronavirus ; Cross-sectional Studies ; Data Collection ; Demography ; Diagnosis ; Disease ; Exercise ; Eye ; Foreign Bodies ; History ; Hospitals ; Hospitals, General ; Hyperemia ; Laboratories ; Male ; Morbidity ; Ophthalmologists ; Pandemics ; Patients ; Population ; Prevalence ; Referral And Consultation ; Role ; Sensation ; Temperature ; Time ; Tissues ; Volition ; World Health Organization ; Writing

OBJECTIVES

To evaluate and compare ectasia and pseudoectasia in post-myopic LASIK patients presenting with corneal topographic changes indicative of ectasia using the Ectasia Risk Factor Score System (ERFSS).

METHODS

Single-center retrospective comparative case series of a consecutive chart review of cases in 18 years who underwent bilateral myopic-LASIK and showed topographic changes indicative of ectasia.

RESULTS

Four patients were included. Group 1: pseudoectasia eyes, consisting of two patients with bilateral pseudoectasia, and Group 2: ectasia eyes, consisting of two patients with unilateral ectasia. The clinical course of the cases was discussed and compared based on the ERFSS parameters: topography pattern, residual stromal bed thickness, age, preop thinnest cornea, and pre-operative spherical equivalent (SE) manifest refraction (MR). Group 1 scored zero to low risk for developing ectasia while Group 2-eyes with ectasia scored moderate risk. The predictive value of the ERFSS was 1 in this study.

CONCLUSION

The ERFSS is a good measure in deciding the suited treatment plan for patient undergoing refractive procedure. Knowing the clinical course of ectasia and pseudoectasia is helpful in the therapeutic approach since pseudoectasia is reversible when identified and managed early as seen in this study.

Dilatation, Pathologic ; Eye

Objective:This study aims to investigate the therapeutic efficacy of staged endoscopic surgery for Shin-Ⅲ stage external auditory canal cholesteatoma. Methods:A retrospective analysis was conducted on the clinical data of 25 patients diagnosed with Shin-Ⅲ cholesteatoma of the external auditory canal, who were admitted to the Otology Center of the First People's Hospital of Foshan City from May 2020 to October 2024. All patients initially underwent endoscopic cholesteatoma removal. Based on the outcomes of the first-stage postoperative follow-up, patients were categorized into two groups: the repair type and the non-repair type. The non-repair type was further subdivided into simple and complex types. Of the total cases, 10 patients were of the repair type, with 9 requiring no further surgical intervention. The non-repair type comprised 15 patients, of which 8 were classified as simple type and underwent either tympanoplasty type Ⅰ or external auditory canal wall reconstruction during the second stage. The remaining 7 patients, identified as complex type, received open mastoidectomy or tympanotomy in the second stage, with or without ossicular chain reconstruction. Results:All patients were monitored for a minimum of six months postoperatively. The incidence of dry ear was observed in 22 patients, corresponding to a dry ear rate of 88.0%. Four cases experienced primary complications. Conclusion:Endoscopic phased operation for managing Shin-Ⅲ stage cholesteatoma of the external auditory canal can ensure that the surgical options match the severity of the lesions, reducing unnecessary surgical trauma and achieving good efficacy.
Humans ; Retrospective Studies ; Ear Canal/surgery* ; Endoscopy/methods* ; Cholesteatoma/surgery* ; Male ; Tympanoplasty ; Female ; Treatment Outcome ; Adult ; Middle Aged ; Cholesteatoma, Middle Ear/surgery* ; Mastoidectomy

Objective:To explore the application value of high-resolution temporal bone CT and DW-MRI fusion technology in achieving precise diagnosis and anatomical localization of middle ear cholesteatoma during endoscopic surgery. Methods:Eighteen patients initially diagnosed with middle ear cholesteatoma in the Department of Otolaryngology Head and Neck Surgery, Shaanxi Provincial People's Hospital, from January to June 2024 were enrolled.Preoperative high-resolution temporal bone CT and DW-MRI were performed, and rtStation software was used for image fusion to construct CT-MRI fused images. The involvement of cholesteatoma in six anatomical subregions of the temporal bone was evaluated. Using surgical pathology as the gold standard, and combining surgical videos and anatomical records, the sensitivity, specificity, and accuracy of pure CT, pure DW-MRI, and CT-MRI fused images in evaluating middle ear cholesteatoma lesions were compared. Results:A total of 18 patients were included, and 17 cases were pathologically confirmed as middle ear cholesteatoma postoperatively. The sensitivity of the preoperative of preoperative CT was 100%, but the specificity was only 44.44%, with an overall accuracy of 72.22%; the sensitivity and specificity of DW-MRI evaluation were 81.46% and 85.19%, the accuracy was 83.33%, respectively. In contrast, the sensitivity and specificity of CT-MRI fusion image to the spatial localization of cholesteatoma were higher than that of DW-MRI alone（92.59% vs 81.46%; 98.15% vs 85.19%）, and the diagnostic accuracy was also significantly improved（95.37% vs 83.33%）. The Kappa values for the agreement between HRCT, DW-MRI, and CT-MRI segmentation localization and pathological results were 0.444, 0.667, and 0.907 respectively. The chi-square paired t-test confirmed statistically significant diagnostic differences between groups（P<0.001）. Results demonstrated that CT-MRI significantly outperformed HRCT and DW-MRI in diagnostic efficacy for segmental localization of primary posterior congenital middle ear cholesteatoma. Conclusion:High-resolution temporal bone CT combined with DW-MRI fusion technology demonstrates higher sensitivity, specificity, and accuracy in the diagnosis and spatial localization of middle ear cholesteatoma than single imaging modalities. It can provide more precise evaluation of lesion scope for endoscopic surgery, showing important clinical application value.
Humans ; Cholesteatoma, Middle Ear/diagnostic imaging* ; Tomography, X-Ray Computed ; Temporal Bone/diagnostic imaging* ; Diffusion Magnetic Resonance Imaging ; Female ; Male ; Adult ; Sensitivity and Specificity ; Middle Aged ; Endoscopy

Patulous eustachian tube（PET） is an otolaryngological disorder caused by various factors, characterized by the loss of normal closure function of the eustachian tube in a resting state, resulting in persistent patency. Surgical treatment is recognized as an effective method for the management of refractory PET, but the surgical approaches for PET are diverse, with therapeutic outcomes varying significantly. The surgical procedure involving the occlusion of the tympanic ostium of the eustachian tube through the tympanic membrane, using specially designed silicone plugs, has shown excellent therapeutic outcomes. This minimally invasive procedure is considered highly safe and is considered as the preferred surgical option for patients with refractory PET. The purpose of this article is to review the current status and progress of endoscopic trans-tympanic eustachian tube plug implantation surgery in the treatment of patulous eustachian tube syndrome.
Humans ; Eustachian Tube/surgery* ; Endoscopy ; Tympanic Membrane/surgery* ; Ear Diseases/surgery*

Objective:To summarize the clinical characteristics and surgical outcomes of endolymphatic sac tumor（ELST）, and improve the experience of diagnosis and treatment of this disease. Methods:A retrospective analysis was conducted on the clinical data of patients with ELST who underwent surgical treatment by the Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University from January 2015 to December 2024.The clinical and image features, perioperative management, surgical methods and follow-up results of the disease were summarized. Results:Of the 6 cases, 4 were male and 2 were female. The primary clinical characteristics were hearing loss（6 cases）, tinnitus（5 cases）, dizziness（2 cases）, facial paralysis（1 case）, and headache（1 case）. CT and MRI of temporal bone were performed in all cases. The manifestation of CT was a space occupying lesion centered on the region of endolymphatic sac, accompanied by bone destruction and intertumoral calcification. MRI showed tumor center isosignal and peripheral hypersignal in T1 and T2 sequences in 3 cases, and mixed hypersignal in T1 and T2 sequences in 3 cases. Enhancement was observed in all cases on the enhanced scan. 5 cases underwent DSA examination and showed the tumors were supplied by the occipital artery（2 cases）, posterior auricular artery（4 cases）, and the bunch of internal carotid artery（1 case）. Embolization of the feeding artery was performed in 3 patients. Five patients underwent tumor resection. Translabyrinthine approach were performed in 4 cases, and middle cranial fossa approach was performed in 1 case. All cases followed up for 24 to 70 months with no distant metastases or death. Two patients experienced twice recurrences and were treated with surgical operation. The tumors were found to be closely related to the internal auditory canal or dura during the surgery. Conclusion:The clinical manifestations of ELST are not typical, and hearing loss is the most common clinical symptom. CT and MRI exhibit typical imaging characteristics. ELST has a risk of recurrence, and the tumor should be carefully managed when invade to the internal auditory canal and dura to reduce postoperative recurrence.
Humans ; Endolymphatic Sac/surgery* ; Male ; Female ; Retrospective Studies ; Ear Neoplasms/diagnosis* ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed ; Adult ; Middle Aged ; Treatment Outcome

Objective:To describe a novel approach for intractable Meniere's disease exclusively through a transcanal endoscopic ear surgery（TEES）. Methods:This retrospective chart review included patients with intractable Menière's disease who underwent endoscopic transcanal labyrinthectomy in the Department of Otolaryngology Head and Neck Surgery, Guangxi Hospital Division, First Affiliated Hospital, Sun Yat-sen University, between February 2023 and October 2024. The first 70-year-old woman and the other 67-year-old woman, who underwent multiple conservative treatment and chemical labyrinthectomy during outpatient and hospitalization, had frequent vertigo, tinnitus and severe sensorineural deafness. The TEES approach provided a wide exposure of the oval window. The incus and the stapes were removed, expanded the oval window. The perilymph was suctioned, The saccule, utricule, macula utriculi and macula sacculi were removed. The ampulla tissue of the three semicircular canal were destroyed with the right-angle crochet. The oval window was obliterated using the perichondrium of the tragal cartilage and cartilage. Results:Two patients underwent endoscopic transcanal labyrinthectomy, and no intraoperative or postoperative complications were observed. Vertigo was controlled in 2 patients during the follow-up of 6 to 12 months. Two patients complained of total hearing loss after surgery. Conclusion:Even though this study presents a limited number of cases, endoscopic transcanal labyrinthectomy is a promising, safe, and effective procedure in selected cases. Additional studies are needed to determine the risk-benefit profile of this technique.
Humans ; Aged ; Female ; Meniere Disease/surgery* ; Retrospective Studies ; Endoscopy/methods* ; Otologic Surgical Procedures/methods* ; Ear, Inner/surgery* ; Treatment Outcome

Extraskeletal Ewing's sarcoma（EES） in the head and neck is extremely rare, with non-specific clinical manifestations, high malignancy, easy recurrence and metastasis, and poor prognosis. This paper reports a case of EES of the parapharyngeal skull base presenting with secretory otitis media as the initial symptom.The treatment consisted of surgery, chemotherapy and radiotherapy. No further metastasis or recurrence was observed during the two years and six months follow-up. Now we reviewed the relevant literatures and summarized the experience of diagnosis and treatment in EES.
Humans ; Otitis Media with Effusion/etiology* ; Sarcoma, Ewing/therapy* ; Skull Base ; Skull Base Neoplasms/therapy*

OBJECTIVES: To observe the therapeutic effect of spermine in neonatal mouse models of severe hand, foot and mouth disease (HFMD) caused by enterovirus 71 (EV71) infection and explore its therapeutic mechanism in light of regulation of macrophage GBP5/NLRP3 inflammasome pathway. METHODS: Neonatal BALB/c mice (3-5 days old) were divided into control group, EV71 infection group and Spermine treatment group. The mice in the latter two groups received an intraperitoneal injection of 50 μL EV71 suspension (1×10⁶ TCID50 of EV71), followed 3 days later by intraperitoneal injection of 50 μL PBS or 100 μmol/L spermine. GBP5, NLRP3, CXCL10, and TNFSF10 expressions in heart, liver, lung and kidney tissues of the mice were detected using Western blotting and qPCR, and tissue pathologies and macrophage infiltration were assessed with HE staining and immunohistochemistry. In cultured THP-1 and RAW264.7 cells, the effects of EV71 infection, GBP5 siRNA transfection and treatment with spermine or eflornithine on GBP5, NLRP3, CXCL10, and TNFSF10 mRNA expressions were investigated using qPCR. RESULTS: In the neonatal mice, EV71 infection resulted in multiple organ damage, macrophage infiltration and activation of the GBP5/NLRP3 pathway, and spermine treatment significantly improved tissue injuries, reduced macrophage infiltration, and down-regulated the expressions of GBP5, NLRP3 and the inflammatory factors in the infected mice. In THP-1 and RAW264.7 cells, EV71 infection caused significant upregulation of GBP5, NLRP3, CXCL10, and TNFSF10 expressions, which were obviously lowered by spermine treatment. In THP-1 cells, treatment with eflornithine significantly suppressed the reduction of GBP5, NLRP3, CXCL10, and TNFSF10 expressions induced by GBP5 siRNA transfection. CONCLUSIONS Spermine suppressed EV71 infection-induced inflammatory responses by inhibiting GBP5-mediated NLRP3 inflammasome activation, suggesting a new strategy for treatment of severe HFMD.
Animals ; NLR Family, Pyrin Domain-Containing 3 Protein ; Mice ; Macrophages/metabolism* ; Enterovirus A, Human ; Mice, Inbred BALB C ; Inflammasomes/metabolism* ; Spermine/therapeutic use* ; Animals, Newborn ; Humans ; Enterovirus Infections ; Hand, Foot and Mouth Disease/drug therapy* ; RAW 264.7 Cells ; Chemokine CXCL10/metabolism*

OBJECTIVES: To analyze the trends of disease burden of lip and oral cancers in East Asia from 1990 to 2021 and its future projections. METHODS: We used the Global Burden of Disease 2021 database to conduct a comprehensive analysis of disease burden data from China (including Taiwan Province of China), Japan, Republic of Korea, Democratic People's Republic of Korea and Mongolia. The data were stratified by age, gender and major risk factors, and a Bayesian age-period-cohort model was employed to predict the future trends. RESULTS: From 1990 to 2021, the burden of lip and oral cancers in East Asian countries exhibited a steady increase. Taiwan Province of China experienced the most significant increases in incidence, prevalence, mortality, and disability-adjusted life years (DALYs), while Mongolia saw a decline in both mortality and DALYs. In 2021, Taiwan Province of China reported the highest rates of lip and oral cancer incidence (27.50 per 100 000), prevalence (137.92 per 100 000), mortality (9.59 per 100 000), and DALYs (292.07 person-years per 100 000), particularly among male and elderly populations. Tobacco use and alcohol consumption significantly exacerbated the disease burden in Taiwan Province of China and Japan. Future projections indicate that the incidence and prevalence of lip and oral cancer in China (excluding Taiwan Province of China) will continue to rise, while their mortality rates are expected to decline in most regions, except for Taiwan Province of China and Democratic People's Republic of Korea. CONCLUSIONS By the year 2035, the disease burden of lip and oral cancers in East Asia is expected to continue to increase, especially in Taiwan Province of China. To address this challenge, it is essential to implement effective measures to control major risk factors, promote early screening, and ensure equitable distribution of healthcare resources.
Humans ; Mouth Neoplasms/epidemiology* ; Incidence ; Lip Neoplasms/epidemiology* ; Asia, Eastern/epidemiology* ; Male ; Disability-Adjusted Life Years ; Prevalence ; Female ; Forecasting ; Risk Factors ; Cost of Illness ; Middle Aged ; Global Burden of Disease ; Aged ; Bayes Theorem