Otorhinolaryngologic Diseases Commons^™

Metabolic Targeting, Immunotherapy And Radiation In Locally Advanced Non-Small Cell Lung Cancer: Where Do We Go From Here?, Annika Dhawan, Phillip M Pifer, Vlad C Sandulache, Heath D Skinner

Faculty, Staff and Students Publications

In the US, there are ~250,000 new lung cancer diagnoses and ~130,000 deaths per year, and worldwide there are an estimated 1.6 million deaths per year from this deadly disease. Lung cancer is the most common cause of cancer death worldwide, and it accounts for roughly a quarter of all cancer deaths in the US. Non-small cell lung cancer (NSCLC) represents 80-85% of these cases. Due to an enormous tobacco cessation effort, NSCLC rates in the US are decreasing, and the implementation of lung cancer screening guidelines and other programs have resulted in a higher percentage of patients presenting with …

Stat6 Suppression Prevents Bleomycin-Induced Dermal Fibrosis, Hua Sun, Ashish Damania, Megan L Mair, Eniola Otukoya, Yi-Dong Li, Katherine Polsky, Yuying Zeng, Jeremiah A Alt, Martin J Citardi, David B Corry, Amber U Luong, John Morgan Knight

Faculty, Staff and Student Publications

Unified airway disease, including concurrent asthma and chronic rhinosinusitis (CRS), is a common, but poorly understood disorder with no curative treatment options. To establish a murine model of chronic unified eosinophilic airway inflammation, mice were challenged with Aspergillus niger, and sinonasal mucosa and lung tissue were evaluated by immunohistochemistry, flow cytometry, and gene expression. Inhalation of A niger conidia resulted in a Th2-biased lung and sinus inflammation that typifies allergic asthma and CRS. Gene network and pathway analysis correlated with human disease with upregulation of not only the JAK-STAT and helper T-cell pathways, but also less expected pathways governing …

Deep-Learning-Based Generation Of Synthetic 6-Minute Mri From 2-Minute Mri For Use In Head And Neck Cancer Radiotherapy, Kareem A Wahid, Jiaofeng Xu, Dina El-Habashy, Yomna Khamis, Moamen Abobakr, Brigid Mcdonald, Nicolette O' Connell, Daniel Thill, Sara Ahmed, Christina Setareh Sharafi, Kathryn Preston, Travis C Salzillo, Abdallah S R Mohamed, Renjie He, Nathan Cho, John Christodouleas, Clifton D Fuller, Mohamed A Naser

Faculty, Staff and Student Publications

Background: Quick magnetic resonance imaging (MRI) scans with low contrast-to-noise ratio are typically acquired for daily MRI-guided radiotherapy setup. However, for patients with head and neck (HN) cancer, these images are often insufficient for discriminating target volumes and organs at risk (OARs). In this study, we investigated a deep learning (DL) approach to generate high-quality synthetic images from low-quality images.

Methods: We used 108 unique HN image sets of paired 2-minute T2-weighted scans (2mMRI) and 6-minute T2-weighted scans (6mMRI). 90 image sets (~20,000 slices) were used to train a 2-dimensional generative adversarial DL model that utilized 2mMRI as input and …

Candida Albicans Elicits Protective Allergic Responses Via Platelet Mediated T Helper 2 And T Helper 17 Cell Polarization, Yifan Wu, Zhimin Zeng, Yubiao Guo, Lizhen Song, Jill E Weatherhead, Xinyan Huang, Yuying Zeng, Lynn Bimler, Cheng-Yen Chang, John M Knight, Christian Valladolid, Hua Sun, Miguel A Cruz, Bernhard Hube, Julian R Naglik, Amber U Luong, Farrah Kheradmand, David B Corry

Faculty, Staff and Student Publications

Fungal airway infection (airway mycosis) is an important cause of allergic airway diseases such as asthma, but the mechanisms by which fungi trigger asthmatic reactions are poorly understood. Here, we leverage wild-type and mutant Candida albicans to determine how this common fungus elicits characteristic Th2 and Th17 cell-dependent allergic airway disease in mice. We demonstrate that rather than proteinases that are essential virulence factors for molds, C. albicans instead promoted allergic airway disease through the peptide toxin candidalysin. Candidalysin activated platelets through the Von Willebrand factor (VWF) receptor GP1bα to release the Wnt antagonist Dickkopf-1 (Dkk-1) to drive Th2 and …

Identification Of An Atp/P2x7/Mast Cell Pathway Mediating Ozone-Induced Bronchial Hyperresponsiveness, Xiaomei Kong, William C Bennett, Corey M Jania, Kelly D Chason, Zachary German, Jennifer Adouli, Samuel D Budney, Brandon T Oby, Catharina Van Heusden, Eduardo R Lazarowski, Ilona Jaspers, Scott H Randell, Barry A Hedgespeth, Glenn Cruse, Xiaoyang Hua, Stephen A Schworer, Gregory J Smith, Samir Np Kelada, Stephen L Tilley

Faculty, Staff and Student Publications

Ozone is a highly reactive environmental pollutant with well-recognized adverse effects on lung health. Bronchial hyperresponsiveness (BHR) is one consequence of ozone exposure, particularly for individuals with underlying lung disease. Our data demonstrated that ozone induced substantial ATP release from human airway epithelia in vitro and into the airways of mice in vivo and that ATP served as a potent inducer of mast cell degranulation and BHR, acting through P2X7 receptors on mast cells. Both mast cell-deficient and P2X7 receptor-deficient (P2X7-/-) mice demonstrated markedly attenuated BHR to ozone. Reconstitution of mast cell-deficient mice with WT mast cells and P2X7-/- mast …

Revisiting The Controversy: The Role Of Fungi In Chronic Rhinosinusitis, Matthew A Tyler, Kent Lam, Michael J Marino, William C Yao, Isaac Schmale, Martin J Citardi, Amber U Luong

Faculty, Staff and Student Publications

In the last two decades, the development of culture-independent genomic techniques has facilitated an increased appreciation of the microbiota-immunity interactions and their role in a multitude of chronic inflammatory diseases such as chronic rhinosinusitis (CRS), asthma, inflammatory bowel disease and dermatitis. While the pathologic role of bacteria in chronic inflammatory diseases is generally accepted, the understanding of the role of fungi remains controversial.

Chronic rhinosinusitis, specifically the phenotype linked to nasal polyps, represents a spectrum of chronic inflammatory diseases typically characterized by a Type 2 immune response. Studies on the microbiota within sinus cavities from healthy and diseased patients have …

Computer-Assisted Analysis Of Oral Antifungal Therapy In Chronic Rhinosinusitis With Airway Mycosis: A Retrospective Cohort Analysis, Evan Li, Michael Scheurer, Farrah Kheradmand, Amber U Luong, David B Corry

Faculty, Staff and Student Publications

Environmental fungi are etiologically related to chronic rhinosinusitis (CRS) with airway mycosis, but their infectious role remains uncertain, in part because of potentially inadequate methods of disease quantitation. Our objective was to determine objective radiographic and symptomatic outcomes of oral antifungal therapy in adult patients with CRS and airway mycosis by using computer-assisted analysis. We conducted a retrospective study of 65 patients with CRS and culture-proven airway mycosis in a single-center referral-based academic practice, comparing paired sinus computed tomography (CT) scans and symptom scores prior to and during chronic oral antifungal therapy using computer-assisted analysis of sino-mucosal area (CAASMA). A …

Resilience And Its Associated Factors In Head And Neck Cancer Patients In Pakistan: An Analytical Cross-Sectional Study, Nida Zahid, Wajeeha Zahid, Wardah Khalid, Syed Iqbal Azam, Mubasher Ikram, Aneesa Hassan, Haissan Iftikhar, Shireen Shehzad Bhamani, Adnan Jabbar, Shabbir Akhtar, Moghira Siddiqui, Mohammad Sohail Awan, Nargis Asad, Khabir Ahmad

Department of Surgery Docs

Introduction: The study aimed to assess resilience and its associated factors in head and neck cancer patients, post-treatment in a low middle income country (LMIC) such as Pakistan.
Methods: An analytical cross-sectional study was conducted from November 2019 to May 2020 among head and neck cancer patients aged at least 18 years at the largest private tertiary care hospital, in Karachi, Pakistan. Information regarding their resilience scores was collected through Wagnild and Young's Resilience scale that comprises of 14 items (RS-14). Moreover, depression and anxiety were also assessed via Hospital Anxiety and Depression Scale (HADS) and social support was assessed …

The Immunoregulatory Landscape Of Human Tuberculosis Granulomas, Evan Li, Antony Rodriguez, Amber U Luong, David Allen, John Morgan Knight, Farrah Kheradmand, David B Corry

Faculty, Staff and Student Publications

The allergic airway diseases chronic rhinosinusitis (CRS), allergic fungal rhinosinusitis (AFRS), asthma, allergic bronchopulmonary mycosis/aspergillosis (ABPM/A), and cystic fibrosis (CF) share a common immunological signature marked by T H 2 and TH 17 cell predominant immune responses, the production of IgE antibody, and atypical inflammatory cell infiltrate that includes eosinophils and other innate immune effector cells. Severe forms of these disorders have long been recognized as being related to hypersensitivity reactions to environmental fungi. Increasingly however,environmental fungi are assuming a more primary role in the etiology of these disorders, with airway mycosis, a type of non-invasive airway fungal infection,recognized as …

Synchronous Primary Diffuse Large B-Cell Lymphoma And Papillary Thyroid Carcinoma: A Case Report Highlighting "Lymphoma First Approach", Rahim Dhanani, Ambreen Abdullah Unar, Muhammad Hassan Danish, Hamdan Ahmed Pasha, Ummiya Tahir, Mubasher Ikram

Section of Otolaryngology, Head & Neck Surgery

Papillary thyroid carcinoma (PTC) is the most common type of all thyroid carcinomas and accounts for up to 90% of all thyroid malignancies. It is the most indolent form of the disease and has an excellent prognosis. On the other hand, Primary thyroid lymphoma (PTL) is a rare entity accounting for only about 1% to 5% of all thyroid malignancies and only 2% of extranodal lymphomas. Synchronous PTC and PTL is a very rare condition and only a few cases have been reported in the literature up till now. We report one such case in a 52-year-old lady who was …

Lymphatic Dissemination And Axillary Web Syndrome In Primary Cutaneous Tuberculosis Secondary To Needlestick Injury, Alexandre E Malek, Caroline E Fife, John C Rasmussen, Ron J Karni, John R Morrow, Audrey Wanger, Eva M Sevick-Muraca, Luis Ostrosky-Zeichner

Faculty, Staff and Student Publications

Cutaneous tuberculosis secondary to skin inoculation of Mycobacterium tuberculosis is uncommon but it can occur in the health care settings. Herein, we report an unusual case of primary cutaneous tuberculosis of the thumb following a needlestick injury. The infection progressed with a necrotic granuloma, lymphatic dysfunction as visualized by near-infrared fluorescence lymphatic imaging, and the development of an axillary web syndrome.

Adenoid Cystic Carcinoma Of External Auditory Canal: A Rare Disease, Abdul Basit Shah Vardag, Muhammad Hassan Danish, Mohammad Sohail Awan, Muhammad Usman Tariq, Omaima Anis Bhatti, Muhammad Hammad Deewani

Section of Otolaryngology, Head & Neck Surgery

External auditory canal, like other epithelialized surfaces is predisposed to malignancies such as Squamous cell carcinomas (SCC), melanomas and adenocarcinomas. In this background, malignancies like adenoid cystic carcinoma (ACC) are a rare occurrence and need to be thoroughly evaluated both locally and for distant extension. The malignancy needs to be addressed with an aggressive approach surgically with adequate marginal clearance. The role of radiation is debatable considering the outcomes in the limited data. Here we present the case of a 35-year-old female who came in with otalgia and otorrhea associated with a mass in the external auditory canal. After biopsy …

Inferior Turbinate Hypertrophy Presenting As Bilateral Nasal Masses In A Paediatric Patient, Nicholas Armando Rossi, Megan L Swonke, Shiva Daram

Faculty, Staff and Student Publications

No abstract provided.

Prevalence Of Allergic Fungal Sinusitis Among Patients With Nasal Polyposis, Rahim Dhanani, Shayan Khalid, Basit Salam, Hamdan Ahmed Pasha, Farah Hafiz Yousuf, Mubasher Ikram

Section of Otolaryngology, Head & Neck Surgery

Objective: To determine the frequency of allergic fungal sinusitis among patients with nasal polyps, and to compare Lund-Mackay scores of patients with and without allergic fungal sinusitis.
Methods: The cross-sectional longitudinal study was conducted at a tertiary healthcare centre in Karachi, Pakistan, from December 2016 to November 2018, and comprised patients with sinonasal polyposis undergoing surgery. The patients were categorised as having allergic fungal sinusitis when histopathology showed allergic mucin with fungal hyphae and culture was positive for fungal growth. Lund-Mackay scoring of each patient was noted and mean scores of allergic fungal sinusitis and non-allergic fungal sinusitis patients were …

Level I Nodal Positivity As A Factor For Involvement Of The Submandibular Gland In Oral Cavity Carcinoma: A Case Series Report, Hamdan Ahmed Pasha, Rahim Dhanani, Shayan Khalid, Kulsoom Ghias, Mumtaz Jamshed Khan

Section of Otolaryngology, Head & Neck Surgery

Introduction: The routine practice of neck dissection in the surgical management of oral carcinoma has evolved into a more functionally conservative approach. Over time, the rationale for removal of the submandibular gland has been questioned. Routine extirpation of the submandibular gland can aggravate the xerostomia experienced by many patients, significantly affecting their quality of life.
Objective: The objective of the present study was to determine the incidence of submandibular gland metastases in oral cavity carcinoma and to identify possible factors that may affect their involvement.
Methods: A total of 149 cases of oral carcinoma presenting at a private tertiary care …

Role Of Contrast Enhanced Computed Tomography In Assessing Cervical Lymph Node Metastases In Oral Cavity Squamous Cell Carcinoma, Talha Ahmed Qureshi, Muhammad Wasif, Mohammad Sohail Awan, Adnan Yar Muhammad, Ainulakbar Mughal, Abdullah Ameen

Section of Otolaryngology, Head & Neck Surgery

Objective: To evaluate the diagnostic accuracy of contrast-enhanced computed tomography scan in detecting cervical nodal metastasis in oral cavity squamous cell carcinoma.
Methods: The retrospective cross-sectional study was conducted at Aga Khan University Hospital, Karachi, Pakistan. and comprised records from January 1, 2015, to October 31, 2016, of patients diagnosed with oral cavity squamous cell carcinoma and who underwent surgical resection of primary tumour along with neck dissection after having a contrast-enhanced computed tomography scan of head and neck. Diagnostic accuracy of the scans was calculated using final histopathology as the gold standard. All scans were reviewed by a consultant …

N95 Respirator Reuse, Decontamination Methods, And Microbial Burden: A Randomized Controlled Trial, Zi Yang Jiang, Zhen Huang, Isaac Schmale, Eric L Brown, Michael C Lorenz, Scott J Patlovich, Karan Goswami, Hannah B Wilson, Jumah Ahmad, Ronda Alexander, William Bryan, Luke Burke, Martin J Citardi, Jose Elias, Tang Ho, Jack Jacob, Garren Low, Pedro Miramón, Aniruddha U Patki, William C Yao, Amber U Luong

Faculty, Staff and Student Publications

PURPOSE: To evaluate the effectiveness and ease of N95 respirator decontamination methods in a clinic setting and to identify the extent of microbial colonization on respirators associated with reuse.

METHODS: In a prospective fashion, N95 respirators (n = 15) were randomized to a decontamination process (time, dry heat, or ultraviolet C light [UVC]) in outpatient clinics. Each respirator was re-used up to 5 separate clinic sessions. Swabs on each respirator for SARS-CoV-2, bacteria, and fungi were obtained before clinic, after clinic and post-treatment. Mask integrity was checked after each treatment (n = 68). Statistical analyses were performed to determine factors …

N95 Respirator Reuse, Decontamination Methods, And Microbial Burden: A Randomized Controlled Trial, Zi Yang Jiang, Zhen Huang, Isaac Schmale, Eric L Brown, Michael C Lorenz, Scott J Patlovich, Karan Goswami, Hannah B Wilson, Jumah Ahmad, Ronda Alexander, William Bryan, Luke Burke, Martin J Citardi, Jose Elias, Tang Ho, Jack Jacob, Garren Low, Pedro Miramón, Aniruddha U Patki, William C Yao, Amber U Luong

Faculty, Staff and Student Publications

PURPOSE: To evaluate the effectiveness and ease of N95 respirator decontamination methods in a clinic setting and to identify the extent of microbial colonization on respirators associated with reuse.

METHODS: In a prospective fashion, N95 respirators (n = 15) were randomized to a decontamination process (time, dry heat, or ultraviolet C light [UVC]) in outpatient clinics. Each respirator was re-used up to 5 separate clinic sessions. Swabs on each respirator for SARS-CoV-2, bacteria, and fungi were obtained before clinic, after clinic and post-treatment. Mask integrity was checked after each treatment (n = 68). Statistical analyses were performed to determine factors …

Training In Temporal Bone Surgery: A Review Of Current Practices, Muhammad Wasif, Abdul Basit Shah Vardag, Ainulakbar Mughal, Syed Akbar Abbas, Shayan Khalid, Hamdan Ahmed Pasha

Section of Otolaryngology, Head & Neck Surgery

The temporal bone consists of complex anatomy, and the presence of various vital structures in close proximity makes the surgery of temporal bone highly challenging. Such a surgery requires years of training under the direct observation of trainers. Over the course of history, different training models have been adopted by experts to help train the young surgeons in this complex procedure. Cadaveric dissections of the temporal bone remains the gold standard in training of residents as the cadavers present the actual anatomical details which the surgeons encounter while operating on patients. However, due to scarcity of available cadavers, their one-time-only …

Use Of Endoscope In Teaching Of Otolaryngology Residents About Site And Size Of Tympanic Membrane Perforation And Its Impact On Degree Of Hearing Loss In Adult Patients: A Cross Sectional Study, Muntazir Hussain, Muhammad Wasif, Mohammad Sohail Awan, Shayan Khalid, Zeeshan Sheikh, Haissan Iftikhar

Section of Otolaryngology, Head & Neck Surgery

Objective: To determine the association between site and size of perforation of the tympanic membrane and the level of conductive hearing.
Methods: The cross-sectional study was conducted from November 2015 to October 2016 at Aga Khan University Hospital Karachi and comprised patients with tympanic membrane perforation without any other middle-ear disease. Karl-Storz Rigid Endoscope attached to a camera was used to take pictures of the tympanic membrane. Site of the perforation was determined using a vertical line to divide the membrane into two anterior and posterior halves. Size of the perforation was calculated as a percentage of the total membrane …

Screening For Malnutrition In Oral Cavity Cancer Patients Prior To Treatment: A Cross-Sectional Study, Haissan Iftikhar, Anwar Suhail, Amna Urooba, Karim Rizwan Nathani, Zeeshan Shaikh, Muhammad Wasif

Section of Otolaryngology, Head & Neck Surgery

This study was conducted to assess the frequency of pre-operative malnourishment in patients being treated for oral cavity squamous cell carcinoma. A retrospective chart review was carried out at the Aga Khan University Hospital, Karachi, on 62 patients. Patients were screened pre-operatively through a standard nutritional assessment tool at the time of admission to assess for malnutrition. Mean age of presentation was 48.34±13.11 years, mean height was 165 ± 8.62cm, weight 66.09±14.98 kg and BMI of 24.09±4.84. Males were 82.3% and 17.7% were females. At the time of admission, a significant number or patients, 12 (19.4%) were prone to malnourishment, …

Costs Associated With Recurrent Epistaxis In A Patient With A Ventricular Assist Device, Eric T. Rohe, Evan M. Ryan, Jayme R. Dowdall, Dwight T. Jones

Graduate Medical Education Research Journal

Mucosal bleeding is a well-known complication of having a ventricular assist device and commonly presents with epistaxis. Although the frequency of epistaxis as a complication in patients with a ventricular assist device has been documented in the literature, to our knowledge the cost of this complication has not been reported. This case report examines the financial burden of ventricular assist device-associated epistaxis in a single patient from September 2018 to December 2019 using ICD 10 diagnostic codes. The patient was found to have accumulated $138,020 in costs over 38 encounters. This case report not only highlights the recurrent nature and …

Aerosol Generation With Common Rhinologic Devices: Cadaveric Study Conducted In A Surgical Suite, Bailey Leconte, Garren M I Low, Martin J Citardi, William C Yao, Arturo A Eguia, Amber U Luong

Faculty, Staff and Student Publications

No abstract provided.

Povidone-Iodine Solution As Sars-Cov-2 Prophylaxis For Procedures Of The Upper Aerodigestive Tract A Theoretical Framework, Syed H S Naqvi, Martin J Citardi, Davide Cattano, Luis Ostrosky-Zeichner, Mark I Knackstedt, Ron J Karni

Faculty, Staff and Student Publications

BACKGROUND: The COVID-19 pandemic has raised concerns of inadvertent SARS-CoV-2 transmission to healthcare workers during routine procedures of the aerodigestive tract in asymptomatic COVID-19 patients. Current efforts to mitigate this risk focus on Personal Protective Equipment, including high-efficiency filtration as well as other measures. Because the reservoir for SARS-CoV-2 shedding is in the nasopharynx and nasal and oral cavities, the application of viricidal agents to these surfaces may reduce virus burden. Numerous studies have confirmed that povidone-iodine inactivates many common respiratory viruses, including SARS-CoV-1. Povidone-iodine also has good profile for mucosal tolerance. Thus, we propose a prophylactic treatment protocol for …

Guidance For Contemporary Use Of Biologics In Management Of Chronic Rhinosinusitis With Nasal Polyps: Discussion From A National Institutes Of Health-Sponsored Workshop, Lauren T Roland, Timothy L Smith, Rodney J Schlosser, Zachary M Soler, Anju T Peters, Tanya M Laidlaw, Benjamin S Bleier, Vijay Ramakrishnan, Elina Toskala, David W Kennedy, Amber U Luong

Faculty, Staff and Student Publications

BACKGROUND: Biologic medications are emerging as options for treating chronic rhinosinusitis with nasal polyps (CRSwNP). Several questions remain regarding patient selection, indications, clinical efficacy, and cost effectiveness.

METHODS: In November 2019, a group of physicians and scientists gathered to consider strategies for future studies regarding biologics. During the discussion, gaps in knowledge highlighted a need for a consensus on the present day use of biologics in polyp patients.

RESULTS: The goal of this guideline is to propose recommendations for the current use of biologics in CRSwNP as new evidence continues to emerge and inform practice.

CONCLUSION: We suggest that physicians …

Prognostic Factors In Patients With Salivary Gland Malignancy: A Retrospective Cohort Study, Moghira Iqbaluddin Siddiqui, Haissan Iftikhar, Umar Farooq Bhatti, Mubasher Ikram

Section of Otolaryngology, Head & Neck Surgery

Our objective was to determine the factors affecting the prognosis in patients with major salivary gland malignancy presenting to Aga Khan University Hospital in Karachi. Retrospective cohort study was carried out at our center on patients diagnosed and treated for salivary gland cancers. Presentation and treatment offered was reviewed from medical charts. Telephonic interviews were conducted to assess the survival of patients who were lost to follow-up. Log rank test was used to compare the mean survival times. A total of 36 patients were included in the study. The mean age was 45.1 +/- 14.6 years. Majority were male 21 …

Longitudinal Effects Of A Novel Advanced Pneumatic Compression Device On Patient-Reported Outcomes In The Management Of Cancer-Related Head And Neck Lymphedema: A Preliminary Report, Carolina Gutiérrez, Harvey N Mayrovitz, Syed Hassan Shiraz Naqvi, Ron J Karni

Faculty, Staff and Student Publications

BACKGROUND: Head and neck cancer (HNC) survivors experience head and neck lymphedema (HNL), which requires treatment to prevent morbidity. We explore the self-reported outcomes and satisfaction of patients with HNC receiving treatment for HNL with an advanced pneumatic compression device (APCD).

METHODS: HNC survivors (n = 205) prescribed with an at-home Flexitouch head and neck APCD completed pretreatment and posttreatment self-reported assessments addressing efficacy, function, and symptoms. Participant average age was 60 years with 74% male. Pre-post responses for ≥25 days of use were assessed via the non-parametric Wilcoxon Signed Rank test.

RESULTS: Analysis revealed statistically significant improvement in all …

Prevalence Of Allergic Rhinitis Among Healthcare Workers And Its Impact On Their Work: A Cross-Sectional Survey At A Tertiary Healthcare Centre In Pakistan, Moghira Iqbaluddin Siddiqui, Rahim Dhanani, Huzaifa Moiz

Section of Otolaryngology, Head & Neck Surgery

A study was conducted to determine the frequency of allergic rhinitis among healthcare professionals and its impact on their work at the Aga Khan University Hospital Karachi Pakistan. Healthcare workers including doctors, nurses, technicians and pharmacists were included. Participants were asked to fill a questionnaire consisting of score for allergic rhinitis (SFAR), and work productivity and activity impairment questionnaires. Out of 167 workers, 101 were males. Mean age of the participants was 29.0 ± 5.9 years. Overall prevalence of allergic rhinitis among healthcare workers was found to be frequency (19.2%). We noted that 13 individuals reported to have missed their …

Covid-19: Implications, Reactions And Future Directions, Rahim Dhanani, Mohammad Wasif, Hamdan Ahmed Pasha,, Muntazir Hussain, Shayan Khalid, Abdul Basit Shah Vardag, Khadija Mahmood, Raza Hussain

Section of Otolaryngology, Head & Neck Surgery

Humanity has faced several foes over the centuries, a formidable one amongst them is the current pandemic of COVID-19. The symptoms of COVID-19 are more or less related to the nose and throat. Therefore, patients more often present to Ear Nose Throat (ENT) clinics with symptoms including cough, sore throat, fever and shortness of breath. In the management of head and neck pathologies, as the airway is a direct source of infection, the impact of COVID-19 holds special significance. This review has attempted to explain the various aspects of the disease itself, its diagnosis, the use of personal protective equipment …

Non-Recurrent Laryngeal Nerve: A Case Report And Review Of Literature, Muhammad Hassan Danish, Rahim Dhanani, Huzaifa Moiz, Mubasher Ikram

Section of Otolaryngology, Head & Neck Surgery

Right recurrent laryngeal nerve can take a "Non-Recurrent" course and can present as a Non Recurrent Laryngeal nerve which is a rare entity. Such anomalies can lead to difficulty in locating the laryngeal nerve during thyroid surgeries and there are higher chances of it being injured. Therefore, surgeons should be mindful of this entity. We report the case of a 53-year-old lady who underwent thyroid surgery and a right Non Recurrent Laryngeal Nerve was identified intra-operatively.