Objectives: Nasopharyngeal (NP) depth prediction is clinically relevant in performing medical procedures, and enhancing technique precision and safety for patients. Nonetheless, clinical predictive variables and normative data in adults remain limited. This study aimed to determine normative data on NP depth and its correlation to external facial measurements. Methods: A multicenter cross-sectional study obtained data from adults presenting to otolaryngology clinics at five sites in Canada, Italy, and Spain. Investigators compared the endoscopically measured depth from sill to nasopharynx along the nasal floor to the facial measurements “curved distance from the alar-facial groove along the face to the tragus” and “distance from the tragus to a plane perpendicular to the philtrum.” When sinus CT images were available, the distance from the nasopharynx to nasal sill was also collected. Results: 371 patients participated in the study (41% women; 51 years old, SD 18). The average endoscopic depth was 9.4 cm (SD 0.86) and 10.1 cm (SD 0.9) for women and men, respectively (p<0.001; 95% CI 0.46 to 0.86). Perpendicular distance was strongly correlated to NP depth (r=0.775; p<0.001), with an average underestimation of 0.1 cm (SD 0.65; 95% CI 0.06 to 0.2). The equation: ND(cm) = perpendicular distance*0.773 + 2.344, generated from 271 randomly selected participants, and validated on 100 participants, resulted in a 0.03 cm prediction error (SD 0.61; 95% CI -0.08 to 0.16). Conclusions: Nasopharyngeal depth can be accurately approximated by the distance from the tragus to a plane perpendicular to philtrum. The generated predictive equation was most accurate but not likely clinically relevant.

OBJECTIVES: Cleft palate children have a higher incidence of otitis media with effusion, more frequent recurrent acute otitis media episodes, and worse conductive hearing losses than non-cleft children. Nevertheless, data on adenoidectomy for middle ear disease in this patient group is scarce, since many feared worsening of velopharyngeal insufficiency after the procedure. This review aims at filling this knowledge gap by collecting the available evidence on this subject, to frame possible further areas of research and interventions. DESIGN: A PRISMA-compliant systematic review was performed. Multiple databases were searched with criteria designed to include all studies focusing on the role of adenoidectomy in treating middle ear disease in cleft palate children. After duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for clinical indications and outcomes. RESULTS: Among 321 unique citations, 3 studies were deemed eligible (2 case series and a retrospective cohort study). The outcomes were positive in all three articles in terms of conductive hearing loss improvement, recurrent otitis media episodes reduction, and effusive otitis media resolution (this last result being not statistically significant). CONCLUSION: Despite promising results, research on adenoidectomy in treating middle ear disease in the cleft population has stopped in the mid-Seventies. No data is therefore available on the role of modern conservative adenoidectomy techniques (endoscopic and/or partial) in this context. Prospective studies are required to define the role of adenoidectomy in cleft children, most interestingly in specific subgroups such as patients requiring re-tympanostomy, given their known risk of otologic sequelae.

Incidentally diagnosed, asymptomatic, paranasal fungus ball might occasionally undergo spontaneous healing. Accurate preoperative workup may avoid unnecessary surgical or anesthesiological procedures.

KEYPOINTSCOVID-19 patients often require prolonged mechanical ventilation, and tracheostomy is a common choice.Shared guidelines for intensive care unit patient tracheostomies for COVID-19 patients do not exist.Our survey indicates the timing and technique of COVID-19 tracheostomies vary considerably among hospitals in Lombardy, Italy.Otolaryngologists are seldom involved with decision-making regarding tracheostomies for intensive care unit COVID-19 patients.Evidence-based interventions are essential for providing the best care to invasively ventilated COVID-19 patients.KEYWORDSSARS-Cov-2; COVID-19; coronavirus; tracheostomy; percutaneous tracheotomy; surgical tracheostomy; intubation; ventilation.INTRODUCTIONAfter identifying the first Italian COVID-19 infected patient on 20 February 2020, a rapidly escalating infection cluster was discovered. On 21 February, a response coordinated by a governmental task force progressively led to a countrywide lockdown beginning on 9 March. Italy became the first Western country to address COVID-19, which on 20 March, the World Health Organization declared a pandemic.Although pneumology, infectious disease, and intensive care units (ICUs), as well as emergency departments, have carried the heaviest healthcare burden during this outbreak,1 other departments must also address the increased infectious risk while meeting patient needs. Given the number of COVID-19 patients requiring long-term invasive ventilation, a surge in tracheostomies have ensued. Otolaryngologists have quickly become involved in patient management, despite previously having been ’second-line’ specialists during infectious outbreaks.2 This unprecedented need for tracheostomies reopened decades-old debates about ICU patient tracheostomy timing, techniques and operators: supporters of late versus early tracheostomies, percutaneous tracheostomies (PTs) versus open surgical tracheostomies (STs) and otolaryngologists versus anaesthesiologists.This unprecedented situation similarly affected all hospitals in the region, overburdening ICUs and inpatient units. Our study aimed to illustrate the COVID-19 healthcare situation and investigate ICU tracheostomy management decisions.MATERIALS AND METHODSWe prepared a 13-item questionnaire asking the following: the number of COVID-19 patients treated, ICU dedicated beds, tracheostomies performed and their timing, preferred tracheostomy techniques with reasons for choosing PT or ST. The questionnaire was sent to each otolaryngology department in the Lombardy region, during the first week of April 2020. Department directors, instructed to collect data by collaborating directly with their respective ICUs, responded by phone the following week.