As we pass the 5th anniversary of the onset of the coronavirus disease 2019 (Covid-19) pandemic and the UK ‘lockdown’, the media has turned its attention to the legacy of this event and implications for health, child development and the wider social implications. While much of the reporting has been speculative and often alarmist, there have been some useful cohort studies which cast light on the effects of this (hopefully) once in a generation event. This issue of the Journal contains an article by Phillips and colleagues from Norwich and many UK centresReference Phillips, Murdin, Grant, Shepstone, Khondoker and Sims1 which examined over 400 Ménière’s patients with a questionnaire on their symptoms, using the Ménière’s disease registry’s database. The recruitment period was November 2020 to September 2021, at the height of the pandemic. Patients with largely self-reported Covid-19 infections (some had positive tests) experienced a subjective worsening of hearing and tinnitus but improvement in vertigo. That tinnitus worsens is no surprise, as the authors noted. However, it is somewhat surprising that vertigo improves in some patients, as a situation in which stress levels were very high might be expected to lead to a worsening of balance and dizziness symptoms, especially when psychological factors are thought to play such a prominent role in this fascinating but mysterious condition.
A previous cohort study was published in the JLO in late 2021Reference Hassani, Lazem and Jafari2 which concluded that there was no lasting impact on the auditory system from Covid-19. A further study examined sudden deafness and Covid-19.Reference Lang, Hintze and Conlon3 The literature overall contains a very confused picture in relation to the pandemic and otological symptoms and conditions with wide variations in findings and conclusions between different narrative studies. This recent JLO paper is more interesting than many, as it used a well-evaluated group of patients to study. The authors have written a comprehensive discussion which covers many of the social, psychological and health factors that must be considered in evaluating findings during the pandemic.
As our population demographics change to have an increasing proportion of elderly citizens, with decreasing proportions of young productive workers, using funds for healthcare interventions in the elderly need to show benefit. This issue contains a paper from Sydney (Australia) which evaluates elderly patients who have received cochlear implants for severe acquired deafness.Reference Shah, Xue, Rehman, Watson, Hitos and da Cruz4 The results are gratifying and show significant positive effects on quality of life, which justifies including the elderly in this intervention, but creates a bigger headache for politicians and healthcare providers who need to somehow find funding as the indications for surgery expand.
‘First bite syndrome’ is the topic of a review by Ang and colleagues from Kent and South-East England, which might be an unfamiliar topic for some general ENT readers.Reference Ang, Goh and Laycock5 The condition was described by Netterville and colleagues in 1998, in a large case series from Nashville, Tennessee (US), in which patients experience sharp or cramping pain in the parotid region on chewing at the start of each meal, which calms down gradually after the first bite.Reference Netterville, Jackson, Miller, Wanamaker and Glasscock6 This has been noted to be a complication of several head and neck and maxillofacial surgical procedures in the region, most notably parotidectomy, particularly surgery on deep lobe tumours (occurrence in 9–18 per cent of operations) and surgery on parapharyngeal space tumours. The JLO published an article on the topic over a decade ago describing tympanic plexus ablation as a treatmentReference Amin, Pelser and Weighill7 and another in which a patient exhibited the symptom as a presenting symptom of a parapharyngeal space adenoid cystic carcinoma.Reference Deganello, Meccariello, Busoni, Franchi and Gallo8 The review focuses on botulinum toxin treatment, which seems to speed up resolution, but the good news is that the condition seems to settle with conservative management in most cases.
