A Multicentre Retrospective Cohort Study on Covid-19-related Physical Interventions and Adult Hospital Admissions for ENT Infections

Objectives: To report changes in adult hospital admission rates for acute ENT infections following the introduction of Covid-19-related physical interventions such as hand washing, use of face mask and social distancing of 2-metres in the United Kingdom. Design: Retrospective cohort study comparing a one-year period after the introduction of Covid-related physical interventions (2020-21) with a one-year period before this (2019-20). Settings: 3 UK secondary care ENT departments Participants: Adult patients admitted with acute tonsillitis, peritonsillar abscess, epiglottitis, glandular fever, peri-orbital cellulitis, acute otitis media, acute mastoiditis, retropharyngeal abscess and parapharyngeal abscess. Main outcome measures: Number of adult hospital admissions Results: In total there were significantly fewer admissions for ENT infections (n=1073, 57.56%, p<0.001; RR 2.36, 95% CI [2.17, 2.56]) in the 2020-2021 period than in the 2019-2020 period. There were significant reductions in admissions for tonsillitis (64.4%; p<0.001), peritonsillar abscess (60.68%; p<0.001), epiglottitis (66.67%; p<0.001), glandular fever (38.79%; p=0.001), acute otitis media (26.85%; p=0.01) and retropharyngeal and/or parapharyngeal abscesses (45.45%; p=0.04) Conclusion: Our study demonstrates a sizeable reduction in adult admissions for ENT infections since the introduction of Covid-19-related physical interventions. There is evidence to support the use of physical interventions in the prevention of viral transmission of respiratory disease. Preventing ENT infections requiring admission through simple physical interventions could be of great benefit to the quality of life of patients and economical benefit to healthcare systems.

Glandular fever and Epstein-Barr virus-related polyneuropathy: a life-threatening complication

An 18-year-old woman presented with a 1-week history of sore throat, lethargy and fevers. She was subsequently diagnosed with glandular fever and was managed conservatively. Following 1 week of conservative measures, she developed acute upper airway obstruction requiring emergency surgical tracheostomy insertion. Further investigation including electromyography demonstrated multiple cranial nerve neuropathies.

Diagnosis and management of glandular fever in primary care

Margaret Perry details the challenges of diagnosis and complications of this viral infection

The mouth, tonsils, and adenoids

The anatomy of the oral cavity is illustrated. Oral conditions from ulcers to white patches are described, in conjunction with their management plans. This includes treatment and staging of oral malignancies. The management of tonsillitis and adenoidal conditions, including glandular fever, is outlined. Indications for tonsillectomy are discussed. The presentation, investigation, staging, and treatment of tonsillar cancer are documented.