Background: COVID-19 patients, especially the patients requiring hospitalisation, have a high risk of several complications such as opportunistic bacterial and fungal infections. Mucormycosis is a rare and opportunistic fungal infection that mainly affects diabetic and immunocompromised patients. An increase has been observed in the number of rhino-orbital mucormycosis in patients with COVID-19 admitted to Imam Khomeini Hospital, Kermanshah, Iran, since October 2020. This is a report of the frequency, risk factors, clinical manifestations, treatment and prognosis of COVID-19 associated with mucormycosis infection. Methods: The medical records of COVID-19 patients with rhino-orbital mucormycosis who were diagnosed in an educational therapeutic hospital in Kermanshah, west of Iran were surveyed. Several parameters were analysed including demographic, clinical, therapeutic and laboratory characteristics.Results: Twelve patients with COVID-19-associated rhino-orbital mucormycosis were identified from 12 October to 18 November 2020. All cases reported as proven mucormycosis had a history of hospitalisation due to COVID-19. Comorbidities mainly included diabetes mellitus (83.33%) and hypertension (58.33%). Seventy-five per cent of patients received corticosteroids for COVID-19 treatment. The sites of involvement were rhino-sino-orbital (83%) and rhino-sino (17%). Amphotericin B/ liposomal amphotericin B alone or in combination with surgical debridement or orbital exenteration was used as the first-line therapy. The overall mortality rate was 66.7% (8/12). Conclusions:We found a high incidence of mucormycosis among COVID-19 patients. Diabetes mellitus and corticosteroid use were the dominant predisposing factor of mucormycosis. Mucormycosis is a life-threatening and opportunistic infection;

Background: Sleep disorders of breathing encompass a spectrum of disorders ranging from primary snoring to obstructive sleep apnea syndrome (OSAS), which leads to septoplasty in the most patients. Objectives: The aim of this study was to evaluate the effects of nasal septoplasty surgery on the severity of OSAS. Methods: The current quasi-experimental self-controlled study was conducted on adult patients with deviated nasal septum and were candidate for nasal septoplasty. Before surgery and two months after surgery, patients underwent respiratory polygraph. The parameters assessed included the airflow and oximetry indices. The severity of sleep apnea will be assessed based on the Apnea-Hypopnea Index (AHI). Also, the severity of snoring was scored from zero to 10 based on the visual analog scale (VAS). The severity of daytime sleepiness was also determined using the Epworth Sleepiness Scale (ESS). Data were analyzed by using SPSS software. Results: There was a significant reduction in the mean score of ESS after the surgery (P<0.001), daytime fatigue (P=0.002), and daytime sleepiness (P<0.001). Also, breathing quality during sleep showed that the severity of apnea (P<0.001), snoring (P<0.001), as well as ESS (P<0001) were significantly improved. There were no significant changes in the means of oxygen saturation (P=0.14) and rapid eye movement (REM) sleep (P=0.06) after non-REM stage 1-2 (P=0.09), but following non-REM stage 3-4 significantly improved (P=0.03). Conclusion: The correction of nasal obstruction improved the general health of OSAS patients. These results further reflected that the corrective surgery could improve the patients’ emotional state and social performance, effectively upgrading their quality of life.

Introduction: Neurofibromas, benign peripheral nerve sheath tumors, are the most common among neural lesion. Neurofibromas are rare in head and neck location, although it may involve any part of oral cavity. However, tongue is the most common region. Case Presentation: A 27 year-old man was admitted to Otorhinolaryngology Department due to a swelling in the base of his tongue, since two weeks before. This mass was painless, and without any associated symptoms. He was suffered from a mild eating disorder, too. He had no any positive past medical history, and only a large soft 6×5 cm mass was found at the base of his tongue without bleeding in the oral cavity. Excisional biopsy was performed for him under general anesthesia and the tumor was easily enucleated. The final diagnosis was neurofibroma. After the diagnosis of neurofibroma, the physical reexamination revealed a series of café au lait spots on his skin. Conclusion: the neurofibroma should be considered by otorhinolaryngologist, as a differential diagnosis of tongue mass, and more accurate physical examination are recommended for better management.