Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was noted to cause coronavirus disease 2019 (COVID-19) in 2019, there have been many trials to develop vaccines against the virus. Messenger ribonucleic acid (mRNA) vaccine as a type of the vaccine has been developed and commercialized rapidly, but there was not enough time to verify the long-term safety. An 82-year-old female patient was admitted to the emergency room with dyspnea accompanied by stridor three days after the 3rd COVID-19 mRNA vaccination (Comirnaty, Pfizer-BioNTech, USA). The patient was diagnosed with bilateral vocal fold paralysis (VFP) by laryngoscope. Respiratory distress was improved after the intubation and tracheostomy in sequence. The brain, chest, and neck imaging tests, serological tests, cardiological analysis, and immunological tests were performed to evaluate the cause of bilateral VFP. However, no definite cause was found except for the precedent vaccination. Because bilateral VFP can lead to a fatal condition, a quick evaluation is necessary in consideration of VFP when dyspnea with stridor occurs after vaccination.

No abstract

Background and Objectives The middle ear, eustachian tube, and nasal cavity are anatomically adjacent, so the middle ear pressure (MEP), eustachian tube function (ETF), and nasal cavity condition are highly correlated. In this study, the effect of nasal septal deviation (NSD) on ETF and the effects of septoplasty on ETF and MEP were meta-analyzed using the results of tympanogram.Subjects and Method A systematic search was conducted using the PubMed, Embase, the Web of Science, and the Cochrane Central Register of Controlled Trials. The MEP and ETF were compared before and after septoplasty. We also compared eustachian tube dysfunction observed from the deviated side and from the non-deviated side of the ear. Heterogeneity was analyzed within the subgroups.Results Eustachian tube dysfunction was about twice as high in the narrowed side of NSD patients than in other patients. The tympanogram results did not show any significant difference when subgroups were observed before, within 1 month after, or 3 months after septoplasty. Eustachian tube dysfunction before septoplasty was about 4.5 times higher than after septoplasty (when followed up for more than 1 month). From the subgroup analysis of deviated and non-deviated sides, MEP before septoplasty was significantly lower than after septoplasty and eustachian tube dysfunction was approximately 4 times higher in the narrowed nasal cavity.Conclusion The narrowed side of the nasal cavity in NSD can be related to eustachian tube dysfunction. Septoplasty may help restore ETF in the ears of narrowed side of the nasal cavity.

Background and Objectives Female are less likely to be diagnosed with obstructive sleep apnea (OSA) than male are and their symptoms are more likely to be overlooked because female usually show less typical classic symptoms of OSA, such as snoring, witnessed apnea, and daytime sleepiness. In this study, we identified sex effects among patients who complained of snoring or sleep apnea with adjusting for age.Subjects and Method This study design was retrospectively conducted to compare sex and age differences in 255 Korean patients complaining of snoring or sleep apnea by evaluating medical history, rhinomanometry, physical examination, and polysomnography.Results The sex difference in the apnea-hypopnea index decreased after 50 years of age. Female OSA patients complained of mild-to-moderate OSA with atypical symptoms. Male OSA patients showed Berlin questionnaire scores, retropalatal Muller maneuver grade, and high body mass index (BMI) as significant risk factors for OSA after adjusting for age. Female OSA patients showed retropalatal Muller maneuver grade and high BMI as significant risk factors. Berlin score was a typical risk factor in old male OSA patients.Conclusion Anatomical and hormonal factors were thought to be risk factors for OSA especially in females, but contrary to expectations, there were no risk factors in old females when adjusted for age. A careful approach should be taken to avoid overlooking sleep apnea in female.

The coronavirus disease 2019 (COVID-19) epidemic originated in Wuhan, China and spread rapidly worldwide, leading the World Health Organization to declare an official global COVID- 19 pandemic in March 2020. The upper aero-digestive tract is known to be the highest viral load reside. The infection spreads via droplets or direct contact with contaminated surfaces via aeorsol. The otolaryngologists deal with diseases of the upper-aerodigestive tract and routinely are engaged in respiratory droplet and aerosol-generating procedures (AGP). In particular, because airborne transmission occurs during examination and AGP, otolaryngologists are considered to be at a high risk of contracting COVID-19 during this pandemic. Therefore otolaryngologists need to do precautions to protect staff and patients and minimize transmission of the disease. We also need to wear adequate personal protective equipment according to the examination and procedure. This article discusses the disease transmission and clinical characteristics of COVID-19 as well as precaution guidelines in outpatient clinics of otorhinolaryngology.