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Stevens MN, Patro A, Rahman B, Gao Y, Liu D, Cmelak A, Wiggleton J, Kim YJ, Langerman A, Mannion K, Sinard RJ, Netterville JL, Rohde SL, Topf MC. Impact of COVID-19 on presentation, staging, and treatment of head and neck mucosal squamous cell carcinoma. Am J Otolaryngol 2022; 43:103263. [PMID: 34653954 PMCID: PMC8500684 DOI: 10.1016/j.amjoto.2021.103263] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES During the COVID-19 pandemic, maintenance of safe and timely oncologic care has been challenging. The goal of this study is to compare presenting symptoms, staging, and treatment of head and neck mucosal squamous cell carcinoma during the pandemic with an analogous timeframe one year prior. MATERIALS AND METHODS Retrospective cohort study at a single tertiary academic center of new adult patients evaluated in a head and neck surgical oncology clinic from March -July 2019 (pre-pandemic control) and March - July 2020 (COVID-19 pandemic). RESULTS During the pandemic, the proportion of patients with newly diagnosed malignancies increased by 5%, while the overall number of new patients decreased (n = 575) compared to the control year (n = 776). For patients with mucosal squamous cell carcinoma (SCC), median time from referral to initial clinic visit decreased from 11 days (2019) to 8 days (2020) (p = 0.0031). There was no significant difference in total number (p = 0.914) or duration (p = 0.872) of symptoms. During the pandemic, patients were more likely to present with regional nodal metastases (adjusted odds ratio (OR) 2.846, 95% CI 1.072-3.219, p = 0.028) and more advanced clinical nodal (N) staging (p = 0.011). No significant difference was seen for clinical tumor (T) (p = 0.502) or metastasis (M) staging (p = 0.278). No significant difference in pathologic T (p = 0.665), or N staging (p = 0.907) was found between the two periods. CONCLUSION Head and neck mucosal SCC patients presented with more advanced clinical nodal disease during the early months of the COVID-19 pandemic despite no change in presenting symptoms.
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Affiliation(s)
- Madelyn N Stevens
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Ankita Patro
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Bushra Rahman
- Vanderbilt University School of Medicine, 1161 21st Ave S, Nashville, TN 37232, USA
| | - Yue Gao
- Department of Biostatistics, Vanderbilt University, 2525 West End Ave Ste 1100, Nashville, TN 37203, USA
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University, 2525 West End Ave Ste 1100, Nashville, TN 37203, USA
| | - Anthony Cmelak
- Department of Radiation Oncology, Vanderbilt University Medical Center, 2220 Pierce Ave, Nashville, TN 37232, USA
| | - Jamie Wiggleton
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Young J Kim
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Alexander Langerman
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Kyle Mannion
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Robert J Sinard
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - James L Netterville
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Sarah L Rohde
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Michael C Topf
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
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Bola S, Jaikaransingh D, Winter SC. COVID-19 and the return to head and neck outpatient activity in the United Kingdom: what is the new normal? Eur Arch Otorhinolaryngol 2021; 278:2641-2648. [PMID: 33159248 PMCID: PMC7647194 DOI: 10.1007/s00405-020-06458-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/13/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE As surgical specialties now begin the graduated return to elective activity and face-to-face clinics, this paper investigates the current head and neck outpatient practices across the United Kingdom. METHODS A cross-sectional study comprised of an online 20-item survey was distributed to members of the British Association of Head & Neck Oncologists (BAHNO). The survey was open on a web-based platform and covered topics including safety measures for patients, protective equipment for healthcare staff and protocols for the use of flexible nasendoscopy in the clinic. RESULTS The survey was completed by 117 participants covering 66 NHS Trusts across the UK. There was a significant reduction in face-to-face Otolaryngology, Maxillofacial and Speech and Language clinic patients when compared to pre-pandemic numbers (p < 0.0001). Risk assessments for flexible nasendoscopy were done for 69% of clinics and 58% had an established protocol. Room downtime after flexible nasendoscopy ranged from 0 to 6 h and there was a significant increase in allocated downtime after a patient had coughed/sneezed (p < 0.001). Natural ventilation existed in 36% of clinics and the majority of responders didn't know the Air Change Per Hour (ACPH) of the clinic room (77%). Where ACPH was known, it often did not match the allocated room downtime. CONCLUSION There is a wide variation in outpatient activity across the United Kingdom, but adaptations are being made to try and maintain staff and patient safety. However, more can still be done by liaising with allied teams to clarify outpatient protocols.
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Affiliation(s)
- Sumrit Bola
- Otolaryngology Department, Oxford University NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK
| | - Dominic Jaikaransingh
- Otolaryngology Department, Oxford University NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK
| | - Stuart C Winter
- Otolaryngology Department, Oxford University NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK.
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
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Šifrer R, Urbančič J, Piazza C, van Weert S, García-Purriños F, Benedik J, Tancer I, Aničin A. Emergent tracheostomy during the pandemic of COVID-19: Slovenian National Recommendations. Eur Arch Otorhinolaryngol 2021; 278:2209-2217. [PMID: 32889621 PMCID: PMC7473826 DOI: 10.1007/s00405-020-06318-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/21/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Emergent tracheostomy under local anaesthesia is a reliable method of airway management when orotracheal intubation is not possible. COVID-19 is spread through aerosol making the emergent tracheostomy a high-risk procedure for surgeons. The surgical establishment of the air conduit in emergency scenarios must be adjusted for safety reasons. METHODS To establish the Slovenian National Guidelines for airway management in cannot intubate-cannot ventilate situations in COVID-19 positive patients. RESULTS Good communication and coordination between surgeon and anaesthesiologist is absolutely necessary. Deep general anaesthesia, full muscle relaxation and adequate preoxygenation without intubation are initial steps. The surgical cricothyrotomy is performed quickly, the thin orotracheal tube is inserted, the cuff is inflated and ventilation begins. Following patient stabilisation, the conversion to the tracheostomy is undertaken with the following features: skin infiltration with vasoconstrictor, a vertical incision, avoidance of electrical devices in favour of classical manners of haemostasis, the advancement of the tube towards the carina, performing the tracheal window in complete apnoea following adequate oxygenation, the insertion of non-fenestrated canulla attached to a heat and moisture exchanger, the fixation of canulla with stitches and tapes, and the cricothyrotomy entrance closure. Appropriate safety equipment is equally important. CONCLUSION The goal of the guidelines is to make the procedure safer for medical teams, without harming the patients. Further improvements of the guidelines will surely appear as COVID-19 is a new entity and there is not yet much experience in handling it.
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Affiliation(s)
- Robert Šifrer
- University Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1104, Ljubljana, Slovenia.
| | - Jure Urbančič
- University Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1104, Ljubljana, Slovenia
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, National Cancer Institute of Milan, Via Giacomo Venezian 1, Milan, Italy
- Department of Oncology and Oncohematology, University of Milan, Via Festa del Perdono 7, Milan, Italy
| | - Stijn van Weert
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Locatie VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Francisco García-Purriños
- Servicio de Otorrinolaringología, Hospital Universitario Los Arcos del Mar Menor, Paraje Torre Octavio 54, 30739, Pozo Aledo, Murcia, Spain
| | - Janez Benedik
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1104, Ljubljana, Slovenia
- Department of Anaesthesiology and Surgical Intensive Therapy, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia
| | - Ivana Tancer
- University Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia
| | - Aleksandar Aničin
- University Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1104, Ljubljana, Slovenia
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Villarreal IM, Morato M, Martínez-RuizCoello M, Navarro A, Garcia-Chillerón R, Ruiz Á, de Almeida IV, Mazón L, Plaza G. Olfactory and taste disorders in healthcare workers with COVID-19 infection. Eur Arch Otorhinolaryngol 2021; 278:2123-2127. [PMID: 32725271 PMCID: PMC7385204 DOI: 10.1007/s00405-020-06237-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/20/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Severe acute respiratory syndrome caused by COVID-19 has spread globally for the last few months. Healthcare workers (HCW) are overexposed and infection rates are higher than in the rest of the population. Strict clinical assessment is paramount to detect suspicious cases. In this context, olfactory or taste dysfunction (OTD) appears as an early and frequent symptom. Evaluating its presence in early stages plays an important role nowadays. METHODS We performed a descriptive observational single-center study among 256 HCW at Hospital Universitario de Fuenlabrada affected by COVID-19 and confirmed using RT-PCR. A telephonic interview was performed, after obtaining oral informed consent. RESULTS OTD was present in up to 70% of the cases as an early symptom, including mild-to-severe cases. The extent of these sensory deficits lasted an average of 11 days. In 26% of the patients, these sensory alterations persisted for over a month. CONCLUSION OTD is reported as an early symptom among HCW with SARS-CoV-2 infection. Its strong association with test positivity is useful in the management of the infection and should be enough to indicate preventive isolation. We consider that OTD needs to be included in clinical screening questionnaires in HCW.
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Affiliation(s)
- Ithzel Maria Villarreal
- ENT Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Camino del Molino, 2, Fuenlabrada, 28942, Madrid, Spain.
| | - Marta Morato
- ENT Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Camino del Molino, 2, Fuenlabrada, 28942, Madrid, Spain
| | - Mar Martínez-RuizCoello
- ENT Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Camino del Molino, 2, Fuenlabrada, 28942, Madrid, Spain
| | - Andrés Navarro
- ENT Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Camino del Molino, 2, Fuenlabrada, 28942, Madrid, Spain
| | - Raimon Garcia-Chillerón
- ENT Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Camino del Molino, 2, Fuenlabrada, 28942, Madrid, Spain
| | - Álvaro Ruiz
- Occupational Health Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | | | - Luis Mazón
- Occupational Health Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Guillermo Plaza
- ENT Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Camino del Molino, 2, Fuenlabrada, 28942, Madrid, Spain
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Sharma A, Bhardwaj R. COVID-19 and ENT surgery: a brief review of essential precautions and triage. Eur Arch Otorhinolaryngol 2021; 278:1301-1305. [PMID: 32654024 PMCID: PMC7353825 DOI: 10.1007/s00405-020-06207-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/08/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE This study is a brief review of the existing knowledge on the ENT surgeon's approach towards management of patients during the COVID-19 pandemic. While it is being recommended to carry out only the emergent procedures and to postpone the non-urgent ones to a later date, this article is meant to provide an insight into triage of the ENT procedures and the various precautions to be taken into account by the ENT surgeons while carrying out a procedure during the COVID-19 pandemic. METHODS The ENT Cochrane, Pubmed and Web of Science databases were searched without a time limit using the terms 'COVID-19 and SARS-CoV-2 in conjunction with ENT surgery. RESULTS Elective and non urgent cases are best avoided during this time. Only absolutely essential and emergent procedures need to be carried out with the use of Personal protective equipment comprising of safety gown, N95 mask, safety goggles, disposable gloves and caps. There is a possibility of transmission of the SARS- CoV-2 through asymptomatic patients and hence all patients, even with an unknown COVID-19 status, need to undergo a preoperative screening. As all procedures under general anesthesia are aerosol generating, the use of Personal protective equipment (PPE) is recommended for all the health care workers present in the operation theater. CONCLUSION A proper knowledge of triage would be of immense help to the ENT surgeon in minimizing the exposure to health care workers and patients during this pandemic. All patients with an unknown COVID-19 status should be considered suspects and essential precautions for their management be taken accordingly.
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Affiliation(s)
- Akriti Sharma
- Department of Otorhinolaryngology, SGT Medical College, Hospital and Research Institute, Village Budhera, Gurugram, Haryana, 122505, India
| | - Rohit Bhardwaj
- Department of Otorhinolaryngology, Safdarjung Hospital and Vardhman Mahavir Medical College, Ansari Nagar, New Delhi, 110029, India.
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Zhang D, Fu Y, Zhou L, Liang N, Wang T, Del Rio P, Rausei S, Boni L, Park D, Jafari J, Kargar S, Kim HY, Tanda ML, Dionigi G, Sun H. Thyroid surgery during coronavirus-19 pandemic phases I, II and III: lessons learned in China, South Korea, Iran and Italy. J Endocrinol Invest 2021; 44:1065-1073. [PMID: 32876925 PMCID: PMC7463102 DOI: 10.1007/s40618-020-01407-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 08/23/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We compared demographic and clinic-pathological variables related to the number of surgeries for thyroid conditions or for cancer, morbidity, and fine needle aspiration (FNA) practices among Covid19 pandemic phases I, II, III and the same seasonal periods in 2019. METHODS The prospective database of the Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, China was used for this study. Covid19 emergency levels were stratified according to the World Health Organization: phase I (January 25-February 25, 2020), phase II (February 26-March 19), phase III (March 20-April 20). RESULTS There were fewer outpatient FNAs and surgeries in 2020 than in 2019. There were no thyroid surgeries during phase I. There were also fewer surgeries for cancer with a significant reduction of advanced stage cancer treatments, mainly stage T1b N1a in phase II and T3bN1b in phase III. Operative times and postoperative stays were significantly shorter during the pandemic compared to our institutional baseline. In phase III, vocal cord paralysis (VCP) increased to 4.3% of our baseline numbers (P = 0.001). There were no cases of Covid19-related complications during the perioperative period. No patients required re-admission to the hospital. CONCLUSION The Covid19 outbreak reduced thyroid surgery patient volumes. The decrease of Covid19 emergency plans contributed to unexpected outcomes (reduction of early stage cancer treatment, decreased operative times and hospital stays, increased VCP rate).
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Affiliation(s)
- D. Zhang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, 130000 People’s Republic of China
| | - Y. Fu
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, 130000 People’s Republic of China
| | - L. Zhou
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, 130000 People’s Republic of China
| | - N. Liang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, 130000 People’s Republic of China
| | - T. Wang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, 130000 People’s Republic of China
| | - P. Del Rio
- Department of Surgery, University of Parma, Parma, Italy
| | - S. Rausei
- Department of Surgery, ASST Valle Olona, Gallarate, Italy
| | - L. Boni
- Department of Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, Italy
| | - D. Park
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - J. Jafari
- Shahid Sadoughi Yazd Medical University, Yazd, Islamic Republic of Iran
| | - S. Kargar
- Shahid Sadoughi Yazd Medical University, Yazd, Islamic Republic of Iran
| | - H. Y. Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - M. L. Tanda
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Ospedale di Circolo, Viale Borri, 57, Varèse, Italy
| | - G. Dionigi
- Division of Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital “G. Martino”, University of Messina, Messina, Italy
| | - H. Sun
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, 130000 People’s Republic of China
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Berryhill McCarty E, Soldatova L, Brant JA, Newman JG. Innovations in otorhinolaryngology in the age of COVID-19: a systematic literature review. World J Otorhinolaryngol Head Neck Surg 2021; 8:S2095-8811(21)00003-2. [PMID: 33520334 PMCID: PMC7825952 DOI: 10.1016/j.wjorl.2021.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/31/2020] [Accepted: 01/14/2021] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Otolaryngologists are at increased occupational risk of Coronavirus Disease 2019 (COVID-19) infection due to exposure from respiratory droplets and aerosols generated during otologic, nasal, and oropharyngeal examinations and procedures. There have been a variety of guidelines and precautions developed to help mitigate this risk. While many reviews have focused on the personal protective equipment (PPE) and preparation guidelines for surgery in the COVID-19 era, none have focused on the more creative and unusual solutions designed to limit viral transmission. This review aims to fill that need. DATA SOURCES PubMed, Ovid/Medline, and Scopus. METHODS A comprehensive review of literature was performed on September 28, 2020 using PubMed, Ovid/Medline, and Scopus databases. All English-language studies were included if they proposed or assessed novel interventions developed for Otolaryngology practice during the COVID-19 pandemic. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS A total of 41 papers met inclusion criteria and were organized into 5 categories ('General Recommendations for Otolaryngologic Surgery', 'Equipment Shortage Solutions', 'Airway Procedures', 'Nasal Endoscopy and Skull Base Procedures', and 'Otologic Procedures'). Articles were summarized, highlighting the innovations created and evaluated during the COVID-19 pandemic. Creative solutions such as application of topical viricidal agents, make-shift mask filters, three-dimensional (3-D) printable adapters for headlights, aerosol containing separation boxes, and a variety of new draping techniques have been developed to limit the risk of COVID-19 transmission. CONCLUSIONS Persistent risk of COVID-19 exposure remains high. Thus, there is an increased need for solutions that mitigate the risk of viral transmission during office procedures and surgeries, especially given that most COVID-19 positive patients present asymptomatically. This review examines and organizes creative solutions that have been proposed and utilized in the otolaryngology. These solutions have a potential to minimize the risk of viral transmission in the current clinical environment and to create safer outpatient and operating room conditions for patients and healthcare staff.
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Affiliation(s)
| | - Liuba Soldatova
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity of Pennsylvania Health System, PhiladelphiaPennsylvaniaPAUSA
| | - Jason A. Brant
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity of Pennsylvania Health System, PhiladelphiaPennsylvaniaPAUSA
| | - Jason G. Newman
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity of Pennsylvania Health System, PhiladelphiaPennsylvaniaPAUSA
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Collateral damage of the COVID-19 pandemic: an alarming decline in critical procedures in otorhinolaryngology in a German university hospital. Eur Arch Otorhinolaryngol 2020; 278:3417-3423. [PMID: 33320294 PMCID: PMC7736669 DOI: 10.1007/s00405-020-06519-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/23/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE The COVID-19 pandemic has a major impact on the diagnosis and treatment of ENT patients. The aim of this study was to analyze the influence of the pandemic on the number of otolaryngological procedures, particularly for critical diagnoses with potential negative effects due to prolonged symptom duration. METHODS We evaluated 10,716 surgical procedures between January 1, 2018 and May 31, 2020, focusing on the 16-week period around March 16, 2020, which includes 1080 observations. We further analyzed subsets of critical procedures. RESULTS We found a decline in critical procedures by 43% although no critical procedures were postponed by the hospital. Meanwhile, the share of critical procedures increased up to 90% caused by the cancellation of elective surgery. Especially worrisome was that diagnostic procedures for suspected malignancies decreased by 41% during the pandemic. CONCLUSION The decline in critical procedures in otorhinolaryngology as collateral damage of the COVID-19 pandemic is considerable and therefore alarming.
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Micarelli A, Granito I, Carlino P, Micarelli B, Alessandrini M. Self-perceived general and ear-nose-throat symptoms related to the COVID-19 outbreak: a survey study during quarantine in Italy. J Int Med Res 2020; 48:300060520961276. [PMID: 33081538 PMCID: PMC8164561 DOI: 10.1177/0300060520961276] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To survey perceived general and ear-nose-throat (ENT) symptoms of COVID-19 in relation to psychological impact, mental health, perception of information and demographic characteristics in quarantined subjects during a lockdown period in Italy. METHODS Participants were 1380 respondents who completed an online survey. A logistic regression model was used to evaluate the association between the independent variables and perceived symptoms. RESULTS Participants reported different prevalences of perceived ENT and general symptoms. Coryza, cough, sore throat and tinnitus were the most common symptoms, and there was a low prevalence of anxiety, depression and stress compared with the psychological impact of the symptom. Comparison of the two symptom groups demonstrated a common need for updates, their relationship with the media and correct information about the route of transmission. CONCLUSIONS The health information provided during a disease outbreak must be grounded in evidence. This would help to prevent adverse psychological reactions and somatization symptoms that can engulf healthcare systems, especially in clinical areas like ENT, which frequently treat airway problems.
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Affiliation(s)
- Alessandro Micarelli
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Ivan Granito
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Pasquale Carlino
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Beatrice Micarelli
- ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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Lovato A, de Filippis C. Regarding COVID-19 and the Otolaryngologist: Preliminary Evidence-Based Review. Laryngoscope 2020; 130:E525. [PMID: 32484927 PMCID: PMC7300841 DOI: 10.1002/lary.28767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Lovato
- Department of Neuroscience DNS, University of Padova, Audiology Unit at Treviso Hospital, Treviso, Italy
| | - Cosimo de Filippis
- Department of Neuroscience DNS, University of Padova, Audiology Unit at Treviso Hospital, Treviso, Italy
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Nguyen TN, Jadhav AP, Dasenbrock HH, Nogueira RG, Abdalkader M, Ma A, Cervantes-Arslanian AM, Greer DM, Daneshmand A, Yavagal DR, Jovin TG, Zaidat OO, Chou SHY. Subarachnoid hemorrhage guidance in the era of the COVID-19 pandemic - An opinion to mitigate exposure and conserve personal protective equipment. J Stroke Cerebrovasc Dis 2020; 29:105010. [PMID: 32807425 PMCID: PMC7274572 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 02/07/2023] Open
Abstract
Aneurysmal subarachnoid hemorrhage (SAH) patients require frequent neurological examinations, neuroradiographic diagnostic testing and lengthy intensive care unit stay. Previously established SAH treatment protocols are impractical to impossible to adhere to in the current COVID-19 crisis due to the need for infection containment and shortage of critical care resources, including personal protective equipment (PPE). Centers need to adopt modified protocols to optimize SAH care and outcomes during this crisis. In this opinion piece, we assembled a multidisciplinary, multicenter team to develop and propose a modified guidance algorithm that optimizes SAH care and workflow in the era of the COVID-19 pandemic. This guidance is to be adapted to the available resources of a local institution and does not replace clinical judgment when faced with an individual patient.
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Affiliation(s)
- Thanh N Nguyen
- Neurology, Neurosurgery, Radiology, Boston Medical Center/Boston University School of Medicine.
| | | | | | - Raul G Nogueira
- Neurology, Neurosurgery, Radiology, Grady Memorial Hospital/Emory University.
| | | | - Alice Ma
- Radiology, Boston Medical Center.
| | | | | | | | - Dileep R Yavagal
- Neurology, Neurosurgery, University of Miami Miller School of Medicine.
| | | | - Osama O Zaidat
- Neuroscience Institute, Bon Secours Mercy Health System/ St. Vincent Hospital.
| | - Sherry Hsiang-Yi Chou
- Neurology, Neurosurgery, University of Pittsburgh Medical Center; Neurology, Neurosurgery, Critical Care Medicine, University of Pittsburgh Medical Center.
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12
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Ali MJ. COVID-19 pandemic and lacrimal practice: Multipronged resumption strategies and getting back on our feet. Indian J Ophthalmol 2020; 68:1292-1299. [PMID: 32587153 PMCID: PMC7574051 DOI: 10.4103/ijo.ijo_1753_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 12/24/2022] Open
Abstract
The aim of this review was to propose multi-pronged resumption strategies for lacrimal practice in an effort to plan a sustainable recommencement of elective surgeries after we emerge from the peak of COVID-19 pandemic. The strategies for lacrimal practice were classified into 7 subtypes, and each of the blueprints were reassessed based on existing information on resumption strategies of elective surgeries from other specialties in COVID-19 era. The specific needs of lacrimal practice were then added to construct algorithms summarizing the resumption strategies. The basic principle of 'primum non nocere' needs to be followed. The overall proposed plan advocates the transition to a more sustainable health care reality in a world where we would still co-exist with COVID-19. A comprehensive effort involving screening, laboratory testing, appropriate triage, effective personal protection and specific precautionary measures for lacrimal clinics and operating room are needed to be able to safely resume elective surgery when the pandemic peak declines. To predict the timing of the resumption of elective surgeries is quite complex and influenced by several geographic, political and economic factors. It is equally important to remember that COVID-19 crisis is a dynamic situation and constantly evolving, hence the strategies provided are subject to change. Strict adherence to standard COVID-19 guidelines combined with effective testing and personal protection strategies can ensure slow yet smooth and safe return to full lacrimal practice after the COVID-19 pandemic calms down. The local government directives, individual and institutional discretion are advised.
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Affiliation(s)
- Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
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13
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Ali MJ, Hegde R, Nair AG, Bajaj MS, Betharia SM, Bhattacharjee K, Chhabra AK, Das JK, Dudeja G, Grover AK, Honavar SG, Kim U, Mahesh L, Mukherjee B, Sethi A, Sharma M, Singh U. All India Ophthalmological Society - Oculoplastics Association of India consensus statement on preferred practices in oculoplasty and lacrimal surgery during the COVID-19 pandemic. Indian J Ophthalmol 2020; 68:974-980. [PMID: 32461408 PMCID: PMC7508093 DOI: 10.4103/ijo.ijo_1415_20] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/10/2020] [Accepted: 05/10/2020] [Indexed: 01/22/2023] Open
Abstract
Oculoplastic surgeries encompass both emergency surgeries for traumatic conditions and infectious disorders as well as elective aesthetic procedures. The COVID-19 pandemic has brought about a drastic change in this practice. Given the highly infectious nature of the disease as well as the global scarcity of medical resources; it is only prudent to treat only emergent conditions during the pandemic as we incorporate evidence-based screening and protective measures into our practices. This manuscript is a compilation of evidence-based guidelines for surgical procedures that oculoplastic surgeons can employ during the COVID-19 pandemic. These guidelines also serve as the basic framework upon which further recommendations may be based on in the future, as elective surgeries start being performed on a regular basis.
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Affiliation(s)
- Mohammad Javed Ali
- Govindram Seksaria, Institute of Dacryology, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Raghuraj Hegde
- Orbit, Ophthalmic Plastic Surgery and Ophthalmic Oncology Service, Department of Ophthalmology, Manipal Hospital, Bengaluru, Karnataka, India
| | - Akshay Gopinathan Nair
- Ophthalmic Plastic Surgery and Ocular Oncology, Aditya Jyot Eye Hospital, Wadala, Mumbai, Maharashtra, India
| | - Mandeep S Bajaj
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Apjit K Chhabra
- Department of Ophthalmology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Jayanta K Das
- Orbit and Oculoplasty Service, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Gagan Dudeja
- Orbit and Oculoplasty Service, Narayana Netralaya, Bangalore, Karnataka, India
| | - Ashok K Grover
- Department of Ophthalmology, Sir Gangaram Hospital, New Delhi, India
| | - Santosh G Honavar
- Editor, Indian Journal of Ophthalmology, Centre for Sight, Hyderabad, Telangana, India
| | - Usha Kim
- Orbit, Oculoplasty and Ocular Oncology Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Lakshmi Mahesh
- Orbit and Oculoplasty Service, Nethradhama Super Speciality Eye Hospital, Bangalore, Karnataka, India
| | - Bipasha Mukherjee
- Orbit, Oculoplasty, Aesthetic and Reconstructive Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Anita Sethi
- Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | | | - Usha Singh
- Advanced Eye Care Center, PGIMER, Chandigarh, India
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14
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Thamboo A, Lea J, Sommer DD, Sowerby L, Abdalkhani A, Diamond C, Ham J, Heffernan A, Cai Long M, Phulka J, Wu YQ, Yeung P, Lammers M. Clinical evidence based review and recommendations of aerosol generating medical procedures in otolaryngology - head and neck surgery during the COVID-19 pandemic. J Otolaryngol Head Neck Surg 2020; 49:28. [PMID: 32375884 PMCID: PMC7202463 DOI: 10.1186/s40463-020-00425-6] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Aerosol generating medical procedures (AGMPs) present risks to health care workers (HCW) due to airborne transmission of pathogens. During the COVID-19 pandemic, it is essential for HCWs to recognize which procedures are potentially aerosolizing so that appropriate infection prevention precautions can be taken. The aim of this literature review was to identify potential AGMPs in Otolaryngology - Head and Neck Surgery and provide evidence-based recommendations. METHODS A literature search was performed on Medline, Embase and Cochrane Review databases up to April 3, 2020. All titles and abstracts of retrieved studies were evaluated and all studies mentioning potential AGMPs were included for formal review. Full text of included studies were assessed by two reviewers and the quality of the studies was evaluated. Ten categories of potential AGMPs were developed and recommendations were provided for each category. RESULTS Direct evidence indicates that CO2 laser ablation, the use of high-speed rotating devices, electrocautery and endotracheal suctioning are AGMPs. Indirect evidence indicates that tracheostomy should be considered as potential AGMPs. Nasal endoscopy and nasal packing/epistaxis management can result in droplet transmission, but it is unknown if these procedures also carry the risk of airborne transmission. CONCLUSIONS During the COVID-19 pandemic, special care should be taken when CO2 lasers, electrocautery and high-speed rotating devices are used in potentially infected tissue. Tracheal procedures like tracheostomy and endotracheal suctioning can also result in airborne transmission via small virus containing aerosols.
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Affiliation(s)
- Andrew Thamboo
- Division of Otolaryngology Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
| | - Jane Lea
- Division of Otolaryngology Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Doron D Sommer
- Division of Otolaryngology Head & Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Leigh Sowerby
- Department of Otolaryngology, Western University, London, ON, Canada
| | - Arman Abdalkhani
- Division of Otolaryngology Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Diamond
- Division of Otolaryngology Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Ham
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Austin Heffernan
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - M Cai Long
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jobanjit Phulka
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Yu Qi Wu
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Phillip Yeung
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Marc Lammers
- Division of Otolaryngology Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
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