1
|
Jamal A, Safar M, Tarakmeh M, Jamal M, Alsaadi K, Safar A. Impact of COVID-19 on Surgical Interventions and Medical Practices in Pediatric Otolaryngology: A Narrative Review. Cureus 2022; 14:e23835. [PMID: 35530923 PMCID: PMC9069848 DOI: 10.7759/cureus.23835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/05/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic has become a major public health challenge. All types of elective and semi-urgent medical care and procedures have been discontinued during the pandemic to maintain the capacity to care for patients with this disease. The pandemic has had a significant impact on almost every medical field, including pediatric otolaryngology. This review highlights the impact of COVID-19 on surgical interventions and medical practices in pediatric otolaryngology owing to its direct association with ear, nose, and throat disorders, with an emphasis on immediate and potential long-term transformations in clinical practice. We reviewed several articles and scientific websites and summarized the currently available evidence and best practices for safety in the field of otolaryngology during the COVID-19 pandemic. Extensively discussed issues in pediatric otolaryngology include surgical interventions, medical practices, modes of transmission of COVID-19, personal protective equipment, and duration of exposure. Otolaryngologists should preserve their integrative medical approaches and subspecialty expertise during the COVID-19 pandemic. There has been a marked change in the approach to managing pediatric ear, nose, and throat conditions, both in the outpatient department and operating room, during the COVID-19 pandemic. The pandemic requires a great deal of flexibility and necessitates exploring new opportunities to create a safe and patient-friendly environment for children with otolaryngology problems. Many of the precautions implemented will remain necessary until a robust evidence shows the pandemic has come to an end.
Collapse
|
2
|
Tüzemen G, Tüzemen NÜ. Particle scattering during otolaryngological examinations. Am J Otolaryngol 2022; 43:103358. [PMID: 34973663 DOI: 10.1016/j.amjoto.2021.103358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE We aimed to analyze particle scattering during common otolaryngology examination procedures which are associated with aerosol-generating procedures. MATERIALS AND METHODS This study was conducted with 109 volunteer patients who have participated between October 2020 and January 2021. We measured aerosol and droplet production during oropharyngeal examination, anterior rhinoscopy, rigid nasopharyngoscopy, and rigid laryngoscopy. Measurements were calculated at the beginning of the examinations and during the otolaryngological examination procedures. RESULTS There was no significant increase when we compared the particle scattering in each examination procedure with the basal measurements. But at the end of all examination methods for each patient, there was a significant increase at each micrometer. When all examination methods are compared with each other, particle increases in the oropharyngeal examination with larger particle sizes than 0,5 μm were found to be higher than other examination methods. We analyzed six patients' measurements, who coughed, gagged, or sneezed during the nasal endoscopy procedure, there was a significant increase in terms of 0,3 μm particle scattering. CONCLUSION When all examination methods are performed together, there is a significant particle increase in all particle sizes in the examination room at the end of the examinations. This causes otolaryngologists to be exposed to a significant particle increase at each micrometer. Because of this reason, otolaryngologists should be careful and should wear personal protective equipment while examining patients.
Collapse
Affiliation(s)
- Gökhan Tüzemen
- Mınıstry of Health, Bursa City Hospital, Department of Otorhinolaryngology- Head and Neck Surgery, Bursa, Turkey.
| | - Nazmiye Ülkü Tüzemen
- Faculty of Medicine, Department of Medical Microbiology, Bursa Uludag University, Bursa, Turkey
| |
Collapse
|
3
|
Windfuhr JP, Günster C. Impact of the COVID-pandemic on the incidence of tonsil surgery and sore throat in Germany. Eur Arch Otorhinolaryngol 2022; 279:4157-4166. [PMID: 35218385 PMCID: PMC8881894 DOI: 10.1007/s00405-022-07308-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/07/2022] [Indexed: 11/21/2022]
Abstract
Purpose To longitudinally evaluate the impact of the COVID-19-pandemic on the incidence of inpatient tonsil surgery and outpatient primary care of sore throat in Germany. Methods A retrospective interrupted time-series analysis was conducted. The national database of the Hospital Remuneration System was used to retrieve the number of operations performed between January 2019 and September 2021 including elective and non-elective cases with the exception of malign diseases. Three episodes were compared on a weekly basis: before, during, and after the first national lockdown (March 16–May 3, 2020). We also analysed the number of outpatient doctor contacts of sore throat patients in 2019 and 2020. Results Overall, 144,069 surgical cases were included in the analysis. The first lockdown resulted in an abrupt and significant decrease of all types of tonsil surgery (p < 0.01). The incidence of tonsillectomy decreased from 556 (before) to 111 (during) and 326 (after) cases per week (relative risk 0.24; 95% CI 0.19–0.30, and 0.82; 95% CI 0.73–0.92). After the lockdown, the incidence persisted on a lower level compared to 2019. The number of doctor contacts decreased from 2,967,322 in 2019 to 1,976,617 in 2020 (− 33.4%). Conclusions The first lockdown was associated with a significant decrease of all types of tonsil surgery. A return to pre-pandemic surgical activity was not identified. The findings were accompanied by a significant decrease of outpatient doctor contacts of sore throat patients in primary care, particularly in the subgroup of children and adolescents. The impact of the second lockdown, starting in December 2020, was by far not comparable. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-022-07308-8.
Collapse
Affiliation(s)
- Jochen P Windfuhr
- Department of Otorhinolaryngology, Plastic Head and Neck Surgery, Kliniken Maria Hilf, Viersener Str. 450, 41063, Mönchengladbach, Germany.
| | | |
Collapse
|
4
|
Ferry AM, Dibbs RP, Ward A, Velez V, Ringold SL, Archer NM, Winebar JM, Andropoulos DB, Hollier Jr LH. Operational Effect of COVID-19 on Surgical Care at a Tertiary Pediatric Hospital. AORN J 2022; 115:147-155. [PMID: 35084769 PMCID: PMC9011624 DOI: 10.1002/aorn.13604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/17/2021] [Accepted: 04/12/2021] [Indexed: 11/12/2022]
Abstract
The detrimental effects of the coronavirus disease 2019 (COVID‐19) pandemic have profoundly disrupted surgical care at health care facilities worldwide. At our tertiary pediatric hospital, we made substantial adjustments to surgical suite utilization and staff member scheduling to account for reductions in surgical volume, increased demand for staff members in other sectors of the hospital, and the highly infectious properties of the virus. Perioperative leaders took advantage of the pandemic’s disruption to clinical activities to design and implement a new procedure‐scheduling process to rectify the inefficiencies that had accumulated as the previous system evolved. The implementation of said directives was largely facilitated by establishing communication with all involved parties for their input and feedback throughout the process. Although COVID‐19 has had varying effects on procedural operations across pediatric health care facilities, we believe our institutional response to the disruptive forces of COVID‐19 is of benefit to pediatric hospitals worldwide.
Collapse
|
5
|
Albilasi TM, Albkiry YA, AlGhamdi FR, Alanazi MM, Albilasi BM. Impact of COVID-19 on otolaryngology head & neck speciality and residency program in Saudi Arabia. Ann Med Surg (Lond) 2022; 74:103271. [PMID: 35096386 PMCID: PMC8786673 DOI: 10.1016/j.amsu.2022.103271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/09/2022] [Accepted: 01/23/2022] [Indexed: 11/27/2022] Open
Abstract
The SARS‐CoV‐2 virus, which causes coronavirus disease 2019 (COVID‐19), has rapidly swept worldwide since its identification in December 2019. As the spread of the disease accelerated both in Wuhan and elsewhere globally, the WHO declared it a pandemic. There is sound evidence to argue that otolaryngologists run high risks of occupational SARS-COV2 among health care workers due to high viral load in upper respiratory examinations. This review article was conducted to determine the effect of the COVID 19 pandemic on the otolaryngology department and residency program in Saudi Arabia. Since the pandemic outbreak, the government of Saudi Arabia has taken severe measures and issued several decisions to limit the spread of the virus. These decisions included operations, procedures, outpatient clinics by prioritizing emergency and time-sensitive cases while rescheduling all electives and routines once. As a result, the residency program was also affected by the substantial reduction of daily surgical activity and preventing endoscopic tests in the clinics, which led to a notable decrease in residents' involvement and risk of procedural skills deterioration which became a concern to many doctors of residency programs. It is difficult to deny that the epidemic will negatively impact. However, adhering to well-prepared guidelines and giving residents an excellent opportunity to overcome the defects will deliver training and patients' care while also protecting safety and health. Otolaryngologists have high risks of COVID-19 infection due to high viral load in the upper aerodigestive tract. COVID-19 pandemic impacts all surgical training residency programs and their academic curriculum. To control transmission of COVID, the number of patients and use of endoscopy except for emergency should be reduced. Elective surgeries should be rescheduled, except patients with time‐sensitive, urgent, or emergent medical conditions. The lack of exposure to clinical examination, surgical skills, and the reduction of teaching activities is of concern to many doctors of residency programs.
Collapse
Affiliation(s)
- Thamer M. Albilasi
- Department of Otolaryngology Head & Neck Surgery, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Yara A. Albkiry
- Collage of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Corresponding author.
| | - Fareed R. AlGhamdi
- Department of Otolaryngology Head & Neck Surgery, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mazyad M. Alanazi
- Department of Otolaryngology Head & Neck Surgery, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Bader M. Albilasi
- Medical Student Collage of Medicine, Al-Jouf University, Kingdom of Saudi Arabia
| |
Collapse
|
6
|
Impact of the novel coronavirus on surgical practices at a tertiary pediatric hospital: A 3 year cross-sectional study. Int J Pediatr Otorhinolaryngol 2021; 151:110923. [PMID: 34537547 PMCID: PMC8436429 DOI: 10.1016/j.ijporl.2021.110923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/09/2021] [Accepted: 09/11/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVE The novel coronavirus (COVID-19) forced unprecedented changes in pediatric otolaryngology workflow in the early pandemic, particularly due to the postponement of elective procedures. In turn, this has impacted timely treatment of patients and ability to train residents and fellows. The objective is to characterize how surgical practices in pediatric otolaryngology have been impacted by the pandemic through a cross sectional analysis over three years. METHODS This cross-sectional study focuses on patients who underwent surgical procedures within the department of otolaryngology at a single tertiary pediatric hospital. Descriptive statistical analysis was used to compare subsets of patients from pre-pandemic in 2019, early-pandemic in 2020, and late-pandemic in 2021. RESULTS Operative volume decreased by 87.57% in the early pandemic and 36.86% in the late pandemic. In the early pandemic, the greatest decreases were seen in airway reconstruction (100%), adenotonsillectomy (96.4%), adenoidectomy (94.7%), myringotomy with tympanostomy tube insertion (94.6%), frenulectomy (94.1%), and sinonasal procedures (93.3%), while in the late-pandemic adenotonsillectomy (42.4%) and myringotomy with tympanostomy tube insertion (70.1%) remained reduced when compared to pre-pandemic volume. Increased average case lengths in the early-pandemic (78.28 ± 51.95 min) and late-pandemic (71.91 ± 70.76 min) were observed when compared to pre-pandemic (52.26 ± 39.20 min) (p < 0.001). An increased proportion of multidisciplinary cases were completed in 2020 and 2021 (p < 0.001). In the 2020, 25% of cases were completed without trainee involvement. There was an overall decrease in case numbers for trainees and increase in cases without their involvement when compared to 2019 and 2021. CONCLUSION The COVID-19 pandemic resulted in a decrease in pediatric otolaryngology surgical procedures, particularly at the onset of the pandemic. While surgical trainees saw a dramatic reduction in case numbers early on, one year into the pandemic case volume is increasing and trending to pre-pandemic numbers. More complex cases, as represented by patients requiring longer operative times, inpatient status, and more frequently multidisciplinary care, were seen in the early pandemic, while drastic reductions were seen in routine outpatient procedures.
Collapse
|
7
|
Mobile meditation for improving quality of life, anxiety, and depression among surgical residents and faculty. The Journal of Laryngology & Otology 2021; 136:1034-1038. [PMID: 34674779 DOI: 10.1017/s0022215121003091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
8
|
Herzog M, Beule AG, Lüers JC, Guntinas-Lichius O, Grafmans D, Deitmer T. [The first year of the SARS-CoV-2 pandemic-impact on otorhinolaryngology]. HNO 2021; 69:615-622. [PMID: 33620505 PMCID: PMC7900796 DOI: 10.1007/s00106-021-01015-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The first year of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has already affected our public health care system to an enormous extent and will continue to do so in the future. Otorhinolaryngologists (ORLs) are suspected to be at high risk of infection, due to the high viral load in the mucosa of the upper airways. The current review evaluates the impact of the pandemic on ORLs' activities and assesses the risk infection. METHODS A selective literature research was conducted using relevant English and German terms for ORL, SARS-CoV‑2, risk, and infection at PubMed, medRxiv, and bioRxiv, as well as in the Deutsches Ärzteblatt and on the websites of the Robert Koch Institute and the Johns Hopkins University. RESULTS Protection recommendations for ORL include general hygiene measures and wearing KN95 masks for routine professional activities. When in contact with coronavirus disease 2019 (COVID-19) patients, it is recommended to extend the personal protective equipment by eye protection, gloves, cap, and gown. International otorhinolaryngology societies have released guidelines for procedures (e.g., tracheostomy, sinus surgery), propagating personal protection for the surgical team and reduction of aerosols. Testing for SARS-CoV‑2 in patients and medical staff can contribute to reducing the risk of infection. Vaccination would provide some additional protection for ORLs and other health care professionals with increased exposure to aerosols. There is increasing evidence that ORLs are at a high risk of contracting SARS-CoV‑2. CONCLUSION Consequent personal protection, frequent testing of patients and health care professionals, and the promised SARS-CoV‑2 vaccinations may provide adequate protection for highly exposed persons.
Collapse
Affiliation(s)
- M Herzog
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Carl-Thiem-Klinikum, Thiemstraße 111, 03048, Cottbus, Deutschland.
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - A G Beule
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster, Münster, Deutschland
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenkrankheiten, Kopf- und Halschirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - J-C Lüers
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Medizinische Fakultät, Uniklinik Köln, Köln, Deutschland
| | - O Guntinas-Lichius
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Jena, Jena, Deutschland
| | - D Grafmans
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Carl-Thiem-Klinikum, Thiemstraße 111, 03048, Cottbus, Deutschland
| | - T Deitmer
- Deutsche Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie e. V., Bonn, Deutschland
| |
Collapse
|
9
|
Shomorony A, Chern A, Long SM, Feit NZ, Ballakur SS, Gadjiko M, Liu K, Skaf DA, Tassler AB, Sclafani AP. Essential inpatient otolaryngology: what COVID-19 has revealed. Eur Arch Otorhinolaryngol 2021; 279:1053-1062. [PMID: 34247264 PMCID: PMC8272617 DOI: 10.1007/s00405-021-06963-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/25/2021] [Indexed: 11/06/2022]
Abstract
Purpose To identify areas of critical otolaryngology contributions to inpatient care resistant to disruption by the COVID-19 pandemic. Methods Medical records of 614 otolaryngology consults seen between January and June of 2019 and 602 seen between January and June of 2020 were reviewed. Extracted data included patient demographics, SARS-CoV-2 status, medical comorbidities, consult location, consult category, reason for consult, procedures performed, and overall outcome. Prevalence of data items was compared using t tests and Chi-squared tests. Results The number of monthly consults to the otolaryngology service remained approximately stable after the onset of the COVID-19 pandemic. However, there was a substantial increase in ICU consults and a decrease in ER and floor consults. The proportion of otology, rhinology, and head and neck consults decreased while that of airway consults—most of which were tracheostomy-related—greatly increased. While the top ten reasons for consult remained essentially the same, they dramatically increased as a percentage of consults during COVID-19 (55–92%), whereas there was a dramatic decrease in the proportion of less frequent consults. Conclusion The changes in otolaryngology consultation patterns seen after the onset of the pandemic are multifactorial, but may be attributed to novel pathologies, attitudes, and policies. Nonetheless, these patterns reveal that a set of core otolaryngologic issues, including acute airway issues, head and neck lesions, severe sinusitis and epistaxis, are essential and need to be addressed in the inpatient setting, whereas the significant drop in other consults suggests that they may be appropriately managed on an outpatient basis. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-021-06963-7.
Collapse
Affiliation(s)
- Andre Shomorony
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America.
| | - Alexander Chern
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America
| | - Sallie M Long
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America
| | - Noah Z Feit
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America
| | - Sarita S Ballakur
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America
| | - Mariam Gadjiko
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America
| | - Katie Liu
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America
| | - Daniel A Skaf
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America
| | - Andrew B Tassler
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America
| | - Anthony P Sclafani
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America
| |
Collapse
|
10
|
Zaubitzer L, Ludwig S, Jungbauer F, Walter B, Lange B, Rotter N, Schell A. [Validity of SARS-CoV-2 swabs taken preoperatively in children]. Laryngorhinootologie 2021; 101:138-146. [PMID: 34010975 DOI: 10.1055/a-1494-3341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Due to the limited compliance, the technically correct collection of a pooled nasopharyngeal swab is significantly more difficult in children. Especially during operations in the area of the upper respiratory tract, there is a significantly increased risk of infection with COVID-19 for everyone present in the operating room. The aim of the study is to analyze the validity of SARS-CoV-2 swabs taken preoperatively under suboptimal conditions. MATERIAL AND METHODS Retrospective comparison of the PCR results of SARS-CoV-2 swaps taken preoperatively and intraoperatively from 62 children in the period from April to November 2020. Median age was 4.49 years. The PCR diagnosis was carried out one or two days preoperatively (in the case of emergency interventions on the same day) and again intraoperatively using a pooled nasopharyngeal swab. RESULTS All 62 preoperatively taken swabs were negative. Deviating from the preoperative test result, one intraoperatively obtained swab was positive. CONCLUSIONS Due to limited compliance, a correct preoperative swab technique (preanalytics) cannot always be assumed for children. Sufficient protective measures for everyone present in the operating room are therefore imperative. Intraoperative test should be considered if the the preoperative test was performed under difficult conditions.
Collapse
Affiliation(s)
| | | | | | | | - Bettina Lange
- Stabsstelle Hygiene, Universitätsklinikum Mannheim, Germany
| | | | | |
Collapse
|
11
|
Boorgu DSSK, Dharmarajan H, Sim ES, Goyal L, Freiser ME, Weinstock M, Whelan R, Corcoran TE, Jabbour N, Wang E, Chi DH. Aerosol and Droplet Risk of Common Otolaryngology Clinic Procedures. Ann Otol Rhinol Laryngol 2021; 130:1245-1253. [PMID: 33730891 DOI: 10.1177/00034894211000502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Define aerosol and droplet risks associated with routine otolaryngology clinic procedures during the COVID-19 era. METHODS Clinical procedures were simulated in cadaveric heads whose oral and nasal cavities were coated with fluorescent tracer (vitamin B2) and breathing was manually simulated through retrograde intubation. A cascade impactor placed adjacent to the nares collected generated particles with aerodynamic diameters ≤14.1 µm. The 3D printed models and syringes were used to simulate middle and external ear suctioning as well as open suctioning, respectively. Provider's personal protective equipment (PPE) and procedural field contamination were also recorded for all trials using vitamin B2 fluorescent tracer. RESULTS The positive controls of nebulized vitamin B2 produced aerosol particles ≤3.30 µm and endonasal drilling of a 3D model generated particles ≤14.1 µm. As compared with positive controls, aerosols and small droplets with aerodynamic diameter ≤14.1 µm were not detected during rigid nasal endoscopy, flexible fiberoptic laryngoscopy, and rigid nasal suction of cadavers with simulated breathing. There was minimal to no field contamination in all 3 scenarios. Middle and external ear suctioning and open container suctioning did not result in any detectable droplet contamination. The clinic suction unit contained all fluorescent material without surrounding environmental contamination. CONCLUSION While patients' coughing and sneezing may create a baseline risk for providers, this study demonstrates that nasal endoscopy, flexible laryngoscopy, and suctioning inherently do not pose an additional risk in terms of aerosol and small droplet generation. An overarching generalization cannot be made about endoscopy or suctioning being an aerosol generating procedure. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
| | - Harish Dharmarajan
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Edward S Sim
- University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lindsey Goyal
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Monika E Freiser
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael Weinstock
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rachel Whelan
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Timothy E Corcoran
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Noel Jabbour
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David H Chi
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
12
|
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: 4] [Impact Index Per Article: 1.0] [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.
Collapse
|
13
|
Meister KD, Pandian V, Hillel AT, Walsh BK, Brodsky MB, Balakrishnan K, Best SR, Chinn SB, Cramer JD, Graboyes EM, McGrath BA, Rassekh CH, Bedwell JR, Brenner MJ. Multidisciplinary Safety Recommendations After Tracheostomy During COVID-19 Pandemic: State of the Art Review. Otolaryngol Head Neck Surg 2020; 164:984-1000. [PMID: 32960148 DOI: 10.1177/0194599820961990] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE In the chronic phase of the COVID-19 pandemic, questions have arisen regarding the care of patients with a tracheostomy and downstream management. This review addresses gaps in the literature regarding posttracheostomy care, emphasizing safety of multidisciplinary teams, coordinating complex care needs, and identifying and managing late complications of prolonged intubation and tracheostomy. DATA SOURCES PubMed, Cochrane Library, Scopus, Google Scholar, institutional guidance documents. REVIEW METHODS Literature through June 2020 on the care of patients with a tracheostomy was reviewed, including consensus statements, clinical practice guidelines, institutional guidance, and scientific literature on COVID-19 and SARS-CoV-2 virology and immunology. Where data were lacking, expert opinions were aggregated and adjudicated to arrive at consensus recommendations. CONCLUSIONS Best practices in caring for patients after a tracheostomy during the COVID-19 pandemic are multifaceted, encompassing precautions during aerosol-generating procedures; minimizing exposure risks to health care workers, caregivers, and patients; ensuring safe, timely tracheostomy care; and identifying and managing laryngotracheal injury, such as vocal fold injury, posterior glottic stenosis, and subglottic stenosis that may affect speech, swallowing, and airway protection. We present recommended approaches to tracheostomy care, outlining modifications to conventional algorithms, raising vigilance for heightened risks of bleeding or other complications, and offering recommendations for personal protective equipment, equipment, care protocols, and personnel. IMPLICATIONS FOR PRACTICE Treatment of patients with a tracheostomy in the COVID-19 pandemic requires foresight and may rival procedural considerations in tracheostomy in their complexity. By considering patient-specific factors, mitigating transmission risks, optimizing the clinical environment, and detecting late manifestations of severe COVID-19, clinicians can ensure due vigilance and quality care.
Collapse
Affiliation(s)
- Kara D Meister
- Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital, Stanford Children's Health, Palo Alto, California, USA.,Center for Pediatric Voice and Swallowing Disorders, Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Lucile Packard Children's Hospital, Stanford Children's Health, Palo Alto, California, USA
| | - Vinciya Pandian
- Department of Nursing Faculty, Johns Hopkins University, Baltimore, Maryland, USA.,Outcomes After Critical Illness and Surgery Research Group, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Brian K Walsh
- Department of Health Sciences, Liberty University, Lynchburg, Virginia, USA
| | - Martin B Brodsky
- Outcomes After Critical Illness and Surgery Research Group, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Physical and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Karthik Balakrishnan
- Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital, Stanford Children's Health, Palo Alto, California, USA.,Center for Pediatric Voice and Swallowing Disorders, Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Lucile Packard Children's Hospital, Stanford Children's Health, Palo Alto, California, USA
| | - Simon R Best
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Michigan, USA
| | - John D Cramer
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,Hollings Cancer Center, Charleston, South Carolina, USA
| | - Brendan A McGrath
- University of Manchester, NHS Foundation Trust, National Tracheostomy Safety Project, Manchester, UK
| | - Christopher H Rassekh
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joshua R Bedwell
- Baylor College of Medicine, Houston, Texas, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA; Global Tracheostomy Collaborative, Raleigh, North Carolina, USA
| |
Collapse
|