Background : Testing for SARS-CoV-2 is important for decision making prior to surgery in otolaryngology. An understanding of current and developing testing methods is important for interpreting test results.Methods : We performed a literature review of current evidence surrounding SARS-CoV-2 diagnostic testing highlighting its utility, limitations, and implications for otolaryngologists.Results : The currently accepted RT-PCR test for SARS-CoV-2 has varying sensitivity according to which subsite of the aerodigestive tract is sampled. Nasal swab sensitivities appear to be about 70%. Chest CT imaging for screening purposes is not currently recommended.Conclusion : Due to the current sensitivity of RT-PCR based testing for SARS-CoV-2, a negative test cannot rule out COVID-19. Full PPE should be worn during high risk procedures such as aerosol generating procedures even if testing is negative. Patients who test positive during screening should have their surgeries postponed if possible until asymptomatic and have tested negative for SARS-CoV-2.
Objective : To investigate olfactory dysfunction (OD) in patients with mild COVID-19 through patient-reported outcome questionnaires and objective psychophysical testing.Methods : COVID-19 patients with self-reported sudden-onset OD were recruited. Epidemiological and clinical data were collected. Nasal complaints were evaluated with the sino-nasal outcome-22 (SNOT-22). Subjective olfactory and gustatory status was evaluated with the National Health and Nutrition Examination Survey (NHNES). Objective OD was evaluated using psychophysical tests.Results : Eighty-six patients completed the study. The most common symptoms were fatigue (72.9%), headache (60.0%), nasal obstruction (58.6%) and postnasal drip (48.6%). Total loss of smell was self-reported by 61.4% of patients. Objective olfactory testings identified 41 anosmic (47.7%), 12 hyposmic (14.0%), and 33 normosmic (38.3%) patients. There was no correlation between the objective test results and subjective reports of nasal obstruction or postnasal drip.Conclusion : A significant proportion of COVID-19 patients reporting OD do not have OD on objective testing.
BackgroundTracheotomy, through its ability to wean patients off ventilation, can shorten ICU length of stay and in doing so increase ICU bed capacity, crucial for saving lives during the COVID-19 pandemic. To date, there is a paucity of patient selection criteria and prognosticators to facilitate decision-making and enhance precious ICU capacity.MethodsProspective study of COVID-19 patients undergoing tracheotomy (n=12) over a 4-week period (March-April 2020). Association between pre- and post- operative ventilation requirements and outcomes (ICU stay, time to decannulation, and death) were examined.ResultsPatients who sustained FiO2≤50% and PEEP≤8cm H2O in the 24h pre-tracheotomy exhibited a favourable outcome. Those whose requirements remained below these thresholds post-tracheotomy could be safely stepped down after 48h.ConclusionSustained FiO2≤50% and PEEP≤8cm H2O in the 48h post-tracheotomy are strong predictive factors for a good outcome, raising the potential for these patients to be stepped down early, thus increasing ICU capacity.
The COVID-19 epidemic was not the first coronavirus epidemic of this century and represents one of the increasing number of zoonoses from wildlife to impact global health. SARS CoV-2, the virus causing the COVID-19 epidemic is distinct from, but closely resembles SARS CoV-1, which was responsible for the severe acute respiratory syndrome (SARS) outbreak in 2002. SARS CoV-1 and 2 share almost 80% of genetic sequences and use the same host cell receptor to initiate viral infection. However, SARS predominantly affected individuals in close contact with infected animals and health care workers. In contrast, CoV-2 exhibits robust person to person spread, most likely by means of asymptomatic carriers, which has resulted in greater spread of disease, overall morbidity and mortality, despite its lesser virulence. We review recent coronavirus-related epidemics and distinguish clinical and molecular features of CoV-2, the causative agent for COVID-19, and review the current status of vaccine trials.
Background: Objective data on chemosensitive disorders during COVID-19 are lacking in the Literature.Methods: Multicenter cohort study that involved four Italian hospitals. 345 COVID-19 patients underwent objective chemosensitive evaluation.Results: Chemosensitive disorders self-reported by 256 patients (74.2%) but the 30.1% of the 89 patients who did not report dysfunctions proved objectively hyposmic. 25% of patients presented serious long-lasting complaints. All asymptomatic patients had a slight lowering of the olfactory threshold. No significant correlations were found between the presence and severity of chemosensitive disorders and the severity of the clinical course. On the contrary there is a significant correlation between the duration of the olfactory and gustatory symptoms and the development of severe COVID-19.Conclusions: patients under-report the frequency of chemosensitive disorders. Contrary to recent reports, such objective testing refutes the proposal that the presence of olfactory and gustatory dysfunction may predict a milder course, but instead suggests that those with more severe disease neglect such symptoms in the setting of severe respiratory disease.
As COVID-19 continues to challenge the practice of head and neck oncology, clinicians are forced to make new decisions in the setting of the pandemic that impact the safety of their patients, their institutions and themselves. The difficulty inherent in these decisions is compounded by potentially serious ramifications to the welfare of patients and healthcare staff, amid a scarcity of data on which to base informed choices. This paper explores the risks of COVID-19 incurred while striving to uphold the standard of care in head and neck oncology. The ethical problems are assessed from the perspective of the cancer patient, healthcare provider, and other patients within the healthcare system. While no single management algorithm for head and neck cancer can be universally implemented, a detailed examination of these issues is necessary to formulate ethically sound treatment strategies.
IntroductionThe COVID-19 pandemic has resulted in an unprecedented need for critical care intervention. Prolonged intubation and mechanical ventilation has resulted in the need for tracheostomy in some patients. The purpose of this international survey was to assess optimal timing, technique and outcome for this intervention.MethodsAn online survey was generated. Otorhinolaryngologists from both the United Kingdom and Abroad were polled with regards to their experience of tracheostomy in COVID-19 positive ventilated patients.ResultsThe survey was completed by 50 respondents from 16 nations. The number of ventilated patients totalled 3403, on average 9.7% required a tracheostomy. This was on average performed on day 14 following intubation. The majority of patients were successfully weaned (mean 7.4 days following tracheostomy).ConclusionThe results of this brief survey suggest that tracheostomy is of benefit in selected patients. There was insufficient data to suggest improved outcomes with either percutaneous versus an open surgical technique.
Background: An increasing number of COVID-19 patients worldwide will probably need tracheostomy in an emergency or at the recovering stage of COVID-19. We explored the safe and effective management of tracheostomy in COVID-19 patients, to benefit patients and protect healthcare workers at the same time.Methods: We retrospectively analyzed 11 hospitalized COVID-19 patients undergoing tracheostomy. Clinical features of patients, ventilator withdrawal after tracheostomy, surgical complications and nosocomial infection of the healthcare workers associated with the tracheostomy were analyzed.Results: All the tracheostomy of 11 cases (100%) were performed successfully, including percutaneous tracheostomy of 6 cases (54.5%) and conventional open tracheostomy of 5 cases (45.5%). No severe postoperative complications occurred, and no healthcare workers associated with the tracheostomy are confirmed to be infected by SARS-CoV-2. Conclusion: Comprehensive evaluation before tracheostomy, optimized procedures during tracheostomy, and special care after tracheostomy can make the tracheostomy safe and beneficial in COVID-19 patients.
Background: Guidelines for ultrasonic devices use are imperative because infectious aerosols arising from airway procedures were a key etiologic factor in prior coronavirus outbreaks. This manuscript aims to summarize the available recommendations and the most relevant concepts about the use of ultrasonic scalpel during the SARS-CoV-2 pandemic. Methods: Literature review of manuscripts with patients, animal models or in vitro studies where the ultrasonic scalpel was used and the plume produced was analyzed in a quantitative and/ or qualitative way. Discussion: Activated devices with tissue produces a biphasic bioaerosol composed (size 68.3 - 994 nm) of tissue particles, blood, intact and no viable cells, and carcinogenic or irritant hydrocarbons (benzene, ethylbenzene, styrene, toluene, heptene, and methylpropene). Conclusion: It is imperative to use an active smoke evacuator, to avoid ultrasonic scalpel use in COVID-19 positive patients and in upper airway surgery, as well as to follow the protection recommendations of the guidelines for management this type of patients.
Background: To show how to safely perform nasopharyngeal and / or oropharyngeal swabs for 2019-Novel Coronavirus. Methods: The video describes in detail the dressing and undressing procedures of health personnel, with the appropriate personal protective equipment. Technical notes for the execution of the nasopharyngeal and oropharyngeal swab are also provided, to avoid sampling errors. Results: The undressing phase is the procedure with the highest risk of self-contamination for the health worker. Following the various steps as shown in the video, there were no cases of contagion among the otolaryngology team appointed to perform the swabs for SARS-CoV-2 testing. Conclusions: This study demonstrates the technical feasibility of safely performing nasopharyngeal and/or oropharyngeal swabs for identification of SARS-CoV-2 viral RNA.
Judy Overton, BFA, MLAProgram Manager, Office of Patient Experience OfficerThe University of Texas M.D. Anderson Cancer CenterT. Boone Pickens Academic Tower1400 Pressler StHouston, Texas 77030 Kathy Denton, BS, MED, PhDThe University of Texas M.D. Anderson Cancer Center,Director, Patient ExperienceThe University of Texas M.D. Anderson Cancer CenterT. Boone Pickens Academic Tower1400 Pressler StHouston, Texas 77030 Michael Frumovitz, MD, MPHGynecologic Oncology and Reconstructive MedicineThe University of Texas M.D. Anderson Cancer CenterDan L. Duncan Building1155 Pressler StHouston, Texas 77030 Carol Lewis, MD Department of Head and Neck SurgeryThe University of Texas M.D. Anderson Cancer CenterT. Boone Pickens Academic Tower1400 Pressler StHouston, Texas 77030 Sarah Christensen, MADirector, Patient EducationThe University of Texas M.D. Anderson Cancer CenterDan L. Duncan Building1155 Pressler StHouston, Texas 77030 Jaymesson Bezerra, MSHAManager, Patient RelationsThe University of Texas M.D. Anderson Cancer CenterRotary House International 1600 Holcombe BlvdHouston, Texas 77030 Chris HernandezExec. Director, Patient Services, Patient AdvocacyThe University of Texas M.D. Anderson Cancer CenterAnderson West1515 Holcombe BlvdHouston, Texas 77030 Michele S. WalkerAssoc. Dir, Pt Advo & Pt Rel, Patient AdvocacyThe University of Texas M.D. Anderson Cancer CenterAnderson West1515 Holcombe BlvdHouston, Texas 77030 Janice P. Finder, BSN, MSN, RNDirrector, Patient Exp Clin Services, askMDAndersonThe University of Texas M.D. Anderson Cancer CenterMid Campus Building 1MC7007 Bertner AvenueHouston, Texas 77054 Ashlyn A. Proske, BSProgram Manager, askMDAndersonThe University of Texas M.D. Anderson Cancer CenterMid Campus Building 1MC7007 Bertner AvenueHouston, Texas 77054 Sanchita Jain, MBAInnovation Strategist, InnovationThe University of Texas M.D. Anderson Cancer CenterMid Campus Building 1MC7007 Bertner AvenueHouston, Texas 77054 Julai Whipple, BAInnovation Designer, InnovationThe University of Texas M.D. Anderson Cancer CenterMid Campus Building 1MC7007 Bertner AvenueHouston, Texas 77054 Wendi L. Martinez, ADN, BSN, RNDir QA & Perf Improvement, Inst Cancer Care InnovationThe University of Texas M.D. Anderson Cancer CenterMid Campus Building 1MC7007 Bertner AvenueHouston, Texas 77054 Jarod EskaInst Cancer Care InnovationThe University of Texas M.D. Anderson Cancer CenterMid Campus Building 1MC7007 Bertner AvenueHouston, Texas 77054 Elizabeth W. Sutherland, MPASPhysician Asst, Surgical OncologyThe University of Texas M.D. Anderson Cancer CenterT. Boone Pickens Academic Tower1400 Pressler St.Houston, Texas 77030 Lisa L. Triche, DNP, MS, RNAdvanced Prac Registered Nurse, Pediatrics - Patient CareThe University of Texas M.D. Anderson Cancer CenterAnderson East1515 Holcombe BlvdHouston, Texas 77054Elizabeth A. Garcia, BSN, MPA, RNAssoc VP, Patient Experience, Ofc of Chief Operating OfficerThe University of Texas M.D. Anderson Cancer Center1515 Holcombe BlvdUnit 1485Houston, Texas 77030Corresponding Author:Randal Weber, MD Chief Patient Experience Ofc, Chief Patient Experience OfficerThe University of Texas M.D. Anderson Cancer CenterT. Boone Pickens Academic Tower1400 Pressler StHouston, Texas 77030
The 2019 Coronavirus Panademic challenges the delivery of care for patients with head and neck cancer. An important aspect of this care has been the evolution of enhanced survivorship services which include surveillance for recurring cancer and prevention of second primaries. The application of evidence based approaches to identification and management of treatment and tumor related toxicities has embraced the use of validated patient reported outcomes instruments (PROs), health promotion, and care coordination. In this manuscript we describe how our multidisciplinary team of survivorship providers have accommodated to the need to provide patients with social distancing while acknowledging the importance of continued care during treatment and through the spectrum of survivorship.
The novel coronavirus disease 2019 (COVID-19) pandemic continues to have extensive effects on public health as it spreads rapidly across the globe. Head and neck cancer patients are a particularly susceptible population to these effects, and we expect there to be a potential surge in patients presenting with head and neck cancers after the surge in COVID-19. Furthermore, the impact of social distancing measures could result in a shift towards more advanced disease at presentation. With appropriate anticipation, multidisciplinary head and cancer teams could potentially minimize the impact of this surge and plan for strategies to provide optimal care for head and neck cancer patients.
IntroductionThe ongoing worldwide pandemic due to COVID-19 has forced drastic changes on the daily lives of the global population. This is most notable within the healthcare sector. The current paper outlines the response of the head and neck oncologic surgery (HNS) division within our academic otolaryngology department in the state of Alabama.MethodsData with regard to case numbers and types were obtained during the pandemic and compared with time matched data. Our overall approach to managing previously scheduled and new cases, personal protective equipment (PPE) utilization, outpatient clinic, and resident involvement is summarized.DiscussionOur HNS division saw a 55% reduction in surgical volume during the peak of the COVID-19 pandemic. We feel that an early and cohesive strategy to triaging surgical cases, PPE usage, and minimizing exposure of personnel is essential to providing care for HNS patients during this pandemic.
The SARS-CoV-2 pandemic has rapidly transformed healthcare delivery around the globe. Because of the heavy impact of COVID-19 spread, cancer treatments have necessarily been de-prioritized, thus exposing patients to increased risk of morbidity and mortality due to delayed care. In this scenario, cancer specialists need to assess critical oncology patients case by case to carefully balance risk versus benefit in treating tumors and preventing SARS-CoV-2 infection. Here we report early insights into how the management of patients with sinonasal and anterior skull base cancer might be affected by the COVID-19 pandemic. We provide recommendations for preoperative tests, indications for immediate care versus possible delayed treatment, warnings relating to dural resection and intracranial dissection given the potential neurotropism of SARS-CoV2 and practical suggestions for managing cancer care in a period of limited resources. We also postulate some thoughts on the promising role of telemedicine in multidisciplinary case discussions and post-treatment surveillance.
Introduction For the ENT surgeon there are many challenges that show-up in the clinical management of a patient affected by a Head and Neck cancer during COVID-19 pandemic, especially in the postoperative period. Methods During the acute COVID-19 emergency phase in Italy, we analysed the management of a patient affected by a Head and Neck cancer. We reported several clinical data about the hospitalization period, pointing out the difficulties encountered both from clinical and management point of view. Results During pandemic, we admitted 27 oncological patients at our ENT department. Delays in surgical procedures, complications of hospitalizations, need for radiological studies and possible transfer to other hospital ward, due to suspect Sars-CoV-2 infection, were registered. Conclusions The changes in the whole health care system during the COVID-19 pandemic have impacted the management of head and neck cancer patients, generating several clinical challenges for the ENT surgeon.
AIM: The COVID-19 pandemic has resulted in society experiencing unprecedented challenges for healthcare practitioners and facilities serving at the frontlines of this pandemic. With regards to oral cancer, there is a complete absence of literature regarding the long-term impact of pandemics on patients with oral potentially malignant disorders (OPMDs). The objective of this article is to put forth an institutional multidisciplinary approach for the evaluation and management of OPMDs. METHODS: A multidisciplinary approach was put formalized within our institution to risk stratify patients based on need for in-person assessment versus telehealth assessment during the COVID-19 pandemic. RESULTS: With judicious risk stratification of patients based on clinical features of their OPMD and with consideration of ongoing mitigation efforts and regional pandemic impact, providers are able to safely care for their patients. CONCLUSIONS: The COVID-19 pandemic has required healthcare practitioners to make novel decisions that are new to us with development of creative pathways of care that focused on patient safety, mitigation efforts, and clinical management of disease processes. The care of patients with OPMDs requires special considerations especially as patients at high-risk for severe COVID-19 illness are also higher risk for the development of OPMDs.