Impact of COVID-19 Pandemic on Ambulatory and Operating Room Rhinology Practice in the US.

INTRODUCTION: The pandemic caused by the novel coronavirus virus has altered all facets of clinical practice in the United States. The goal of this study is to better understand the impact of COVID-19 on rhinologic ambulatory and operative practice. METHODS: A 27-item survey to assess these objectives was created and approved by the Division of Rhinology faculty at Rush University Medical Center in April 2020. The survey was then distributed to rhinologists in a web based format via www.surveymonkey.com from April 10 through April 23, 2020. RESULTS: A total of 277 U.S based rhinologists responded to the survey (23.04%). The most common practice types were single specialty private (44.9%) and academic (24.6%). 90.2% practice in a state under a shelter in place order. Comparing pre-COVID baseline to during-COVID, there was statistically significant reduction in the number of patients of seen daily in clinic (p < 0.001). The number of nasal endoscopies in the office and surgical procedures fell dramatically. Overall, 5 respondent rhinologists have been infected with COVID-19 and 27 have been furloughed. CONCLUSION: COVID-19 has drastically affected rhinologic practice. There is a dramatic reduction of in person care in the office setting and surgical management of sinonasal and skull base disease. Enhanced PPE is being used in only half of potentially aerosolizing procedures which represents an area of further education. Novel approaches such as use of virtual encounters and point of care testing should be considered as options to facilitate care.

Etiology and management of pediatric hemoptysis.

OBJECTIVE: To review the diagnostic and treatment strategies of hemoptysis in children. DESIGN: Retrospective analysis of patients evaluated between January 1, 1995, and August 31, 1999. SETTING: Tertiary pediatric referral center. PATIENTS: Nineteen consecutive children presenting with hemoptysis to the otolaryngology service. RESULTS: Chest radiography and bronchoscopy established the correct etiology in 15 patients. Infection and tracheostomy-related complications were the most common underlying problems. Other causes included congenital heart disease, pulmonary hemosiderosis, inflammatory bronchial mass, cystic fibrosis, factitious hemoptysis, and esophagitis. Appropriate management, ranging from antibiotics to emergency embolization, resulted in control of hemoptysis in all patients. CONCLUSIONS: Hemoptysis is a rare but potentially life-threatening symptom of underlying respiratory tract abnormality in children. An efficient systematic evaluation is imperative to identifying the underlying etiology; aggressive management is important because of the potential severity of the problem. The otolaryngologist plays a pivotal role in the diagnosis and management, by flexible endoscopy of the nose, nasopharynx, and larynx, and through the use of rigid bronchoscopy, especially in cases of massive hemoptysis.

Recurrent respiratory papillomatosis with esophageal involvement.

OBJECTIVE: To report a case of recurrent respiratory papillomatosis with diffuse involvement of the esophagus in a child. DESIGN: Retrospective case report and literature review. SETTING: Tertiary Children's Hospital. CONCLUSION: Endoscopy is recommended for detection of esophageal papillomas, especially in patients with significant laryngeal lesions or post-cricoid involvement.

Conductive hearing loss associated with pressure equalization tubes.

Pressure equalization (PE) tube placement traditionally has been used to lessen conductive hearing loss with chronic middle ear effusion. It is assumed that the small diameter of the tube should not interfere with the conduction of sound. In this article we present 5 patients in whom placement of a PE tube resulted in significantly worse conductive hearing. Occlusion of the PE tube with cigarette paper or Gelfoam improved hearing, as documented with audiometry. The average conductive hearing losses attributable to the ventilation tube for this series of patients were 22, 17, 15, 13, 4, and 10 dB at the frequencies of 250, 500, 1000, 2000, 4000, and 8000 Hz, respectively. This amount of change attributable to PE tubes in this small selection of patients is much greater than would be commonly appreciated. We conclude that the opening in the tympanic membrane provided by PE tubes can potentially result in a significant conductive hearing loss. Discussion includes those conditions in which reduced hearing may be more likely to occur.

Preventing myringotomy closure with topical mitomycin C in rats.

The purpose of this study was to determine whether mitomycin C could be used to prolong the patency of the myringotomy site in the absence of ventilation tubes in rats. We examined the effect of increased exposure time and repeat application of mitomycin C to the myringotomy site. Sixty animals were separated into 4 groups: group A had a single application of mitomycin C for 10 minutes; group B had a single application for 20 minutes; group C received 2 10-minute applications separated by 1 week; and group D received 2 applications (20 and 10 minutes) separated by 1 week. Mitomycin C and bacteriostatic saline solution were applied to the right and left myringotomy sites in each rat, respectively. Experimental ears in groups A, B, C, and D remained open for a median time of 6.5, 5.5, 6.5, and 8.5 weeks, respectively. The control ears healed within 1. 5 weeks. This difference was statistically significant with P < 0.001 for each group. We conclude that mitomycin C is effective in prolonging the patency of myringotomies in rat tympanic membranes. Increased exposure time or repeat application of mitomycin C did not statistically alter the patency rate.

Enhanced neointimal growth in cultured rabbit aorta following in vivo balloon angioplasty.

We have used in vivo balloon catheterization in combination with in vitro organ culture to develop a model system for vascular neointima formation. A Fogarty balloon catheter was used to deendothelialize and rupture the internal elastic lamina of aortae in adult rabbits. After three d of recovery, aortae were harvested, divided into segments, and placed into organ culture. We obtained a daily index of cell proliferation in cultured vessels using [3H]thymidine incorporation into DNA. Also, segments were collected and processed for routine histology or immunohistochemistry. Aortic segments that had undergone ballooning 3 d before harvest and then cultured exhibited diffuse neointimal growth after several d in vitro, whereas those from sham-operated (nonballooned) rabbits showed generally only a single endothelial cell layer that is characteristic of normal intima. Aortae that were harvested, balloon-damaged in vitro, and then cultured exhibited no neointimal growth. The neointima that developed in cultured segments from in vivo ballooned rabbits was primarily of smooth muscle cell origin as determined by positive immunostaining for alpha-smooth muscle actin. The intima:media thickness ratios were significantly higher in aortic segments from ballooned rabbits at harvest and after 4 or 7 d in culture compared with those from nonballooned rabbits. Also, the [3H]thymidine index was higher in the in vivo ballooned aorta compared to non-ballooned or in vitro ballooned vessel. We conclude that ballooning in vivo followed by exposure to blood-borne elements produces an enhanced proliferative response in cultured vessels that is distinct from other in vitro models of neointimal growth.

Functional endoscopic sinus surgical outcomes for contact point headaches.

Headaches secondary to sinonasal anatomic abnormalities continue to remain a difficult entity to diagnose and to manage. This retrospective study analyzed the outcome of care for 34 patients who presented with headaches as one of their primary sinonasal complaints and were subsequently found to have contact points between the nasal septum and one or more turbinates on nasal endoscopy and/or computed tomography scan. Following functional endoscopic sinus surgery to relieve the contact points, these patients were interviewed regarding preoperative and postoperative intensity and frequency of the headaches and the overall response of the chronic sinusitis and headaches to surgery, after a mean follow-up period of 13.9 months. After surgery, reduction in intensity and frequency of headaches was experienced in 91% and 85% of the patients, respectively. This investigation demonstrates that surgical management of contact point headaches can make a significant impact on the headache symptomatology in children and adults.