Otolaryngology in the Time of Corona: Assessing Operative Impact and Risk During the COVID-19 Crisis.

OBJECTIVE: Limited research exists on the coronavirus disease 2019 (COVID-19) pandemic pertaining to otolaryngology-head and neck surgery (OHNS). The present study seeks to understand the response of OHNS workflows in the context of policy changes and to contribute to developing preparatory guidelines for perioperative management in OHNS. STUDY DESIGN: Retrospective cohort study. SETTING: Pediatric and general adult academic medical centers and a Comprehensive Cancer Center (CCC). SUBJECTS AND METHODS: OHNS cases from March 18 to April 8, 2020-the 3 weeks immediately following the Ohio state-mandated suspension of all elective surgery on March 18, 2020-were compared with a 2019 control data set. RESULTS: During this time, OHNS at the general adult and pediatric medical centers and CCC experienced 87.8%, 77.1%, and 32% decreases in surgical procedures as compared with 2019, respectively. Aerosol-generating procedures accounted for 86.8% of general adult cases, 92.4% of pediatric cases, and 62.0% of CCC cases. Preoperative COVID-19 testing occurred in 7.1% of general adult, 9% of pediatric, and 6.9% of CCC cases. The majority of procedures were tiers 3a and 3b per the Centers for Medicare & Medicaid Services. Aerosol-protective personal protective equipment (PPE) was worn in 28.6% of general adult, 90% of pediatric, and 15.5% of CCC cases. CONCLUSION: For OHNS, the majority of essential surgical cases remained high-risk aerosol-generating procedures. Preoperative COVID-19 testing and intraoperative PPE usage were initially inconsistent; systemwide guidelines were developed rapidly but lagged behind recommendations of the OHNS department and its academy. OHNS best practice standards are needed for preoperative COVID-19 status screening and PPE usage as we begin national reopening.

[Principals of high frequency surgery]. / Hochfrequenzchirurgie -- Prinzipien und Anwendungen.

Electrosurgical instruments are routinely and daily applied at a variety of indications in Otorhinolaryngology. They can be used for cutting, coagulation and devitalisation. All have in common that the high frequency energy is transported into the tissue via an instrument and by this causes a thermal change. Depending on the duration and characteristic of the electricity a vaporisation of the tissue is effected through coagulation, devitalisation and carbonisation. The knowledge of the effects on the tissue by the choice of the different instrument parameters and application systems is essential for an ingenious therapeutically indication. In principal the following application methods for electrosurgery by modulation of the high frequency parameters are distinguished: the monopolar and the bipolar coagulation and devitalisation and the monopolar and the bipolar cutting. This article deals with the physical basis, the effects in the tissue as well as the single application methods of the high frequency surgery.

[The influence of bioceramics on phagocytosis of human leukocytes]. / Untersuchungen zum Einfluss von Biokeramiken auf die Phagozytoserate humaner Leukozyten.

BACKGROUND: After implantation of biomaterials in the regions of head and neck with resident microbial contamination the interaction between the implant and microbes play an important role for the success of the implantation. The host immune defence is important for the outcome after implantation, too. Phagocytosis plays an important role in the human immune response on infections. MATERIAL AND METHODS: The method described by Suess was used to investigate and measure the influence of the bioceramics Bioverit((R)) and Al(2)O(3)-ceramic on phagocytosis of yeast by human leukocytes. RESULTS: The bioceramics showed no statistically significant influence on phagocytosis function by human leukocytes. There was a tendency towards lower phagocytosis rates in all samples with bioceramics. CONCLUSIONS: The bioceramics Bioverit((R)) and Al(2)O(3) ceramic have no influence on phagocytosis of human leukocytes. In conclusion these biomaterials did not cause any inhibition of this important part of the human immune response on microbial infections after alloplastic implantation in head and neck regions.

[The value of hyperbaric oxygen therapy (HBO) in treatment of problem wounds in the area of plastic-reconstructive head and neck surgery]. / Der Stellenwert der hyperbaren Sauerstofftherapie (HBO) in der Behandlung von Problemwunden im Bereich der plastisch-rekonstruktiven Kopf-Hals-Chirurgie.

BACKGROUND: Hyperbaric oxygenation therapy is presently predominantly discussed in connection with sudden deafness and tinnitus. Amongst this ongoing controversy, the primary indications of this in the middle of the 20th century established therapy, especially in regard to problem wounds in the plastic-reconstructive surgery go mainly underrated. The present paper reviews the attention towards this area in plastic surgery. PATIENTS AND METHODS: Three typical cases (traumatic nasal tip reconstruction, wound ulceration after radiotherapy and lobe necrosis together with fistula following laryngopharyngectomy) are presented. RESULTS: Because of protracted and complicated wound healing HBO was applied in all three cases, eventually leading to very satisfying subconsequent wound-healing. In connection with these cases, the underlying problems and the effects of HBO are discussed. SUMMARIZING: The authors conclude, that HBO primary clinical application in treatment of problematic wound healing in head and neck appears to be very effective and helpful and should not be underrated whilst discussing this therapy in different contexts.

Análisis de la atención intrahospitalaria del servicio de otorrinolaringología del Hospital Guillermo Grant Benavente de Concepción 1993-1997 / Analysis of intrahospitalary care at the otolaryngology departament of Guillermo Grant Benavente hospital, Concepción 1993-1997

Presentamos una análisis estadístico de los egresos e intervenciones quirúrgicas realizadas en el servicio de otorrinolaringología del Hospital Guillermo Grant Benavente de Concepción en el período 1993-1997. Se estudia un total de 8.275 egresos y 9.607 cirugías y/o procedimientos, analizando las características de los pacientes, patologías e intervenciones más frecuentes

Blood transfusion requirements in otolaryngology--head and neck surgery.

BACKGROUND: Blood requirements for Head and Neck surgical procedures have not been studied carefully. In order to set up an autotransfusion program, the blood loss and transfusion requirements should be known precisely. METHODS: The blood bank database was used to determine which Head and Neck procedures required blood transfusion during the previous 5 years. A list of 10 transfusion-associated operations was established, the records of all patients who underwent these procedures during a 5-year period were reviewed, and average the blood loss and number of units transfused determined. RESULTS: All procedures were for cancer resection. The operations were classified in 3 groups according to their transfusion probability: high (> 80%), low (< 5%) and moderate. For the moderate transfusion group, age, preoperative hemoglobin, and past medical history of cardiac and pulmonary disease were associated with higher incidence of transfusion. An average delay of 3 weeks was found between the diagnosis and the actual surgery. CONCLUSION: The transfusion requirements of Head and Neck surgical procedures could be safely met by an autotransfusion protocol, given the average delay of 3 weeks between diagnosis and surgery.

[Techniques of local anesthesia in the area of the head]. / Techniken der Lokalanästhesie im Gesichtsbereich.

In the head and neck region, many procedures can be performed under local anesthesia. The anesthetic agent can be applied onto the surface of the skin or mucosa (surface anesthesia), it can be infiltrated into the tissue to be treated, or it can be used to block the regional sensory nerve (conduction anesthesia). In this paper, the most important techniques for local anesthesia of the face are presented as a short clinical guide.

[Ultracaine anesthesia in surgical otorhinolaryngology]. / Anesteziia ul'trakainom v khirurgicheskoi otorinolaringologii.

The results of ultracaine trial are available for 136 patients with ENT diseases. This new drug for local anesthesia proved effective, safe, nontoxic and, therefore, is recommended for wide use in ENT surgery.

[Local anesthesia in operations of the head-neck area]. / Lokalanästhesie bei Operationen im Kopf-Hals-Bereich.

BACKGROUND: Many operations in the head and neck area can be performed under local anesthesia. However, the use of local anesthesia does not automatically reduce the risk for the patient undergoing surgery. RESULTS: In the present paper, the authors discuss local anesthetics used in surgical procedures in the head and neck region. Aminoesters are currently the most commonly used local anesthetics. Local anesthetics vary with respect to the onset and duration of the local anesthetic effect. The choice of local anesthetic depends on the estimated duration of the surgical procedure. Possible side effects of these substances may affect the central nervous as well as the cardiovascular system. Certain changes in serum electrolytes (i.e., hyperkalemia) as well as hypoxia and hypercapnia significantly increase the cardiotoxic potential of local anesthetics. Different vasoconstrictor agents are used in addition to local anesthetics to prolong the duration of the local anesthetic effect and to provide the surgeon with a nearly bloodless field. The two groups of vasoconstrictors used in these days are catecholamines (epinephrine) and vasopressin analogs. Systemic side effects of catecholamines include cardiovascular reaction, mainly in patients with typical risk factors (i.e., coronary heart disease, high blood pressure, or chronic heart failure). Vasopressin analogs produce fewer side effects than epinephrine. Even so, an overdose of these vasoconstrictors might still result in severe cardiac complications. The recommended maximum doses of these drugs should be strictly observed. CONCLUSIONS: For several reasons, local anesthesia has become popular for a variety of surgical procedures in the head and neck in recent years. Even though the use of local anesthetics and vasoconstrictors in head and neck procedures has its advantages for both the patient and the surgeon, the limitations for the use of these drugs must always be taken into consideration.

Incentive spirometry for tracheostomy and laryngectomy patients.

Sustained maximal inspiration (incentive spirometry) is used for the prevention and management of atelectasis in major abdominal and thoracic surgery. Patients with head and neck surgery are predisposed to postoperative disturbances in lung function after extensive surgical resection, immobilization, or significant chest wall deformity from various reconstructive procedures. The patient often requires tracheostomy or permanent laryngeal stoma. A prospective clinical study on patients with major head and neck surgery was conducted to evaluate the use of incentive spirometry to improve postoperative lung function. An adaptor was first designed to allow patients with tracheostomy tubes to use the spirometers. Parameters studied include vital signs, arterial blood gases (A-a gradient), and pulmonary function test. Significant improvement of lung function and lack of complication warrant the use of incentive spirometry in postoperative head and neck surgery patients.

[ORL surgery in Albucasis's treatise on surgery. A vision of cervicofacial surgical therapeutics in the year 1000]. / La chirurgie orl dans le traité de chirurgie d'Albucasis. Une vision de la thérapeutique chirurgicale cervico-faciale en l'an mille.

The work of the famous Arab doctor, Albucasis, is not well known to head and neck surgeons. However, the thirtieth time of his treatise on medicine is essentially a surgical textbook and includes many. Facts concerning otorhinolaryngology. Albucasis's complete work is an exhaustive compilation of late tenth century medical knowhow which ensured the link between ancient medicine, essentially of Greek origin, and modern western medicine. The important work of Jewish and Arab physicians in the early and late Middle Ages was necessary for the transmission of knowledge from the ancient near last to the modern western world. Among Albucasis's descriptions of surgical techniques, tonsillectomy and trachestomy are particularly interesting. In order to accurately formulate indications for surgery, Albucasis endeavors to present the signs and symptoms of pathological conditions requiring surgical treatment. Finally, Albucasis reveals himself to be a humanist, as well as a physician and surgeon.

Efficacy of preadmission testing in ambulatory surgical patients.

A retrospective study was done with 325 patients who had preadmission testing prior to ambulatory surgery. At least one laboratory abnormality was noted in 84% of the patients. The serial multiple analysis (SMA)-7 was abnormal 63% of the time. Abnormalities were seen in 54% of the SMA-12 panels and 38% of the urinalyses performed. Twenty-four percent of the patients treated had an abnormal electrocardiogram (ECG). An abnormal chest roentgenogram was found in 19% of the patients. Only three (1%) patients potentially benefited from preadmission testing. Ninety-six percent of the abnormal laboratory results were ignored by the attending physicians. Therefore, we conclude that preadmission testing should be done on a selective basis. Patients older than 50 years of age should have an ECG. A hematocrit should be obtained only if major blood loss is anticipated. All other tests should be ordered based on the history and physical examination.

Local anesthesia of the head and neck.

In theory, most ear, nose, and throat surgery involving the soft tissues of the head and neck may be performed under local anesthesia. This includes surgery on the middle ear, even mastoidectomy; partial or total laryngectomies; surgery on the nose and paranasal sinuses; and surgery on the major salivary glands. For this purpose, local anesthetics, with or without epinephrine, are administered either by infiltration injection or by topical application. The selection of either local or general anesthesia for a surgical procedure will depend on many important factors, not the least of which is the preference of the patient. This paper presents factors to be considered in making this choice, as well as surgical indications and contraindications to the use of local anesthesia.

Lasers in otolaryngology.

Otolaryngology has employed laser technology since the early 1970s for treatment of the ear, nasal and nasopharyngeal cavities, vocal cords, tongue, and oral mucosa. Perioperative nursing responsibilities center on preoperative education, intraoperative support, monitoring of a safe laser environment, and postoperative discharge management.

[Midazolam in ORL endoscopy in adults]. / Le midazolam dans les endoscopies ORL de l'adulte.

A prospective study was carried out in 20 selected subjects undergoing ENT endoscopy, with spontaneous ventilation of room air after premedication with midazolam IM 1.5 kg-10 [corrected] and then sedation with 0.07 mg.kg-1 IV and dextromoramide 0.03 mg.kg-1 IV and local anesthesia. The procedure was satisfactorily completed in the 20 cases; alertness was preserved in the 20 cases; total amnesia for the procedure was obtained in 19 cases. There were significant alterations in systolic blood pressure, heart rate and respiratory rate but these remained within strictly physiological limits. Blood gas results were similarly affected but at the limit of normal in 6 cases after 30 minutes of the procedure. Cardiovascular tolerance was excellent but close surveillance of the sedative effects on ventilation was required. Provided these conditions are respected, midazolam would appear to be of particular interest in ENT endoscopy.

[Plasma concentrations of lidocaine and prilocaine following infiltration anesthesia in otorhinolaryngologic surgery]. / Plasmakonzentrationen von Lidocain und Prilocain nach Infiltrationsanästhesien bei Operationen im Hals-Nasen-Ohren-Bereich.

UNLABELLED: Infiltration anaesthesia is still relevant for the surgical treatment of patients in otorhinolaryngology. The injection of local anaesthetics in well vascularised areas constantly causes the danger of high plasma concentrations of local anaesthetics combined with undesirable side effects. In our study we tried to determine the development of plasma concentrations of local anaesthetics in patients scheduled for routine tonsillectomies and tympanoplasty. MATERIALS AND METHODS: In 45 patients the development of plasma concentrations was measured immediately after the injection at short intervals; the samples were obtained between 1 minute and 60 minutes after the first injection. Group 1: Lidocaine 0.5% with epinephrine (1:200,000) 15-20 ml for tonsillectomy (n = 18). Group 2: Lidocaine 0.5% with epinephrine (1:200,000) 8-15 ml for tympanoplasty (n = 15). Group 3: Prilocaine 1% with epinephrine (1:200,000) 8-15 ml for tympanoplasty (n = 15). For tactical reasons infiltration anaesthesia for the patients of group 2 was - in addition to general anaesthesia - applied by the otorhinolaryngologist, whereas the patients of groups 1 and 3 were operated exclusively under local anaesthesia. RESULTS: Within the first minute after the initial injection plasma concentrations of the local anesthetic increased close to toxic threshold levels that are associated with undesirable systemic side effects. In the patients of group 1, who underwent tonsillectomy, plasma concentrations of 4-7 micrograms/ml were found during the first minute. The highest average values always appeared within the first five minutes: group 1 2.07 micrograms/ml, group 2: 0.45 micrograms/ml, and group 3: 1.15 micrograms/ml. DISCUSSION: With infiltration anaesthesia in well vascularised areas it may happen that there are--mainly in the early stage--high plasma concentrations of the applied substances, although the total dose was below the known maximum. Despite careful technique (repeated aspiration test in two levels) at least partial intravascular injections are apparently not always avoidable according to the pharmacokinetic data. Our results demonstrate that in addition to a safe peripheral venous line and prophylactic oxygen therapy, intraoperative monitoring of blood pressure, heart rate, electrocardiogram and verbal patient monitoring is of advantage in this group of patients. In our opinion the "standby function" of an anaesthesiologist can avoid severe complications.