Hyperosmia after COVID-19: hedonic perception or hypersensitivity?

OBJECTIVE: COVID-19 has been associated with a wide range of quantitative and qualitative disorders of smell, including hyposmia/anosmia, parosmia, and phantosmia; however, no reports to date have reported hyperosmia as a sequela of SARS-CoV-2 infection. PATIENTS AND METHODS: We present two cases of subjective hyperosmia in a South Tyrolean Alps family, occurring within days after recovery from SARS-CoV-2 infection with transient anosmia. RESULTS: The subjects, a mother and son, exhibited subjective hyperosmia despite normal objective olfactory testing. During independent assessments, the severity of hyperosmia and specific odors affected were highly correlated, consistent with shared genetic and environmental factors. In contrast, two other family members with COVID-19 had no perceptual distortion and normal recovery of smell. CONCLUSIONS: Subjective hyperosmia after COVID-19 infection exhibited striking similarity in two affected family members, suggesting interaction of environment, genetics, and perception.

Multidisciplinary tracheostomy teams: Transforming care and preventing harm amid the pandemic

Session Description: A landmark study found that in intensive care units (ICUs), tracheostomy incidents accounted for up to half of all airway-related deaths and hypoxic brain damage. Multidisciplinary adult and pediatric tracheostomy teams have achieved dramatic reductions in adverse events and improved patient outcomes, but dissemination of highly reliable practices has lagged. This panel addresses this gap by providing a strategy for rapid performance improvement with specific building blocks for enhancing care. Five key drivers-multidisciplinary ward rounds, standardized protocols, interdisciplinary education and staff allocation, patient and family involvement, and using data to drive improvement-can result in transformative change. We present data from 4 institutions, providing turnkey solutions and lessons learned from the creation of teams. We cover from the index procedure to decannulation and discharge, discussing obstacles encountered and how they are overcome. After presenting institution-level experience, we report on the largest implementation of these principles to date, drawing on prospectively captured patient-level global data from nearly 10,000 cases. We take a deep dive into a 3-year-long, 20-hospitalwide multipronged implementation that involved mixedmethods analysis, data tracking, and benchmarking to demonstrate powerful, statistically significant effects of reducing hospital and ICU length of stay, ventilator duration, time to cuff deflation, time to first vocalization, time to first oral intake, prevalence of anxiety and depression, and cost savings, projected at >$15,000 per patient. While heterogeneity is a defining feature of tracheostomy, we demonstrate how across age and geographies, multidisciplinary teams are a game changer in tracheostomy care. In addition, the imperatives of the COVID-19 pandemic have necessitated additional measures in relation to aerosol-generating procedures. We curate salient data and present practical evidence-based recommendations. Outcome Objectives: (1) Present building blocks and discuss obstacles to creating a multidisciplinary tracheostomy care team. (2) Leverage data-science and ongoing efforts to improve tracheostomy outcomes. (3) Compare the approaches of different hospital systems in the creation of tracheostomy care teams in the context of COVID-19.

Current controversies in otolaryngology: Do masks matter? A pro/con debate

Session Description: As practicing otolaryngologists, we must critically consume medical information. With the onset of the COVID-19 pandemic, the information surrounding safe and effective provision of care has been overwhelming in its volume and speed of change. In addition, there are political, social, and other pressures outside medicine that have led to challenges in understanding best practices. The concept for this panel grew out of an interesting debate that happened via the ENTConnect discussion board on the utility of mask usage in otolaryngology clinics. The overarching goal of this panel will be to expand that debate, with attendees hearing a balanced presentation and having time for questions. This panel discussion will start with an overview of general principles when assessing the literature. The majority of the panel will be a pro vs con debate surrounding the issue of face mask use during the pandemic and the ability of mask wearing to prevent the spread of the SARS-CoV-2 virus. The panelists will also consider how the vaccination efforts and related public health efforts inform this dialogue. The guidelines of the debate will be the respectful interchange of information with equal time being given to each side. Although mask wearing has been associated with many political, economic, and social issues, the primary focus of this panel will be limited to the medical literature. Outcome Objectives: (1) Improve the ability of attendees to be effective consumers of knowledge and critically assess information from various sources. (2) Apply historical and contemporary evidence on viral transmission to the current controversy around mask wearing. (3) Understand the role played by otolaryngologists in particular and physicians in general to the dissemination of public health messaging.

From E-Cig to Puff Bar: Otolaryngology and the vaping epidemic

Session Description: Every otolaryngologist should know about vaping. Vaping-related harm may include catastrophic lung injury, fatal accidental ingestion in children, explosion of combustible devices, accelerated nicotine addiction, and interaction with COVID-19 risk. Vaping amplifies disparities in use and addiction, mediated through social determinants of health. This panel reveals the evidence around vaping most relevant to practicing otolaryngologists trying to grasp this complex public health concern. We explain vaping epidemiology, sociological undercurrents and disparities, pathophysiology of vapingrelated disease, and what to do about it. We describe how JUUL's meteoric rise to dominance in the electronic cigarette (e-cigarette) space-growth rivaling that of Facebook-was catalyzed by social media, positioning as new technology, stealthy design, and alluring flavors. We probe the science of vaping from surgical wound healing to effects of inhaling formaldehyde, propylene glycol, heavy metals, and other vapors-risks magnified in unregulated cannabinoids. The experiences of individuals who survived vaping-related injury, from respiratory exacerbation to ventilator dependence, is testimony to the crisis. The session offers insights on vaping-related disease, persistent misconceptions, and social determinants of health. e-Cigarettes, a potential “off ramp” for adult smokers have evolved into a heavily trafficked “on ramp” for the next generation. We close with counseling pearls, advice for patients grappling with misinformation, and opportunities for our specialty to lead. Outcome Objectives: (1) Describe trends in electronic nicotine device use, interaction with social determinants of health, current slang used for these habits, and forthcoming inhaled tobacco technology. (2) Describe how sociological factors and biology interact in the pathogenesis of vaping-related respiratory injury and wound healing. (3) Discuss specific talking points for counseling patients and strategies for dispelling misconceptions around vaping-related disease.

New age mentoring: Navigating the uncharted with vision and equity

Session Description: This panel explores the changing face of mentorship and professional development amid technological disruption, virtual learning, and calls for racial justice. For individuals aspiring to a career in otolaryngology-head and neck surgery, mentorship can shape destiny. Mentorship helps assure safe passage into the specialty, and it influences the arc of professional development across the career continuum. Even before the novel coronavirus disease 2019 (COVID-19) pandemic, technology and social networking were transforming mentorship in otolaryngology. Now, in an increasingly virtual world, where in-person interactions are the exception, mentorship plays an even more pivotal role. Mentors serve as trusted guides, helping learners navigate accelerating trends toward early specialization, competencybased assessments, and key milestones. However, several structural barriers render the playing field unlevel. For medical students, cancellation of visiting clerkships, in-person rotations, and other face-to-face interactions may limit access to mentors. The pandemic and virtual landscape particularly threaten the already-leaky pipeline for underrepresented medical students. These challenges may persist into residency and later career stages, where structural inequities continue to subtly influence opportunities and pairings of mentors and mentees. Hence, overreliance on serendipitous encounters can exacerbate disparities, even amid societal mandates for equity. The decision to take deliberate steps toward mentoring outreach and engagement has profound implications for what otolaryngology will look like in years to come. This session introduces the concept of new age mentoring, shining a light on how to modernize practices. The key shifts are from passive to active engagement, from amorphous to structured relationships, and from hierarchical dynamics to bidirectional mentoring. Success is predicated on intentional outreach and purposefulness in championing diversity, equity, and inclusion within the progressively technology-driven landscape. Outcome Objectives: (1) Understand the potential barriers to mentorship and professional development, encompassing challenges of work-life balance, limited access to mentors of diverse backgrounds, and structural factors. (2) Identify how new mentoring paradigms surmount traditional barriers through providing structured mentoring frameworks, embracing the vision of the mentee, and allowing for reverse mentoring. (3) Describe multifaceted interventions that promote inclusivity in a virtual mentoring landscape, including leveraging social media platforms, local and national forums, and networking resources.

Practice of tracheostomy in patients with acute respiratory failure related to COVID-19 - Insights from the PRoVENT-COVID study.

OBJECTIVE: Invasively ventilated patients with acute respiratory failure related to coronavirus disease 2019 (COVID-19) potentially benefit from tracheostomy. The aim of this study was to determine the practice of tracheostomy during the first wave of the pandemic in 2020 in the Netherlands, to ascertain whether timing of tracheostomy had an association with outcome, and to identify factors that had an association with timing. METHODS: Secondary analysis of the 'PRactice of VENTilation in COVID-19' (PRoVENT-COVID) study, a multicenter observational study, conducted from March 1, 2020 through June 1, 2020 in 22 Dutch intensive care units (ICU) in the Netherlands. The primary endpoint was the proportion of patients receiving tracheostomy; secondary endpoints were timing of tracheostomy, duration of ventilation, length of stay in ICU and hospital, mortality, and factors associated with timing. RESULTS: Of 1023 patients, 189 patients (18.5%) received a tracheostomy at median 21 [17 to 28] days from start of ventilation. Timing was similar before and after online publication of an amendment to the Dutch national guidelines on tracheostomy focusing on COVID-19 patients (21 [17-28] vs. 21 [17-26] days). Tracheostomy performed ≤ 21 days was independently associated with shorter duration of ventilation (median 26 [21 to 32] vs. 40 [34 to 47] days) and higher mortality in ICU (22.1% vs. 10.2%), hospital (26.1% vs. 11.9%) and at day 90 (27.6% vs. 14.6%). There were no patient demographics or ventilation characteristics that had an association with timing of tracheostomy. CONCLUSIONS: Tracheostomy was performed late in COVID-19 patients during the first wave of the pandemic in the Netherlands and timing of tracheostomy possibly had an association with outcome. However, prospective studies are needed to further explore these associations. It remains unknown which factors influenced timing of tracheostomy in COVID-19 patients.

Randomized clinical trial "olfactory dysfunction after COVID-19: olfactory rehabilitation therapy vs. intervention treatment with Palmitoylethanolamide and Luteolin": preliminary results.

OBJECTIVE: Approximately 30% of patients with confirmed COVID-19 report persistent smell or taste disorders as long-term sequalae of infection. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is associated with inflammatory changes to the olfactory bulb, and treatments with anti-inflammatory properties are hypothesized to attenuate viral injury and promote recovery of olfaction after infection. Our study investigated the efficacy of a supplement with Palmitoylethanolamide (PEA) and Luteolin to support recovery of olfaction in COVID-19 patients. PATIENTS AND METHODS: We conducted a randomized-controlled pilot study in outpatients with history of confirmed COVID-19 with post-infection olfactory impairment that persisted ≥ 90 days after SARS-CoV-2 negative testing. Patients were randomized to two times a day olfactory rehabilitation alone or weekly olfactory rehabilitation plus daily oral supplement with PEA and Luteolin. Subjects with preexisting olfactory disorders were excluded. Sniffin' Sticks assessments were performed at baseline and 30 days after treatment.  Data on gender, age, and time since infection were collected. Kruskal-Wallis (KW) test was used to compare variances of Sniff scores between groups over time, and Spearman's correlation coefficients were calculated to assess for correlations between Sniff Score and gender or duration of infection. RESULTS: Among 12 patients enrolled (n=7, supplement; n=5, controls), patients receiving supplement had greater improvement in olfactory threshold, discrimination, and identification score versus controls (p=0.01). Time since infection was negatively correlated with Sniff Score, and there was no correlation between gender. CONCLUSIONS: Treatment combining olfactory rehabilitation with oral supplementation with PEA and Luteolin was associated with improved recovery of olfactory function, most marked in those patients with longstanding olfactory dysfunction. Further studies are necessary to replicate these findings and to determine whether early intervention including olfactory rehabilitation and PEA+Luteolin oral supplement might prevent SARS-CoV-2 associated olfactory impairment.