Post-intubation Laryngeal Disorders in COVID-19 Patients: A Prospective Study. (preprint)

Objective: To investigate post-intubation laryngeal complications in severe COVID-19 patients. Methods: From September 2020 to April 2021, consecutive patients presenting with laryngological symptoms following severe COVID-19 infection and related intubation were included. Demographic, age, gender, comorbidities, symptoms, intubation duration, tracheostomy features, and laryngeal findings were collected. Videolaryngostroboscopy findings were analyzed by two senior laryngologists in a blind manner. Results: Forty-three patients completed the evaluations. The intubation duration was <14 days in 22 patients (group 1) and >14 days in 21 patients (group 2). The following abnormalities were found on an average post-intubation time of 51.6 days: posterior glottic stenosis (N=14), posterior commissure hypertrophy (N=19) or laryngeal diffuse edema (N=10), granuloma (N=8), laryngeal necrosis (N=2), vocal fold atrophy (N=2), subglottic stenosis (N=1) and glottic flange (N=1). Sixteen patients required surgical treatment (N=17 procedures). The number of intubation days was significantly higher in patients with posterior glottic stenosis (26.1 ± 9.4) compared with those presenting posterior commissure hypertrophy (11.5 ± 2.9) or granuloma (15.1 ± 5.8; p<0.001). Fourteen patients required surgical management. Conclusion: Prolonged intubation used in severe COVID-19 patients is associated with significant laryngeal disorders. Patients with a history of >2-week intubation have a higher risk of posterior glottic stenosis.

Post-intubation Laryngeal Disorders in COVID-19 Patients: A Prospective Study. (preprint)

Objective: To investigate post-intubation laryngeal complications in severe COVID-19 patients. Methods: From September 2020 to April 2021, consecutive patients presenting with laryngological symptoms following severe COVID-19 infection and related intubation were included. Demographic, age, gender, comorbidities, symptoms, intubation duration, tracheostomy features, and laryngeal findings were collected. Videolaryngostroboscopy findings were analyzed by two senior laryngologists in a blind manner. Results: Forty-three patients completed the evaluations. The intubation duration was <14 days in 22 patients (group 1) and >14 days in 21 patients (group 2). The following abnormalities were found on an average post-intubation time of 51.6 days: posterior glottic stenosis (N=14), posterior commissure hypertrophy (N=19) or laryngeal diffuse edema (N=10), granuloma (N=8), laryngeal necrosis (N=2), vocal fold atrophy (N=2), subglottic stenosis (N=1) and glottic flange (N=1). Sixteen patients required surgical treatment (N=17 procedures). The number of intubation days was significantly higher in patients with posterior glottic stenosis (26.1 ± 9.4) compared with those presenting posterior commissure hypertrophy (11.5 ± 2.9) or granuloma (15.1 ± 5.8; p<0.001). Fourteen patients required surgical management. Conclusion: Prolonged intubation used in severe COVID-19 patients is associated with significant laryngeal disorders. Patients with a history of >2-week intubation have a higher risk of posterior glottic stenosis.

Effectiveness and safety of PRP on persistent olfactory dysfunction related to COVID-19: towards a new therapeutic hope (preprint)

Introduction and aim Olfactory dysfunction (OD) is a prevalent symptom of coronavirus disease 2019 (COVID-19), accounting for 48 to 85% of patients. In 1 to 10% of cases, patients develop a chronic olfactory dysfunction (COD) lasting more than 6 months. Recently, platelet-rich plasma (PRP) was used in patients with non-COVID-19 COD and authors reported encouraging results. In the present study, we investigated the usefulness and safety of PRP injection in 56 patients with COVID-19 COD. Material and methods 56 adult patients with COVID-19 COD were prospectively recruited from CHU Saint-Pierre. Participants underwent olfactory function testing by means of the Sniffin Sticks Test battery (Medisense, Groningen, Netherlands), resulting in the Threshold Discrimination Identification TDI score, at baseline and 1 month post-injection. PRP injections were performed in each olfactory cleft via nasal endoscopy and under local anesthesia by the same physician (YS), following the protocol of Yan et al. (GS30-PURE II Protocol A: Emcyte, Ft Myers, Florida).1 Olfactory outcome from patients who had PRP injection were compared to a control group made of patient with COVID-19 COD treated with nasal irrigation during a month. Results 36 patients received a PRP injection. Among those, 6 were lost to follow-up and therefore excluded. The control group, matched for age, gender and TDI score at baseline, included 26 patients. Both groups were comparable regarding demographics, duration of OD, and TDI scores. At 1-month post-PRP injection, the mean TDI score significantly improved by 6.7 points in the PRP group (p

Appropriateness for SARS-CoV-2 Vaccination for Otolaryngologist and Head and Neck Surgeons in case of Pregnancy, Breastfeeding or Childbearing potential: YO-IFOS and CEORL-HNS joint clinical consensus statement (preprint)

Purpose: SARS-CoV-2 vaccines are a key step in fighting the pandemic. Nevertheless, their rapid development did not allow for testing among specific population subgroups such as pregnant and breastfeeding women, or elaborating specific guidelines for healthcare personnel working in high infection risk specialties, such as otolaryngology (ORL). This clinical consensus statement (CCS) aims to offer guidance for SARS-CoV-2 vaccination to this high-risk population based on the best evidence available. Methods: : A multidisciplinary international panel of 33 specialists judged statements through a 2-rounds modified Delphi method survey. Statements were designed to encompass the following topics: risk of SARS-Cov-2 infection and use of protective equipment in ORL; SARS-Cov-2 infection and vaccines and respective risks for the mother/child dyad; and counseling for SARS-CoV-2 vaccination in pregnant, breastfeeding, or fertile healthcare workers (PBFHW). All ORL PBFHW were considered as the target audience. Results: : Of the 13 statements, 7 reached consensus or strong consensus, 2 reached noConsensus and 2 reached near-consensus. According to the statements with strong consensus Otorhinolaryngologists – Head & Neck Surgeons who are pregnant, breastfeeding or with childbearing potential should have the opportunity to receive SARS-Cov-2 vaccination. Moreover, personal protective equipment (PPE) should still be used even after the vaccination. Conclusion: Until prospective evaluations on these topics are available, ORL-HNS must be considered a high infection risk specialty. While the use of PPE remains pivotal, ORL PBFHW should be allowed access to SARS-CoV-2 vaccination provided they receive up-to-date information.

Prevalence and Recovery of Olfactory Dysfunction in 1,363 patients with coronavirus disease 2019: A Multicenter Longitudinal Study. (preprint)

Olfactory dysfunction (OD) is a key symptom of coronavirus disease 2019 (COVID-19). Currently, a few data are available about the recovery of OD after the infection resolution. In this study, we investigated both prevalence and recovery rate of OD with subjective and objective clinical tools in 2,581 patients. First, our data showed that the prevalence of OD was significantly higher in mild form (85.9%) compared with moderate-to-critical forms (4.5-9.7%; p=0.001). Second, focusing on patients with OD who completed the 2-month follow-up period (N=1,363), we observed that 328 patients (24.1%) did not subjectively recover olfaction 60 days after the onset of the dysfunction. The mean duration of self-reported OD was 21.6±17.9 days. Third, the objective olfactory evaluations performed on a subset of patients (N=233) reported hyposmia or anosmia in 54.7% and 36.6% of mild and moderate-to-critical forms, respectively (p=0.001). At the end of follow-up, 15.3% of anosmic/hyposmic patients did not objectively recover olfaction. The higher baseline severity of objective olfactory evaluations was strongly predictive of persistent OD (p<0.001). OD disappeared in 75% to 85% of patients regarding self-reported or objective olfactory evaluations.

Objective olfactory testing in patients presenting with sudden onset olfactory dysfunction as the first manifestation of confirmed COVID-19 infection (preprint)

Abstract Background: The aims of this study are to investigate the COVID-19 status of patients with initial sudden olfactory anosmia (ISOA) using nasopharyngeal swabs for RT-PCR analysis and to explore their olfactory dysfunctions with psychophysical olfactory evaluation. Methodology: This prospective study included 78 ISOA patients who fulfilled a patient-reported outcome questionnaire and underwent a nasopharyngeal swabs. Among these, 46 patients performed psychophysical olfactory evaluation using sniffing tests. Based on the duration of the ISOA, two groups of patients were compared: patients with anosmia duration [≤]12 days (group 1) and those with duration >12 days (group 2). Results: Among group 1, 42 patients (87.5%) had a positive viral load regarding RT-PCR while 6 patients (12.5%) were negative. In group 2, 7 patients (23%) had a positive viral load and 23 patients (77%) were negative. Among the 46 patients having performed a psychophysical olfactory evaluation, we observed anosmia in 52% (N=24), hyposmia in 24% (N=11) and normosmia in 24% (N=11) of patients. The viral load significantly decreased throughout the 14-days following the onset of the olfactory disorder. Conclusions: Our results support that a high proportion of ISOA patients are Covid+. Our study supports the need to add anosmia to the list of symptoms used in screening tools for possible COVID-19 infection.