Nasal Irrigation to Prevent and Treat Viral Upper Respiratory Tract Infections During the COVID-19 Pandemic

Introduction: Nasal irrigation is a common treatment used for symptomatic relief during a viral upper raspatory tract infection. It is currently unknown if the regular use of nasal rinses contributes to a reduction in viral load and transmissibility in patients with upper respiratory tract infections, including COVID-19. Method(s): A systematic review was completed in April 2022 with predefined search criteria using keywords related to nasal irrigation and viral illnesses. Common nasal solutions used for irrigation, including saline, corticosteroid and providineiodine were included. Databases included MEDLINE, Embase, Web of Science, Cochrane, ClinicalTrials.gov. Data related to the type of nasal rinse, virus studied, effects on symptoms, viral load, and transmission were gathered in a standardized data extraction tool. Result(s): Title and screening was performed for 1267 unique results, where 65 studies received full-text review and 12 were included in data extraction. Eight of these 12 studies looked specifically at COVID-19. Six out of 10 randomized controlled trials (RCTs) used saline, 3 used providine- iodine, and 1 used an intranasal corticosteroid. Eight out of 10 RCTs showed that nasal irrigation reduced upper respiratory tract symptoms. Three trials showed a reduction in viral load. Four studies demonstrated a reduction of viral load in the nasopharynx. Four studies reported data on side effects. The most common was mild nasal irritation. Study methods were heterogeneous. Data on transmission were reported in only 1 study. Conclusion(s): Nasal irrigation is well tolerated in patients with viral upper respiratory tract infections with minimal risk. The data for nasal rinses for the prevention and treatment of viral infection are limited, and there are conflicting results. Saline and providine-iodine rinses may have some efficacy in reducing viral titres. While nasal rinses appear to be beneficial in reducing nasal symptoms of an upper respiratory tract infection, a larger scale study is needed to identify if these rinses impact the viral load, illness severity, and transmissibility in patients with COVID-19.

The UK national registry of ENT surgeons with coronavirus disease 2019: one year on.

OBJECTIVES: To report the one-year findings of the UK national registry of ENT surgeons with suspected or confirmed coronavirus disease 2019, and the results of a survey on the coronavirus disease 2019 experience of UK ENT trainees. METHOD: An online registry was created in April 2020. A separate survey was circulated electronically to all members of the Association of Otolaryngologists in Training. RESULTS: The registry recorded 98 clinicians with confirmed or suspected coronavirus disease 2019. The majority of infections were reported in the first wave of spring 2020. Two ENT surgeons were hospitalised and one died. The majority suspected workplace exposure, with a significant proportion attributing this to a lack of personal protective equipment at a time before formal guidance had been introduced. Of the ENT trainees surveyed, almost one-third believed that they had contracted coronavirus disease 2019. CONCLUSION: This highlights the importance of ongoing risk-reduction measures, including optimal personal protective equipment and vaccination.

Revised recommendations from the CSO-HNS taskforce on performance of tracheotomy during the COVID-19 pandemic - what a difference a year makes.

BACKGROUND: During the early part of the COVID-19 pandemic, the Canadian Society of Otolaryngology - Head & Neck Surgery (CSO-HNS) task force published recommendations on performance of tracheotomy. Since then, our understanding of the virus has evolved with ongoing intensive research efforts. New literature has helped us better understand various aspects including patient outcomes and health care worker (HCW) risks associated with tracheotomy during the COVID-19 pandemic. Accordingly, the task force has re-evaluated and revised some of the previous recommendations. MAIN BODY: Based on recent evidence, a negative reverse transcription polymerase chain reaction (RT-PCR) COVID-19 swab status is no longer the main deciding factor in the timing of tracheotomy. Instead, tracheotomy may be considered as soon as COVID-19 swab positive patients are greater than 20 days beyond initial symptoms and 2 weeks of mechanical ventilation. Furthermore, both open and percutaneous surgical techniques may be considered with both techniques showing similar safety and outcome profiles. Additional recommendations with discussion of current evidence are presented. CONCLUSION: These revised recommendations apply new evidence in optimizing patient and health care system outcomes as well as minimizing risks of COVID-19 transmission during aerosol-generating tracheotomy procedures. As previously noted, additional evidence may lead to further evolution of these and other similar recommendations.

One year of COVID 19: Results of a national web-based survey on the SARS-CoV-2 infectious state of otorhinolaryngologists in Germany

Background Otorhinolaryngologists (ORL) are said to be at high risk due to a close professionally contact with the mucosa of the upper airway where SARS-CoV-2 can be detected to a high degree. Anyhow, only few data is available for German ORLs. Methods The German Society of ORL, Head and Neck Surgery and the German ENT Association addressed German ORLs to participate in a web-based survey about infection with SARS-CoV-2. Data of infections and concomitant parameters in German ORLs were compared to the total number of infections in Germany. An initial survey was launched May 2020 and a monthly follow-up survey was active until January 2021. Results 970 out of 6383 German ORLs (15%) participated in the initial survey and the June follow-up. Testing positive for SARS-CoV-2 until June 2020 was reported by 54 ORLs. The relative risk of contracting SARS-CoV-2 for ORLs is calculated as an OR of 3.67 (95% CI 2.82;4.79) compared to the total population of Germany. As treatment, 2 individuals were admitted to hospital without intensive care and domestic quarantine was conducted in 96.3% of cases. No casualties were reported. In 31 cases the source of infection was not identifiable whereas 23 had a clear etiology: infected patients: n = 5, 9.26% ;medical staff: n = 13, 24.1% . 9.26% (n = 5) of the identified cases were related to contact to infected family members (n = 3), closer neighborhood (n = 1) or general public (n = 1). There does not seem to be an increased risk of infection performing surgery. The follow-up data for 12 month of COVID-19 will be implemented in the presentation. Conclusion There is an almost 3.7-fold risk of contracting SARS-CoV-2 for German ORLs compared to the population baseline level. Appropriate protection appears to be necessary for this occupational group.

CSO (Canadian Society of Otolaryngology - Head & Neck Surgery) position paper on return to Otolaryngology - Head & Neck Surgery Clinic Practice during the COVID-19 pandemic in Canada.

The novel Coronavirus (COVID-19) has created a worldwide deadly pandemic that has become a major public health challenge. All semi-urgent and elective medical care has come to a halt to conserve capacity to care for patients during this pandemic. As the numbers of COVID-19 cases decrease across Canada, our healthcare system also began to reopen various facilities and medical offices. The aim for this document is to compile the current evidence and provide expert consensus on the safe return to clinic practice in Otolaryngology - Head & Neck Surgery. These recommendations will also summarize general precaution principles and practical tips for office across Canada to optimize patient and provider safety. Risk assessment and patient selection are crucial to minimizing exposure to COVID-19. Controversial topics such as COVID-19 mode of transmission, duration of exposure, personal protective equipment, and aerosol-generating procedures will be analyzed and discussed. Practical solutions of pre-visit office preparation, front office and examination room set-up, and check out procedures are explored. Specific considerations for audiology, pediatric population, and high risk AGMPs are also addressed. Given that the literature surrounding COVID-19 is rapidly evolving, these guidelines will serve to start our specialty back into practice over the next weeks to months and they may change as we learn more about this disease.

The UK national registry of ENT surgeons with coronavirus disease 2019.

BACKGROUND: ENT surgeons are likely to be at high risk of coronavirus disease 2019 exposure. METHODS: A national registry of UK ENT surgeons with suspected or confirmed coronavirus disease 2019 was created with the support of ENT UK. Voluntary entry was made by either the affected individual or a colleague, using a web-based platform. RESULTS: A four-month data collection period is reported, comprising 73 individuals. Coronavirus disease 2019 was test-confirmed in 35 respondents (47.9 per cent). There was a need for hospitalisation in two cases (2.7 per cent) and tragically one individual died. Symptom onset peaked in March. The majority suspected their exposure to have been in the workplace, with a significant proportion attributing their disease to a lack of personal protective equipment at a time before formal guidance had been introduced. CONCLUSION: The registry suggests that a significant number of ENT clinicians in the UK have contracted coronavirus disease 2019, and supports the need for tailored personal protective equipment guidance and service planning.

Patterns of smell recovery in 751 patients affected by the COVID-19 outbreak.

BACKGROUND AND PURPOSE: Post-viral olfactory dysfunction is well established and has been shown to be a key symptom of COVID-19 with more than 66% of European and US patients reporting some degree of loss of smell. Persistent olfactory dysfunction appears to be commonplace and will drive the demand for general practitioner, otolaryngology or neurology consultation in the next few months - evidence regarding recovery will be essential in counselling our patients. METHODS: This was a prospective survey-based data collection and telemedicine follow-up. RESULTS: In total, 751 patients completed the study, of whom 477 were females and 274 males. The mean age of the patients was 41 ± 13 years (range 18-60). There were 621 patients (83%) who subjectively reported a total loss of smell and 130 (17%) a partial loss. After a mean follow-up of 47 ± 7 days (range 30-71) from the first consultation, 277 (37%) patients still reported a persistent subjective loss of smell, 107 (14%) reported partial recovery and 367 (49%) reported complete recovery. The mean duration of the olfactory dysfunction was 10 ± 6 days (range 3-31) in those patients who completely recovered and 12 ± 8 days (range 7-35) in those patients who partially recovered. CONCLUSIONS: According to our results, at this relatively early point in the pandemic, subjective patterns of recovery of olfactory dysfunction in COVID-19 patients are valuable for our patients, for hypothesis generation and for treatment development.