Increased Incidence of Ulcerative Laryngitis During Spring 2022 Omicron-Variant Wave of COVID19.

OBJECTIVES: Ulcerative laryngitis is a distinctive condition which typically follows illness with severe cough, and is characterized by dysphonia, ulcerative lesions of the vocal folds, and a prolonged clinical course. We present four patients with ulcerative laryngitis who presented in close succession amid the surge in omicron-variant COVID19 cases. STUDY DESIGN: Retrospective review. METHODS: Patient records for patients with ulcerative laryngitis from April and May 2022 were reviewed and compared with patients who presented with the same diagnosis from January 2017 through March 2022. Incidence, patient demographics, occupation, vaccination status, disease history, and treatment were obtained and compared. RESULTS: Four patients presented with ulcerative laryngitis over six weeks. Compared to the previous 4 years, this represented an eight-fold increase in monthly incidence. Average time from symptom onset to presentation was 15 days. All patients presented with dysphonia, with an average VHI10 of 23 and SVHI10 of 28. Two patients were COVID positive, one negative, and one had unknown COVID status. Three patients were fully vaccinated while one patient had only received one dose. Treatments included voice rest, steroids, antibiotics, antireflux medicine, and cough suppressants. Clinical course tended to be shorter and outcomes similar to the comparison group. CONCLUSION: The incidence of ulcerative laryngitis appeared to increase markedly with the prevalence of omicron-variant COVID19. Potential explanations include the apparent upper airway focus of omicron infection in contrast with prior variants and/or change in COVID19 infection characteristics in a vaccinated population.

Is Office Laryngoscopy an Aerosol-Generating Procedure?

OBJECTIVES/HYPOTHESIS: The aims of this work were 1) to investigate whether office laryngoscopy is an aerosol-generating procedure with an optical particle sizer (OPS) during clinical simulation on healthy volunteers, and 2) to critically discuss methods for assessment of aerosolizing potentials in invasive interventions. STUDY DESIGN: Prospective quantification of aerosol and droplet generation during clinical simulation of rigid and flexible laryngoscopy. METHODS: Two healthy volunteers were recruited to undergo both flexible and rigid laryngoscopy. An OPS was used to quantify aerosols and droplets generated for four positive controls relative to ambient particles (speech, breathing, /e/ phonation, and /ae/ phonation) and for five test interventions relative to breathing and phonation (flexible laryngoscopy, flexible laryngoscopy with humming, flexible laryngoscopy with /e/ phonation, rigid laryngoscopy, and rigid laryngoscopy with /ae/ phonation). Particle counts in mean diameter size range from 0.3 to >10 µm were measured with OPS placed at 12 cm from the subject's nose/mouth. RESULTS: None of the laryngoscopy interventions (n = 10 each) generated aerosols above that produced by breathing or phonation. Breathing (n = 40, 1-3 µm, P = .016) and /ae/ phonation (n = 10, 1-3 µm, P = .022; 3-5 µm. P = .083; >5 µm, P = .012) were statistically significant producers of aerosols and droplets. Neither speech nor /e/ phonation (n = 10 each) were associated with statistically significant aerosols and droplet generation. CONCLUSIONS: Using OPS to detect droplets and aerosols, we found that office laryngoscopy is likely not an aerosol-generating procedure. Despite its prior use in otolaryngological literature, an OPS has intrinsic limitations. Our study should be complemented with more sophisticated methods of droplet distribution measurement. LEVEL OF EVIDENCE: 3 Laryngoscope, 130:2637-2642, 2020.

Establishing an Office-Based Framework for Resuming Otolaryngology Care in Academic Practice During the COVID-19 Pandemic.

OBJECTIVE: The COVID-19 health crisis abruptly disrupted the practice of otolaryngology. This article aims to define the changes needed to operate an academic otolaryngology practice safely and efficiently from within the epicenter of the pandemic. We define the areas of normal patient workflow that have been affected by COVID-19, and we offer mitigation strategies with attention paid to the specific needs of subspecialties. DATA SOURCES: The article includes data specific to the office practice metrics of the Weill Cornell Medicine Department of Otolaryngology-Head and Neck Surgery, as well as publically available data from New York Presbyterian Hospital system and the New York Times. REVIEW METHODS: Expert opinion. CONCLUSIONS: Through careful planning and execution, it is possible to reestablish safe otolaryngologic patient care during the COVID-19 pandemic. It will require a significant change from prior practice models for successful implementation. Additionally, telemedicine can be positively integrated into the treatment of otolaryngology diseases for new and established patients. IMPLICATIONS FOR PRACTICE: The information conveyed in this review can be used as a guide by large and small otolaryngology groups to identify aspects of the patient visit that are "at risk" due to COVID-19, and it suggests sensible responses that can be made without a significant disruption to normal practice. The methods used to identify vulnerabilities with the patient visit process can be applied to future unforeseen crises, such as a resurgence of COVID-19 or a novel pandemic.

Flexible Laryngoscopy and COVID-19.

Flexible laryngoscopy, the gold-standard evaluation of the larynx and the pharynx, is one of the most commonly performed procedures in otolaryngology. During the coronavirus disease 2019 (COVID-19) pandemic, flexible laryngoscopy represents a risk for patients and an occupational hazard for otolaryngologists and any clinic staff involved with the procedure or endoscope reprocessing. Here we present a set of recommendations on flexible laryngoscopy performance during the pandemic, including patient selection, personal protective equipment, and endoscope disinfection, based on a consensus reached during a virtual webinar on March 24, 2020, attended by approximately 300 participants from the American laryngology community.