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.

Sinus and Anterior Skull Base Surgery during the COVID-19 pandemic: Systematic review, Synthesis and YO-IFOS position. (preprint)

Purpose: The COVID-19 pandemic has caused significant confusion about healthcare providers and patients pandemic-specific risks related to surgery. The aim of this systematic review is to summarize recommendations for sinus and anterior skull base surgery during the COVID-19 pandemic. Methods: PubMed/MEDLINE, Google Scholar, Scopus and Embase were searched by two independent otolaryngologists from the Young Otolaryngologists of IFOS (YO-IFOS) for studies dealing with sinus and skull base surgery during COVID-19 pandemic. The review also included unpublished guidelines edited by Otolaryngology-Head and Neck Surgery or Neurosurgery societies. Perioperative factors were investigated including surgical indications, preoperative testing of patients, practical management in operating rooms, technical aspects of surgery and postoperative management. The literature review was performed according to PRISMA guidelines. The criteria for considering studies or guidelines for the review were based on the population, intervention, comparison, outcome, timing and setting (PICOTS) framework. Results: 15 international publications met inclusion criteria. Five references were guidelines from national societies. All guidelines recommended postponing elective surgeries. An algorithm is proposed that classifies endonasal surgical procedures into three groups based on the risk of postponing surgery. Patients COVID-19 status should be preoperatively assessed. Highest level of personal protective equipment (PPE) is recommended, and the use of high-speed powered devices should be avoided. Face-to-face postoperative visits must be limited. Conclusions: Sinus and skull base surgeries are high-risk procedures due to potential aerosolization of SARS-CoV-2 virus. Protection of health care workers by decreasing exposure and optimizing use of PPE is essential with sinus and anterior skull base surgery.

Systematic review of international guidelines for tracheostomy in COVID-19 patients. (preprint)

At this moment, the world leaves under the SARS-CoV-2 outbreak pandemic. As Otolaryngologists - Head & Neck Surgeons, we need to perform and participate in examinations and procedures within the head and neck region and airway that are at particularly high risk of exposure and infection because of aerosol and droplet contamination. One of those surgical procedures on demand at this moment is tracheostomy, due the increasing admission in ICU departments and the increased need of ventilatory support secondary to respiratory distress syndrome. This review of international guidelines for tracheostomy in COVID-19 infected patients, aiming to summarize in a systematic way the available recommendations from 18 guidelines from all over the world.