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1.
Clin Infect Dis ; 2022 Apr 20.
Article in English | MEDLINE | ID: covidwho-1915535

ABSTRACT

In this study of 45 patients with COVID-19 undergoing tracheostomy, nasopharyngeal and tracheal cycle threshold (Ct) values were analyzed. Ct values rose to 37.9 by the time of tracheostomy and remained >35 postoperatively, demonstrating that persistent test positivity may not be associated with persistent transmissible virus in this population.

3.
Eur Arch Otorhinolaryngol ; 279(2): 1053-1062, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1303318

ABSTRACT

PURPOSE: To identify areas of critical otolaryngology contributions to inpatient care resistant to disruption by the COVID-19 pandemic. METHODS: Medical records of 614 otolaryngology consults seen between January and June of 2019 and 602 seen between January and June of 2020 were reviewed. Extracted data included patient demographics, SARS-CoV-2 status, medical comorbidities, consult location, consult category, reason for consult, procedures performed, and overall outcome. Prevalence of data items was compared using t tests and Chi-squared tests. RESULTS: The number of monthly consults to the otolaryngology service remained approximately stable after the onset of the COVID-19 pandemic. However, there was a substantial increase in ICU consults and a decrease in ER and floor consults. The proportion of otology, rhinology, and head and neck consults decreased while that of airway consults-most of which were tracheostomy-related-greatly increased. While the top ten reasons for consult remained essentially the same, they dramatically increased as a percentage of consults during COVID-19 (55-92%), whereas there was a dramatic decrease in the proportion of less frequent consults. CONCLUSION: The changes in otolaryngology consultation patterns seen after the onset of the pandemic are multifactorial, but may be attributed to novel pathologies, attitudes, and policies. Nonetheless, these patterns reveal that a set of core otolaryngologic issues, including acute airway issues, head and neck lesions, severe sinusitis and epistaxis, are essential and need to be addressed in the inpatient setting, whereas the significant drop in other consults suggests that they may be appropriately managed on an outpatient basis.


Subject(s)
COVID-19 , Otolaryngology , Humans , Inpatients , Pandemics , Referral and Consultation , SARS-CoV-2
4.
Laryngoscope ; 131(12): E2849-E2856, 2021 12.
Article in English | MEDLINE | ID: covidwho-1242750

ABSTRACT

OBJECTIVE: Report long-term tracheostomy outcomes in patients with COVID-19. STUDY DESIGN: Review of prospectively collected data. METHODS: Prospectively collected data were extracted for adults with COVID-19 undergoing percutaneous or open tracheostomy between April 4, 2020 and June 2, 2020 at a major medical center in New York City. The primary endpoint was weaning from mechanical ventilation. Secondary outcomes included sedation weaning, decannulation, and discharge. RESULTS: One hundred one patients underwent tracheostomy, including 48 percutaneous (48%) and 53 open (52%), after a median intubation time of 24 days (IQR 20, 31). The most common complication was minor bleeding (n = 18, 18%). The all-cause mortality rate was 15% and no deaths were attributable to the tracheostomy. Eighty-three patients (82%) were weaned off mechanical ventilation, 88 patients (87%) were weaned off sedation, and 72 patients (71%) were decannulated. Censored median times from tracheostomy to sedation and ventilator weaning were 8 (95% CI 6-11) and 18 (95% CI 14-22) days, respectively (uncensored: 7 and 15 days). Median time from tracheostomy to decannulation was 36 (95% CI 32-47) days (uncensored: 32 days). Of those decannulated, 82% were decannulated during their index admission. There were no differences in outcomes or complication rates between percutaneous and open tracheostomy. Likelihood of discharge from the ICU was inversely related to intubation time, though the clinical relevance of this was small (HR 0.97, 95% CI 0.943-0.998; P = .037). CONCLUSION: Tracheostomy by either percutaneous or open technique facilitated sedation and ventilator weaning in patients with COVID-19 after prolonged intubation. Additional study on the optimal timing of tracheostomy in patients with COVID-19 is warranted. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2849-E2856, 2021.


Subject(s)
COVID-19/therapy , SARS-CoV-2 , Tracheostomy/methods , Aged , Airway Extubation/mortality , Airway Extubation/statistics & numerical data , COVID-19/mortality , Cause of Death , Conscious Sedation/mortality , Conscious Sedation/statistics & numerical data , Female , Humans , Male , Middle Aged , New York City/epidemiology , Prospective Studies , Respiration, Artificial/mortality , Respiration, Artificial/statistics & numerical data , Time Factors , Tracheostomy/mortality , Treatment Outcome , Ventilator Weaning/mortality , Ventilator Weaning/statistics & numerical data
5.
Ann Surg ; 273(3): 403-409, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1066511

ABSTRACT

OBJECTIVE: The aim of this study was to report the safety, efficacy, and early results of tracheostomy in patients with COVID-19 and determine whether differences exist between percutaneous and open methods. SUMMARY BACKGROUND DATA: Prolonged respiratory failure is common in symptomatic patients with COVID-19, the disease process caused by infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Tracheostomy, although posing potential risk to the operative team and other healthcare workers, may be beneficial for safe weaning of sedation and ventilator support. However, short- and long-term outcomes remain largely unknown. METHODS: A prospectively collected database of patients with COVID-19 undergoing tracheostomy at a major medical center in New York City between April 4 and April 30, 2020 was reviewed. The primary endpoint was need for continued mechanical ventilation. Secondary outcomes included complication rates, sedation weaning, and need for intensive care unit (ICU) level of care. Patient characteristics, perioperative conditions, and outcomes between percutaneous and open groups were analyzed. RESULTS: During the study period, 67 consecutive patients underwent tracheostomy, including 48 males and 19 females with a median age of 66 years [interquartile range (IQR) 52-72]. Two surgeons alternated techniques, with 35 tracheostomies performed percutaneously and 32 via an open approach. The median time from intubation to tracheostomy was 23 days (IQR 20-26). At a median follow-up of 26 days, 52 patients (78%) no longer required mechanical ventilation and 58 patients (87%) were off continuous sedation. Five patients (7.5%) died of systemic causes. There were 11 total complications (16%) in 10 patients, most of which involved minor bleeding. There were no significant differences in outcomes between percutaneous and open methods. CONCLUSIONS: Tracheostomy under apneic conditions by either percutaneous or open technique can be safely performed in patients with respiratory failure due to COVID-19. Tracheostomy facilitated weaning from continuous intravenous sedation and mechanical ventilation. Continued follow-up of these patients to ascertain long-term outcome data is ongoing.


Subject(s)
COVID-19/therapy , Critical Care , Postoperative Complications/epidemiology , Respiration, Artificial , Tracheostomy/adverse effects , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/mortality , Cohort Studies , Female , Humans , Male , Middle Aged , New York City , Survival Rate , Tracheostomy/methods
6.
Otol Neurotol ; 42(1): e10-e14, 2021 01.
Article in English | MEDLINE | ID: covidwho-966021

ABSTRACT

OBJECTIVE: To describe a case of bilateral sudden sensorineural hearing loss (SSNHL) and intralabyrinthine hemorrhage in a patient with COVID-19. STUDY DESIGN: Clinical capsule report. SETTING: Tertiary academic referral center. PATIENT: An adult woman with bilateral SSNHL, aural fullness, and vertigo with documented SARS-CoV-2 infection (IgG serology testing). INTERVENTIONS: High-dose oral prednisone with taper, intratympanic dexamethasone. MAIN OUTCOME MEASURES: Audiometric testing, MRI of the internal auditory canal with and without contrast. RESULTS: A patient presented with bilateral SSNHL, bilateral aural fullness, and vertigo. Serology testing performed several weeks after onset of symptoms was positive for IgG COVID-19 antibodies. MRI showed bilateral intralabyrinthine hemorrhage (left worse than right) and no tumor. The patient was treated with two courses of high-dose oral prednisone with taper and a left intratympanic dexamethasone injection, resulting in near-resolution of vestibular symptoms, a fluctuating sensorineural hearing loss in the right ear, and a severe to profound mixed hearing loss in the left ear. CONCLUSIONS: COVID-19 may have otologic manifestations including sudden SSNHL, aural fullness, vertigo, and intralabyrinthine hemorrhage.


Subject(s)
COVID-19/complications , Hearing Loss, Sensorineural/virology , Hemorrhage/virology , Labyrinth Diseases/virology , Adolescent , Anti-Inflammatory Agents/therapeutic use , Dexamethasone/administration & dosage , Female , Hearing Loss, Bilateral/virology , Hearing Loss, Sudden/virology , Humans , Injection, Intratympanic , Prednisone/therapeutic use , SARS-CoV-2
7.
Otolaryngol Head Neck Surg ; 165(1): 1-2, 2021 07.
Article in English | MEDLINE | ID: covidwho-952209

ABSTRACT

The COVID-19 pandemic has led to many unintended, long-lasting consequences for society. Preventative practices such as mask wearing, social distancing, and virtual meetings and classrooms to address contagion concerns may negatively affect communication, particularly in the pediatric population, as schools have begun to open this fall. Increasing awareness and creating innovative methods to promote communication and language learning in settings both in person and virtual is paramount. Although more studies are needed to characterize the pandemic's impact on pediatric speech and language development, clinicians and parents should be cognizant of this phenomenon and proactive in facilitating an optimal communication environment for children.


Subject(s)
COVID-19 , Communication , Language Development , Child , Humans
8.
Laryngoscope ; 130(11): 2508-2515, 2020 11.
Article in English | MEDLINE | ID: covidwho-777607

ABSTRACT

OBJECTIVES: During a public health crisis, it is important for medical journals to share information in a timely manner while maintaining a robust peer-review process. This review reports and analyzes The Laryngoscope's publication trends and practices during the COVID-19 pandemic, before the COVID-19 pandemic, and during previous pandemics. METHODS: Comprehensive review of two databases (PubMed and The Laryngoscope) was performed. COVID-19 manuscripts (published in The Laryngoscope during the first 4 months of the pandemic) were identified and compared to manuscripts pertaining to historic pandemics (published in The Laryngoscope during the first 2 years of each outbreak). Keywords included "Laryngoscope", "flu", "pandemic", "influenza", "SARS", "severe acute respiratory syndrome", "coronavirus", "COVID-19", and "SARS-CoV-2". Data were obtained from The Laryngoscope to characterize publication trends during and before the COVID-19 pandemic. RESULTS: From March 1, 2020 to June 30, 2020, The Laryngoscope had 203 COVID-19 submissions. As of July 8, 2020, 20 (9.9%) were accepted, 117 (57.6%) under review, and 66 (32.5%) rejected. During the first 4 months of the pandemic, 18 COVID-19 manuscripts were published. The mean number of days from submission to online publication was 45, compared to 170 in 2018 and 196 in 2019. A total of 4 manuscripts concerning previous pandemics were published during the initial 2 years of each outbreak. CONCLUSIONS: The Laryngoscope rapidly disseminated quality publications during the COVID-19 pandemic by upholding a robust peer-review process while expediting editorial steps, highlighting relevant articles online, and providing open access to make COVID-19-related publications available as quickly as possible. Laryngoscope, 130:2508-2515, 2020.


Subject(s)
COVID-19 , Health Information Exchange/trends , Otolaryngology/trends , Periodicals as Topic/trends , Public Health , Humans , SARS-CoV-2
9.
Laryngoscope ; 130(11): 2595-2597, 2020 11.
Article in English | MEDLINE | ID: covidwho-726307

ABSTRACT

Acute sialadenitis may be caused by viruses, including coronaviruses. Although there are anecdotal reports of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) salivary gland infections, there have been no well-documented cases of sialadenitis in patients with COVID-19 described in the literature. We report a case of parotitis and submandibular gland sialadenitis, as well as an isolated case of parotitis, in two patients with concurrent SARS-CoV-2 infections. Computed tomography imaging demonstrated parotid and submandibular gland enlargement with heterogenous enhancement and attenuation, consistent with sialadenitis. Medical management was sufficient for successful resolution of the acute sialadenitis. Laryngoscope, 130:2595-2597, 2020.


Subject(s)
COVID-19/complications , Parotitis/virology , SARS-CoV-2 , Sialadenitis/virology , Submandibular Gland Diseases/virology , Aged, 80 and over , COVID-19/virology , Female , Humans , Male , Middle Aged , Submandibular Gland/virology
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