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Otol Neurotol ; 42(8): 1275-1284, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1358514


OBJECTIVE: To investigate the influence of the COVID-19 pandemic on operative practices of otology and neurotology providers internationally. STUDY DESIGN: Cross-sectional survey. METHODS: A 78-question survey was distributed to otologists and neurotologists between May 12, 2020 and June 8, 2020 to assess the impact of the pandemic on surgical practices. Sections within the survey delineated time periods: prior to the crisis, onset of the crisis, during the crisis, postcrisis transition. RESULTS: Of 396 survey respondents, 284 participants from 38 countries met inclusion criteria.Respondents were 16.9% female and 82.4% male, with a most common age range of 40 to 49 years (36.3%). 69.8% of participants had been in practice for over 10 years and most respondents worked in an academic medical center (79.2%). The average operative weekly caseload was 5.3 (SD 3.9) per surgeon prior to the crisis, 0.7 (SD 1.2) during the COVID-19 crisis, and 3.5 (SD 3.3) for those who had begun a postcrisis transition at the time of survey administration (p < 0.001). 71.5% of providers did not perform an elective otologic or neurotologic operative procedure during the initial crisis period. 49.8% reported modifying their surgical technique due to the COVID-19 pandemic. Use of powered air-purifying respirators and filtering facepiece 2 or 3 (FFP2/FFP3) respirators were in minimal supply for 66.9% and 62.3% of respondents, respectively. CONCLUSION: The COVID-19 pandemic impacted the otology and neurotology community globally, resulting in significant changes in operative volume and case selection. Modification of surgical technique and shortages of personal protective equipment were frequently reported.

COVID-19 , Pandemics , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Otolaryngologists , SARS-CoV-2 , Surveys and Questionnaires
Otol Neurotol ; 42(4): 606-613, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-913295


BACKGROUND: During the Covid-19 pandemic, otolaryngologists are at risk due to aerosol-generating procedures such as mastoidectomy and need enhanced personal protective equipment (PPE). Eye protection can interfere with the use of a microscope due to a reduction in the field of vision. We aimed to study the effect of PPE on the microsurgical field. METHODS: Five surgeons measured the visual field using digital calipers at different power settings. They were done with no PPE, a surgical mask, FFP3 mask (N99), and with the addition of small goggles, large vistamax goggles, vistamax plus a face shield, and only a face shield. The measurements were repeated with rings of 5 mm increments. We also measured the "eye relief" of the microscope which is the ideal distance for maximum field of view. RESULTS: There was no major reduction of the field with the surgical or FFP3 mask. But even simple goggles reduced the field up to 31.6% and there were progressive reductions of up to 75.7% with large goggles, 76.8% when a face shield was added, and 61.9% when only face shield was used. The distance rings more than 5 mm also affected the field of view.The eye relief of our eyepiece was found to be 15 mm. CONCLUSION: The current PPE eye protection is not compatible with the use of a microscope. There is scope for research into better eye protection. Mitigation strategies including barrier drapes and alternative techniques such as endoscopic surgery or use of exoscopes should also be considered.

COVID-19/prevention & control , Microsurgery , Otolaryngologists , Personal Protective Equipment/adverse effects , Visual Fields , COVID-19/transmission , Humans , Mastoidectomy/adverse effects , Microsurgery/instrumentation , Microsurgery/methods , SARS-CoV-2
Eur Arch Otorhinolaryngol ; 277(9): 2619-2623, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-271025


PURPOSE: The COVID-19 infection is an aggressive viral illness with high risk of transmission during otolaryngology examination and surgery. Cholesteatoma is known for its potential to cause complications and scheduling of surgery during the pandemic must be done carefully. The majority of otological surgeries may be classified as elective and postponed at this time (e.g., stapedotomy, tympanoplasty); whereas, others are emergencies (e.g., complicated acute otitis media, complicated cholesteatoma with cerebral or Bezold's abscess, meningitis, sinus thrombosis) and require immediate intervention. What is the ideal time for the surgical management of Cholesteatoma during the COVID-19 pandemic? METHODS: Senior otologic surgeons from six teaching hospitals from various countries affected by the COVID-19 from around the world met remotely to make recommendations on reorganizing schedules for the treatment of cholesteatoma which has a risk of severe morbidity and mortality. The recommendations are based on their experiences and on available literature. RESULTS: Due to the high risk of infecting the surgical staff it is prudent to stop all elective ear surgeries and plan cholesteatoma surgery after careful selection of patients, based on the extent of the disease and available resources. Specific precautions including use of appropriate personal protection equipment should be followed when operating on all patients during the pandemic. To facilitate the decision-making in the management of cholesteatoma, timing for surgery can be divided into two categories with 3 and 2 sub-groups based on disease severity. CONCLUSIONS: Evidence on the timing of surgery of patients with cholesteatoma during the COVID-19 pandemic is lacking. This manuscript contains practical tips on how cholesteatoma surgery can be reorganized during this pandemic.

Cholesteatoma/surgery , Coronavirus Infections , Elective Surgical Procedures/methods , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Otologic Surgical Procedures/methods , Pandemics/prevention & control , Personal Protective Equipment , Pneumonia, Viral , Betacoronavirus , COVID-19 , Cholesteatoma/complications , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Emergencies , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Otolaryngology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2