Case Report of Succesful Multidisiplinary Treatment for Patient with Metastatic Lung Cancer and Relapsed/Refractory Chronic Lymphatic Leukemia/Small Lymphocytic Lymphoma

Introduction: Croatian National Cancer Registry of Croatian Institute for Public Health reported that in year 2020 lung cancer was the second most common cancer site diagnosed in men with 16% and the third most common in women with 10% incidence among all cancer sites. Unfortunatelly lung cancer has the highest mortality in both men and women. Haematological malignancies had 7% share in all malignancies in both male and female cances cases. In 2020 190 newly diagnosed cases of lymphatic leukemia in men and 128 cases in women were reporeted, meaning 1.5 and 1.2% of all malignancies, respectively. Chronic lymphatic leukemia (CLL) is an advanced age disease and incidence increases with age. Impaired immunity, T and B cell dysfunction in CLL, chromosomal aberations, long-term immunosuppressive therapy and genetic factors can all cause secondary malignancies. Co- occurence of solid tumors and CLL is very rare. Although patiens with CLL have an increased risk of developing second primary malignancies including lung carcinoma, the data about their clinical outcomes are lacking. Parekh et al. retrospectively analyzed patients with simultaneous CLL and lung carcinoma over a 20-year period, and they found that ~2% of patients with CLL actually developed lung carcinoma. The authors claimed that up to 38% of patients will also develop a third neoplasm more likely of the skin (melanoma and basal cell carcinoma), larynx (laryngeal carcinoma) or colon. Currently there are no specific guidelines for concurrent CLL and non-small cell lung carcinoma (NSCLC) treatment. Usually, when the tumors are diagnosed simultaneously, treatment is based to target the most aggressive malignancy, as the clinical outcomes depend on the response of the tumor with the poorest prognosis. For this reason, a multidisciplinary approach is mandatory. Case report: A patient with history of coronary heart disease, myocardial infarction and paroxysmal atrial fibrillation was diagnosed in 2019 (at the age of 71) with B chronic lymphocytic leukemia with bulky tumor (inguinal lymph nodes 8x5 cm), stage B according to Binet, intermediate risk. He was treated with 6 cycles of chemoimmunotherapy (rituximab/cyclofosfamid/fludarabine). In 10/2019 remission was confirmed, but MSCT described tumor in the posterior segment of upper right lung lobe measuring 20x17 mm and bilateral metastases up to 11 mm. Bronchoscopy and biopsy were performed, and EGFR neg, ALK neg, ROS 1 neg, PD-L1>50% adenocarcinoma was confirmed. He was referred to Clinical Hospital Center Osijek where monotherapy with pembrolizumab in a standard dose of 200 mg intravenously was started in 01/2020. Partial remission was confirmed in October 2020. Immunotherapy was discontinued due to development of pneumonitis, dysphagia and severe weight loss (20kg), but without radiologically confirmed disease progression. At that time he was referred to our hospital for further treatment. Gastroscopy has shown erosive gastritis with active duodenal ulcus, Forrest III. Supportive therapy and proton pump inhibitor were introduced. After complete regression of pneumonitis, improvement of general condition and resolution of dysphagia, no signs of lung cancer progression were found and pembrolizumab was reintroduced in 12/2021. Hypothyroidism was diagnosed in 01/2021 and levothyroxine replacement ther apy was started. In 03/2021 he underwent surgical removal of basal cell carcinoma of skin on the right temporal region with lobe reconstruction. From 02/2021, when pembrolizumab was reintroduced, regression in tumor size was continously confirmed with complete recovery of general condition. He was hospitalized for COVID 19 infection in 09/2021, and due to complications pembrolizumab was discontinued till 11/2021. Lung cancer immunotherapy proceeded till 11/2022, when Multidisciplinary team decided to finish pembrolizumab because of CLL relapse. CLL was in remission till August 2022 when due to B symptoms, lymphcytosis, anemia and generalized lymphadenopathy, hematological workup including biopsy of cervical lymph node was performed and CLL/SLL relapse was confirmed. Initially chlorambucil was introduced, but disease was refractory. Based on cytogenetic test results (IGHV unmutated, negative TP53) and due to cardiovascular comorbidity (contraindication for BTK inhibitors) venetoclax and rituximab were started in 01/2023. After just 1 cycle of treatment normal blood count as well as regression of B symptoms and peripheral lymphadenopathy occured, indicating the probability of complete disease remission. In our patient with metastatic lung adenocarcinoma excellent disease control is achieved during 41 month of treatment in first line setting. Furthermore, relapsed/refractory CLL/SLL is currently in confirmed remission. Conclusion(s): Successful treatment of patients with multiple primary malignancies is based on multidisciplinarity, early recognition and management of side effects, treatment of comorbidities with the aim of prolonging life, controlling symptoms of disease and preserving quality of life.

Tracheostomy care and outcomes during the COVID-19 pandemic- an observational cohort perspective from Cardiff

Introduction: Prior to the COVID-19 pandemic an estimated 5000 surgical and 12000 percutaneous tracheostomies were completed in the UK each year.1 A UK study looking at COVID-19 tracheostomy outcomes found 1605 tracheostomy cases from 126 hospital, median time from intubation to tracheostomy was 15 days while 285 (18%) patients died following the procedure.2 COVID-19 patients also typically spend longer in critical care with prolonged time receiving organ support when compared to patients diagnosed with other viral pneumonias.3 Incidence of laryngeal pathologies are also higher in COVID-19 patients post tracheostomy.4 Objectives: The aim of this observational study was to review the outcomes of patients post tracheostomy insertion during the COVID-19 pandemic compared to non-COVID patients. Method(s): A service evaluation was completed including all patients requiring a tracheostomy since the beginning of the COVID-19 pandemic in March 2020 within University Hospital Wales, Cardiff. Data was captured from local tracheostomy databases. Patients were grouped into either COVID or non-COVID based on their clinical history. The key outcomes evaluated were number of tracheostomies, average time to cuff deflation and decannulation, critical care and hospital length of stay, occurrence of adverse events and time from critical care admission to tracheostomy insertion. Data was evaluated using descriptive statistics using Microsoft ExcelTM. Result(s): During the review period 58 patients with COVID-19 and 158 without required a tracheostomy. In the COVID-19 group cuff deflation occurred at a median of 10 days post insertion compared to 7 days. Decannulation occurred at a median of 16 days in patients with COVID-19 compared to 18 days. The rate of decannulation was also higher in the COVID-19 group at 74.1% compared to 67.1%. Critical care length of stay was 37 days in the COVID-19 compared to 25 days. Time from intubation to tracheostomy was comparable between groups at a median of 16 days for our COVID-19 cohort compared to 15 days. The incidence of clinical incidents was higher in the non-COVID-19 group at 10.1% compared to 5.2%. Conclusion(s): This internal service evaluation has shown that COVID-19 patients typically spend longer in critical care but their time to decannulation was shorter and their rate of decannulation was higher in our cohort then in the comparison group. This could be due to the tertiary neuroscience and major trauma specialities within our Health Board. Both with groups of patients that, due to the nature of their injuries may require prolonged periods of tracheostomy insertion even after critical care discharge.

Subglottic Hemangioma: A Hidden Mass Presenting in an Unusual Age Group.

Subglottic hemangiomas are rare in adulthood. The presence of the lesion in the subglottic region makes it even more unusual. Moreover, these lesions do not have a typical course and involution changes as seen in the infantile forms. An elderly female initially came with a brief history of dyspnea and symptoms of upper respiratory tract infection. The patient also complained of a change of voice and noisy breathing, with a recent history of intubation following COVID-19 pneumonia and late-onset bronchial asthma. Flexible nasopharyngolaryngoscopy showed a mass below the vocal folds, which was seen to arise from the posterior subglottic region. The patient eventually underwent endoscopic excision of the lesion under general anesthesia and recovered well. Symptoms of hoarseness and stridor, along with a history of intubation, should raise a high index of suspicion for laryngeal diseases. A delay in the diagnosis of an obstructing lesion in the subglottis occurs in the presence of a confounding lung infection and overlap of clinical features with those of bronchial asthma. Surgical excision is required not only to alleviate obstructive symptoms but also to rule out malignancy.

Special Issue: Supplement of rhinology and anterior skull base - laryngology and head and neck surgery - Covid-19 in Ent and mucormycosis. (Special Issue: Supplement of rhinology and anterior skull base - laryngology and head and neck surgery - Covid-19 in Ent and mucormycosis.)

This special issue contains 491 featuring clinical reports, clinical studies, research articles in basic and applied Otolaryngology, short communications, clinical records reporting unusual presentations or lesions and new surgical techniques in laryngology and head and neck surgery in COVID-19 and mucormycosis.

Focus on laryngeal disease in the cat

This is a title only record which contains no .

Risk signals mining of ribavirin and interferon-alpha based on the US FDA Adverse Event Reporting System database.

Objective: To identify which induced the symptoms/signs and laboratory abnormal findings occurred in patients with novel coronavirus pneumonia, by disease itself or by ribavirin and interferon-alpha treatments, through mining the adverse events (AEs) signals of the 2 antivirus agents. Method(s): According to the symptoms/signs and laboratory abnormal findings of novel coronavirus pneumonia mentioned in the literature and "Diagnosis and Treatment scheme of Novel Coronavirus Pneumonia (trial version 5)", AEs in this study were selected. Related data were collected from the U.S. FDA Adverse Events Reporting System (FARES) from Jan 1, 2004 to Dec 31, 2019, and the reporting odds ratio (ROR) method was used for signals detection for the above-mentioned 2 drugs. Result(s): A total of 7 582 463 AEs related to drugs were reported in the FAERS database, of which 31 775 related to ribavirin and 2 345 related to interferon-alpha. The results showed that AEs related to ribavirin in respiratory, thoracic, and mediastinal disorders were nasal congestion, cough, laryngeal pain, pharyngeal oedema, productive cough, and dyspnoea;AEs related to interferon-alpha were laryngeal pain and haemoptysis. In other system organ class, AEs related to above 2 drugs were pyrexia, feeling cold, pyrexia, nausea, vomiting, diarrhoea, headache, arthralgia, myalgia, and rash. AEs of laboratory abnormal results related to ribavirin were white blood cell/platelet count decrease and aspartate/alanine aminotransferase increase;AEs related to interferon-alpha were white blood cell/platelet count decrease, aspartate/alanine aminotransferase increase, and lymphocyte count decrease. Conclusion(s): Some AEs induced by ribavirin and interferon-alpha were similar to symptoms/signs and laboratory abnormal findings of novel coronavirus pneumonia, which should be distinguished in the clinical practice.Copyright © 2020 by the Chinese Medical Association.

Teledermatology and the Montgomery rule of consent

The Montgomery vs. Lanarkshire case of March 2015 is one of the most important UK judgments on informed consent. The ruling dictated that any intervention should be based on a shared decision, whereby patients are aware of all options and supported in making an informed decision. There is debate over whether patients requiring a procedure after a store-andforward teledermatology consultation need a preoperative face-to-face (F2F) appointment to comply with this consent. We evaluated patient experiences of our skin cancer teledermatology pathway, whereby patients had a telephone consultation before a surgical appointment and their first visit to the hospital was for the procedure. On average, we receive 9000 2-week-wait referrals a year. In March 2020, following the UK's nationwide lockdown, our dermatology department had 700 new referrals pending without any opportunity of F2F appointments. To meet this demand and the subsequent restrictions of the COVID-19 pandemic, we established a teledermatology service. Patients attended a community hub where a detailed history was taken and lesions photographed by a medical photographer, including dermoscopic images. Clinical images were subsequently reviewed by a consultant dermatologist. For those requiring surgical procedures, preoperative telephone consultations were conducted. Patients requiring complex procedures and those with likely highgrade malignant melanoma were offered F2F appointments. During the telephone consultation, the planned procedure was explained, with risks, benefits and alternative treatments discussed. The first 50 patients were sent a survey comprising eight questions pertaining to their experience of the new pathway. Over a 4-week period, 34 responded. Mean age was 67 years (range 29-93). Ninety-seven patients felt photographs were taken in a timely manner. All patients reported that appropriate safety and social distancing precautions were taken. All patients described an overall positive experience, felt that sufficient information was provided throughout the pathway and were happy to engage with this service should they require a similar procedure in the future. In this cohort of patients, their first visit to hospital was for a procedure. There are many benefits in reducing F2F hospital attendances. As well as reducing footfall during the pandemic, there is less lost work time and cost of travel for patients or their relatives, more efficient use of hospital facilities and reduced carbon footprint. Our survey suggests that preoperative telephone consultations are liked by patients and appropriate in meeting the requirements of Montgomery consent for a teledermatology service.

Case report of recurrent respiratory papillomatosis

Recurrent respiratory papillomatosis is a chronic disease caused by the human papillomavirus and can affect both children and adults. Although it is a benign disease, papilloma growth can cause severe, sometimes life-threatening airway obstruction. We report the case of a 28-year-old male patient who was admitted to the hospital with a fever and prolonged cough. A computed tomography (CT) scan showed solid and cavitated nodules in his right lung and solid nodules on his vocal cords. Bronchoscopy demonstrated polypoid lesions on his vocal cords. Histopathological study of the lesions confirmed a diagnosis of respiratory papillomatosis.Copyright © 2022 Biomedpress.

Outcomes from treating rhinitis in patients with refractory breathlessness

Background: In our multi-disciplinary airways service, we assess refractory breathlessness due to suspected inducible laryngeal obstruction (ILO) and/or breathing pattern disorder (BPD). A significant proportion of patients have evidence of uncontrolled co-morbidity, including rhinitis and asthma, which aggravate airway symptoms. Aim(s): To identify the impact of rhinitis management on i) nasal symptoms ii) asthma control and iii) cough control, for individuals referred with suspected ILO +/- BPD and evidence of rhinitis. Method(s): Patient demographics/clinical data were collected between January 2021 and January 2022. Symptoms were recorded using the Total Nasal Symptom Score (TNSS), Asthma Control Questionnaire (ACQ) in those with asthma and a 10-point self-rating scale in chronic refractory cough (CRC). Result(s): Data were available for 43 patients [72% female, 18% atopic, median (IQR) age 54 (41-64) years] with symptoms of rhinitis, confirmed by nasendoscopy in 41% (not all patients had nasendoscopy due to COVID-19 pandemic). Co-morbidities included asthma 54% (39%, of whom were on biologic treatment), CRC (21%), ILO (35%) and BPD (35%). Rhinitis management comprised education (100%), nasal corticosteroids (91%), saline nasal douche (49%) and antihistamines (10%). TNSS scores improved [from 5 (4-6) to 3 (2-4), p<0.001] following intervention. In those with asthma, there was improvement in ACQ [2.98 (2.15-3.70) to 2.00 (0.95-3.05), p<0.001], and in those with chronic refractory cough in self-rating score [8 (4-9) to 2 (2-6), p=0.11]. Conclusion(s): Optimisation of medical treatment for individuals with rhinitis is important and can improve outcomes in patients with asthma, CRC, ILO and BPD.

Original Article Evaluation of clinical outcomes, laboratory and imaging data of patients with solid tumor infected with COVID-19 infection

Background: COVID-19 is associated with higher mortality rates in patients with cancer. In this study, we aimed to evaluate the clinical outcomes, and laboratory and imaging data of patients with solid tumor infected with COVID-19 infection. Method(s): This is a cross-sectional retrospective study performed in 2020-2022 on 85 patients with a previous diagnosis of solid tumors infected with COVID-19. We included all patients with tumors of solid organs that were diagnosed with COVID-19 infection and required hospitalization those patients previously hospitalized for treatments and were infected with COVID-19 during hospitalization. Demographic data of patients were collected using a checklist. We collected data regarding clinical outcome (discharge, hospitalization or death), duration of hospitalization, requiring ICU admission, duration of hospitalization divided by received drugs and type of tumor and mean survival time. Furthermore, we collected laboratory data from all patients. The radiologic characteristics of patients were also extracted from their data. Result(s): Breast cancer was the most common solid tumor (34.9%), followed by lung cancer (19.3%). The mortality rate was 24.1% (20 patients). The highest mortality rate in this study was for metastatic intestinal cancer to the lung (100%, one patient), followed by metastatic prostatic cancer to lung (50%, three patients). The highest hospitalization duration was for patients with glioblastoma multiform (GBM) (30 days). The mean survival time among patients with mortality was 19.15+/-1.80 days. The mean CT severity score of all patients was 27.53+/-22.90. Patient's most common radiologic sign was air space consolidation (89.1%). The highest CT severity score was found in patients with stomach cancer (46.67+/-5.77). Conclusion(s): The mortality rate in this study was 24.1%. Based on the results of our study and previous research, special care should be provided to patients with solid tumors during the COVID-19 pandemic and in infected cases.Copyright © 2022, E-Century Publishing Corporation. All rights reserved.

Laryngeal injury in a coronavirus disease 2019 caregiver following voluntary cough-holding within an inappropriately sized personal protective equipment suit.

OBJECTIVE: To document laryngeal framework rupture following voluntary cough-holding as an airway complication of donning a personal protective equipment suit that was too small in size. METHODS: Clinical record and literature review, with proposition of plausible aerodynamics of the airway injury. RESULTS: Whilst carrying out his duty in the coronavirus disease ward, a resident attempted to stifle a paroxysm of cough when wearing a personal protective equipment suit that was too small with his neck flexed and restricted. There was a sudden release of pressure, intense pain and swelling in the neck with crepitus. Imaging revealed a non-displaced fracture in the lower end of the partially ossified right thyroid lamina, a cricothyroid membrane tear and subcutaneous emphysema. The symptoms resolved gradually on conservative management. CONCLUSION: This report underlines the importance of donning appropriately sized personal protective equipment and encouraging its proper use amongst coronavirus disease 2019 caregivers. Non-traumatic laryngeal injury, itself a rare event, has never been reported as a posture-related complication of wearing personal protective equipment.

Functional Laryngeal Assessment in Patients with Tracheostomy Following COVID-19 a Prospective Cohort Study.

To explore laryngeal function of tracheostomised patients with COVID-19 in the acute phase, to identify ways teams may facilitate and expedite tracheostomy weaning and rehabilitation of upper airway function. Consecutive tracheostomised patients underwent laryngeal examination during mechanical ventilation weaning. Primary outcomes included prevalence of upper aerodigestive oedema and airway protection during swallow, tracheostomy duration, ICU frailty scores, and oral intake type. Analyses included bivariate associations and exploratory multivariable regressions. 48 consecutive patients who underwent tracheostomy insertion as part of their respiratory wean following invasive ventilation in a single UK tertiary hospital were included. 21 (43.8%) had impaired airway protection on swallow (PAS ≥ 3) with 32 (66.7%) having marked airway oedema in at least one laryngeal area. Impaired airway protection was associated with longer total artificial airway duration (p = 0.008), longer tracheostomy tube duration (p = 0.007), multiple intubations (p = 0.006) and was associated with persistent ICU acquired weakness at ICU discharge (p = 0.03). Impaired airway protection was also an independent predictor for longer tracheostomy tube duration (p = 0.02, Beta 0.38, 95% CI 2.36 to 27.16). The majority of our study patients presented with complex laryngeal findings which were associated with impaired airway protection. We suggest a proactive standardized scoring and review protocol to manage this complex group of patients in order to maximize health outcomes and ICU resources. Early laryngeal assessment may facilitate weaning from invasive mechanical ventilation and liberation from tracheostomy, as well as practical and objective risk stratification for patients regarding decannulation and feeding.

Severe and Life-Threatening Paroxysmal Laryngospasm: Uncommon Presentation of COVID-19

Introduction: Laryngospasm is a life-threatening condition caused due to involuntary contraction in laryngeal muscles. It can last seconds to minutes and may cause hypoxemia, loss of consciousness, and death. Case Presentation: We report a case of laryngospasm in a patient with Coronavirus-2 infection who was admitted to the emergency department for the first time. Laryngospasm was revealed after treatment. Conclusion(s): The clinician should note that laryngospasm can be triggered by Coronavirus-2 infection. Copyright © 2023, Author(s).

Swallowing Dysfunction and its Impact on Patients Undergoing Oncological Treatment

Loco-regional control rates and tumour response have increased as a result of advancements in Head and Neck Cancer (HNC) therapy. [...]mortality is still high despite advancements in treatment and diagnostic methods. Keywords: Covid-19 pandemic * Nigeria situation * Global perspective Introduction Loco-regional control rates and tumour response have increased as a result of advancements in Head and Neck Cancer (HNC) therapy. [...]mortality is still high despite advancements in treatment and diagnostic methods. [...]we may divide the variables that predict dysphagia into three categories: treatment-related, patient-related, and tumour-related. [...]for specific procedures such as arytenoid cartilage and base of the tongue resections, dysphagia may be precisely anticipated. According to Taberna, anatomical reasons and the food consistency of dysphagia are related.

Tele-rehabilitation in voice disorders during the pandemic: a consensus paper from the French Society of Phoniatrics and Laryngology.

OBJECTIVES: To establish a consensus protocol for telerehabilitation in speech therapy for voice disorders. METHODS: The study was conducted according to a modified Delphi method. Twenty speech therapist or laryngologist experts of the French Society of Phoniatrics and Laryngology assessed 24 statements of voice telerehabilitation with a 10-point visual analog scale ranging from 1 (totally disagree) to 10 (totally agree). The statements were accepted if more than 80% of the experts rated the item with a score of ≥ 8/10. The statements with ≥ 8/10 score by 60-80% of experts were improved and resubmitted to voting until they were validated or rejected. RESULTS: The French Society of Phoniatrics and Laryngology experts validated 10, 6, and 2 statements after the first, second and third voting round, respectively. Seven statements did not reach agreement threshold and were rejected. The validated statements included recommendations for setting (N = 4), medical/speech history (N = 2), subjective voice evaluations (N = 3), objective voice quality measurements (N = 3), and voice rehabilitation (N = 5). The experts agreed for a follow-up consisting of combined telerehabilitation and in-office rehabilitation. The final protocol may be applied in context of pandemic but could be assessed out of pandemic period for patients located in rural regions. CONCLUSIONS: This Delphi study established the first telerehabilitation protocol of the French Society of Phoniatrics and Laryngology for patients with voice disorders. Future controlled studies are needed to assess its feasibility, reliability, and the patient perception about telerehabilitation versus in-office rehabilitation.

Manifestation of anterior necrotising scleritis and reactive infectious mucocutaneous eruption after COVID-19 2022: A case report

Purpose: To report a case of reactive infectious mucosal eruption and anterior scleritis in a vaccinated patient following recent recovery from COVID-19. Reactive infectious mucosal eruption (RIME) is a newly recognised complication of SARS COVID-19. Scleritis has also been reported in COVID-19 infections;however, these cases were from early in pandemic prior to vaccine development and were not reported to occur concurrently with RIME. Method(s): This case report illustrates a 25-year old male fully vaccinated against COVID-19 (ComirnatyTM) who presented 2 weeks after recovering from COVID-19 infection with RIME involving the oral mucosal and larynx, and concurrent bilateral anterior necrotising scleritis. Result(s): Consultation was sought from ophthalmology, otolaryngology and dermatology and dental regarding diagnoses and management. The patient's condition rapidly improved following treatment with IV methyprednisolone and oral prednisone taper. Conclusion(s): In cases of diagnostic uncertainty, multidisciplinary collaboration is critical to achieve a timely diagnosis and prevent serious complications.

Clinically Relevant Sound-Based Features in COVID-19 Identification: Robustness Assessment With a Data-Centric Machine Learning Pipeline

As long as the COVID-19 pandemic is still active in most countries worldwide, rapid diagnostic continues to be crucial to mitigate the impact of seasonal infection waves. Commercialized rapid antigen self-tests proved they cannot handle the most demanding periods, lacking availability and leading to cost rises. Thus, developing a non-invasive, costless, and more decentralized technology capable of giving people feedback about the COVID-19 infection probability would fill these gaps. This paper explores a sound-based analysis of vocal and respiratory audio data to achieve that objective. This work presents a modular data-centric Machine Learning pipeline for COVID-19 identification from voice and respiratory audio samples. Signals are processed to extract and classify relevant segments that contain informative events, such as coughing or breathing. Temporal, amplitude, spectral, cepstral, and phonetic features are extracted from audio along with available metadata for COVID-19 identification. Audio augmentation and data balancing techniques are used to mitigate class disproportionality. The open-access Coswara and COVID-19 Sounds datasets were used to test the performance of the proposed architecture. Obtained sensitivity scores ranged from 60.00% to 80.00% in Coswara and from 51.43% to 77.14% in COVID-19 Sounds. Although previous works report higher accuracy on COVID-19 detection, this research focused on a data-centric approach by validating the quality of the samples, segmenting the speech events, and exploring interpretable features with physiological meaning. As the pandemic evolves, its lessons must endure, and pipelines such as the proposed one will help prepare new stages where quick and easy disease identification is essential.

Long-term Outcomes Following Prolonged Mechanical Ventilation for COVID-19

Introduction: The purpose of this study is to evaluate longterm laryngotracheal outcomes in patients who required 10 or more days of invasive mechanical ventilation (IMV) for COVID-19. Method(s): This is a prospective cohort study of patients previously hospitalized for active COVID-19 infection between January 2020 and March 2021 who required intubation for 10+ days. Subjects who met criteria were enrolled at an outpatient laryngology clinic, where they underwent a clinical evaluation with head and neck exam, nasolaryngoscopy, and patient-reported outcome measures (Voice Handicap Index, EAT-10). Medical history was collected through electronic medical record review. Result(s): In total, 166 patients met criteria based on chart review. Of these patients, 31 (18.6%) were deceased since discharge. Enrolled subjects included 16 patients, 2 women and 14 men, with mean (SD) age of 57.4 (14.12) years. The mean duration (SD) of IMV was 36.8 (21.8) days. Fourteen of 16 patients underwent tracheostomy for prolonged endotracheal intubation. The mean time (SD) from hospital admission to intubation was 2.7 (3.2) days, intubation to tracheostomy or extubation was 13.9 (5.3) days, and tracheostomy to decannulation was 38.1 (22.6) days. Conclusion(s): Patients who required prolonged mechanical ventilation to treat COVID acute respiratory distress syndrome demonstrated significant laryngeal or tracheal pathology during laryngoscopy at 1-year follow-up, though subjectively, their self-reported voice and swallowing deficits were mild.