Cost-Effective Microscopic Draping: COVID-19 Umbrella.

We describe a cost-effective solution to limit aerosol transmission to the surgeon and other personnel in the operating room during otologic surgery.

The Virtual Neurologic Exam: Instructional Videos and Guidance for the COVID-19 Era

Objective:To outline features of the neurologic examination that can be performed virtually through telemedicine platforms (the virtual neurological examination [VNE]), and provide guidance for rapidly pivoting in-person clinical assessments to virtual visits during the COVID-19 pandemic and beyond.Methods:The full neurologic examination is described with attention to components that can be performed virtually.Results:A screening VNE is outlined that can be performed on a wide variety of patients, along with detailed descriptions of virtual examination maneuvers for specific scenarios (cognitive testing, neuromuscular and movement disorder examinations).Conclusions:During the COVID-19 pandemic, rapid adoption of virtual medicine will be critical to provide ongoing and timely neurological care. Familiarity and mastery of a VNE will be critical for neurologists, and this article outlines a practical approach to implementation.

Contemporary trends can be revealed in an enquiry of presentations at a surgical symposium.

AIMS: Ascertain whether a demographic analysis of the archives of an annual national meeting head and neck section could reflect contemporary issues in our specialty and compare the results with available analysis from other ORL-HNS meetings. MATERIALS AND METHODS: A review of all accepted abstracts of Sylvester O'Halloran Symposium-H&N section, from 2005 to 2020. RESULTS: ORL-HNS was responsible for 77% of the accepted abstracts. Presentations on H&N Malignancy were predominantly from ORL-HNS (84%), while Thyroid presentations were divided with General Surgery (45%). Medical students have appeared in recent years and produced 4% of papers at the last meeting while more junior presenters are participating with an increasing female preponderance (ranging from 7 to 53%). The overall publication rate was 27%, where male authors had a rate of 28% and females 22%. Similar papers published subsequent to the relevant meeting were identified from other institutions in 40% of presentations. CONCLUSION: This review of presentations at a surgical meeting provides an insight into contemporary issues involving our specialty and lays down markers or challenges for organisers and presenters alike. Presentations on H&N Malignancy have become almost exclusively ORL-HNS, while Thyroid presentations are becoming more valorised to General Surgery and Facial Plastics with our colleagues in Plastic Surgery and Maxillofacial. Our publication rate of 27% is similar to other ORL-HNS meetings. Approximately 10% are published over 5 years after the meeting but presenters should endeavour to publish earlier as others may usurp publication in up to 40% of presentations.

A retrospective cohort study of telephone versus face-to-face clinics for the management of new otology referrals.

PURPOSE: To compare outcomes of telephone and face-to-face consultations for new otology referrals and discuss the wider use of telemedicine in otology. METHODS: Retrospective cohort study including new adult otology referrals to our unit, sampled consecutively between March 2021 and May 2021, seen in either a face-to-face or telephone clinic. Primary outcome measure was the proportion of patients with a definitive management outcome (discharged or added to waiting list for treatment) versus the proportion of patients requiring follow-up for further assessment or review. RESULTS: 150 new patients referred for a routine otology consultation (75 telephone, 75 face-to-face) were included. 53/75 patients (71%) undergoing a face-to-face consultation received a definitive outcome following initial review, versus 22/75 (29%) telephone patients (χ2 < 0.001, OR 5.8). 52/75 (69%) telephone patients were followed up face-to-face for examination. The mean (SD) number of appointments required to reach a definitive outcome was 1.22 (0.58) and 1.75 (0.73) in the face-to-face and telephone cohorts, respectively (p < 0.001). CONCLUSIONS: Telephone clinics in otology have played an important role as part of the COVID19 response. However, they are currently limited by a lack of clinical examination and audiometry. Remote assessment pathways in otology that incorporate asynchronous review of recorded examinations alongside audiometry, either conventional or boothless, may mitigate this problem; however, further research is required.

Tele Otology in India: Last 10 Years-A Scopic Review.

Hearing loss is the commonest sensory deficit among humans, affecting 466 million people worldwide. Early detection is the key to hearing rehabilitation, as speech and language develops early in the childhood. Scarcity of human resources and infrastructure in developing countries like India leads to difficulty in implementation of hearing screening programmes. Tele otology is very fruitful methodology in providing health care facility from distant site to the doorsteps of needy individuals. The action initiated in the field of tele otology in India was reviewed at electronic databases: Pubmed, Google scholar, Medline, Cochrane library, science direct and author mapper using the keywords 'tele otology' and 'tele audiometry' in January 2021. Eligible studies were those related to tele otology and tele audiometry in India. A total of 16 articles were shortlisted for the present study. Tele hearing testing was satisfactory for the parents in regard to accessibility, testing process and counselling. Tele audiometry surveillance shows better overall follow-up compliance rate then in-person audiological surveillance. During covid 19 pandemic virtual approach to the patient through video calling and telephone calls proved handy approach, ensuring safety profile of both health care professionals and patients. Even Tele ABR conducted in tele van shows similar results as in face-to-face mode ABR. Tele otology should be considered by the service providers and policy makers while planning for hearing screening programmes for both new-born and school going children in view of its reliability, low-cost, non-invasive and portability. The village health workers (VHWs) should be well trained in assisting tele practice and internet connectivity should be well established. Tele otology looks very promising in providing health services through the ever-expanding reach of global connectivity.

Long-Term Outcomes of COVID-19 Otolaryngology Symptoms in Saudi Arabia.

OBJECTIVES: The objectives of the study are to measure the prevalence of the most common symptoms and different long-term otorhinolaryngology manifestations among COVID-19-positive patients in Saudi Arabia. METHODS: This is a cross-sectional study. Data were collected using a Google form questionnaire sent to the study sample. The data were entered and then analyzed using SPSS version 25.0 (IBM Corp, Armonk, NY). RESULTS: A total of 13,530 COVID-19-positive adult patients were enrolled in the current study. The most reported initial symptom was fever (53.3%) followed by headache (49.3%), sore throat (48.9%), nasal congestion, rhinorrhea (42.1%), and loss of smell and/or loss of taste (37.8%). Regarding the continuation of the symptoms, vertigo was mentioned by 5852 (43.3%) followed by fever (16.1%) and blocked ear sensation (15.6%). CONCLUSION: The most commonly reported initial symptom was fever followed by headache. Interestingly, vertigo is a frequent long-term complication after a COVID-19 infection. Other otology-related symptoms include hearing loss and ear blockage, while rhinology and upper airway-related symptoms were less frequent in the long term after the acute phase of the infection.

A Tried and Tested Waterproof Draping Method for Major Ear Surgery.

Preparing and maintaining a clean operative field is the standard of care in all surgical fields globally. Major ear surgery has its own challenges such as the long surgical procedure time and the tricky local anatomical landscape. A waterproof method of draping for major ear surgery is described in this technical report. This method allows for the collection of irrigation fluid in a reservoir while maintaining continued isolation of the operative field during surgery. We discuss the advantages of using a 3M Steri-DrapeTM Aperture Pouch Drape to square the surgical site and create a pouch dedicated to irrigation fluid. Following that, running locking stitches are performed for further reinforcement of the adhesion to the skin, often done in longer procedures. We have identified a technique to ensure better draping. In over 150 cases draped in this method, we have not witnessed drape edge lift, water ingress, or skin avulsion/injury.

Evaluation of cost data associated with pediatric cochlear implantation (CI) throughout 2016-2021.

INTRODUCTION: Cochlear Implants (CI) are a mainstay in the treatment of severe sensorineural hearing loss with proven cost-effectiveness and improved quality of life. However, costs associated with CI are variable. During the Covid-19 pandemic, elective surgeries decreased. The investigation into how the pandemic affected CI procedures, costs, and demographic utilization has not been elucidated. METHODS: A retrospective cohort study using the Pediatric Health Information System® (PHIS) database, which consists of 50 children's hospitals, was performed. Regions were defined according to PHIS guidelines. We evaluated number of CIs, total charges and costs, Charge to Cost Ratios (CCR), demographic information, and subgrouped this analysis by region throughout 2016-2021. Charges were adjusted by CMS wage index for hospital location. RESULTS: During the years of 2016-2021, there was a rising number of CIs every year except for 2020 which had a decrease, largely driven by the southern and midwestern regions. The median number of cases did not differ between the years. The median adjusted charges increased every year, but not significantly ($103,883-$125,394). The median CCR also did not differ throughout the years (2.7-3.1). Still, there was a larger interquartile range in 2021 (2.3-4.4) for the median CCR compared to all other years (2.1-3.8), particularly in the South. The percentage of white, non-Hispanic/Latino patients who underwent CI was larger in 2020-2021 (78-79.8 %) compared to 2016-2019 (73.3-77.5 %). CONCLUSIONS: The number of CIs in 2020 was lower than in 2019 or 2021. The median CCR for CI procedures increased from 2016 to 2021 but not significantly. The range of CCR was larger in 2021 compared to the years prior, suggestive of cost shifting by some hospitals to offset the loss in revenue. There was a small but significant increase in white, non-Hispanic patients receiving CI in 2020 and 2021, suggestive of a socio-economic shift in care post pandemic.

A balancing act: changing the referral pathway following remote consultations for dizziness during the coronavirus disease 2019 pandemic.

BACKGROUND: This paper reports our experience in managing dizzy patients remotely during the coronavirus disease 2019 pandemic, and explored its safety as an alternative to face-to-face consultations. METHODS: Dizzy patients referred by their general practitioner were contacted to answer a validated questionnaire. Clinicians recorded the time needed for consultations, and the diagnosis at each of the following assessment stages: after review of the electronic general practitioner letter; following completion of the questionnaire; following the telephone consultation; and/or at follow up. Patients were telephoned no earlier than three months later to determine satisfaction with the service and symptom resolution. Electronic patient records were checked for presentation to hospital because of dizziness. RESULTS: Seventy patients had telephone consultations. None presented to the emergency department or were admitted. The majority of consultations took 15-30 minutes. The most diagnosed condition was benign positional paroxysmal vertigo. Seventy-nine per cent of patients were satisfied with the service. The questionnaire and telephone consultations demonstrated the greatest diagnosis agreement (κ = 0.40). CONCLUSION: Validated questionnaire and telephone consultations are a safe alternative to face-to-face consultations. Our patient referral pathway has now changed to include elements of the questionnaire.

A rare case of external ear canal stenosis caused by COVID-19-related arterial thrombosis.

Thrombosis is a characteristic symptom of coronavirus disease 2019 (COVID-19). Here, we present a case of external ear stenosis caused by arterial thrombosis after COVID-19 infection. To the best of our knowledge, this is the first report of external ear stenosis related to COVID-19. A 62-year-old man presented with left hearing loss. The patient had a history of hospitalization for COVID-19 treatment 11 months prior to visiting our hospital. He had been experiencing ear fullness and tinnitus after COVID-19 treatment. Physical examination revealed severe left external ear canal stenosis with a subcutaneous mass. Surgical removal of the subcutaneous mass was performed. Histopathological analysis revealed that a subcutaneous thrombosis caused the external ear canal stenosis. This case describes an unusual case of external ear canal stenosis after COVID-19. Clinical and pathological findings indicate that COVID-19 affected the external ear canal. In addition, histopathological results confirmed the formation of arterial thrombosis in the temporal bone region after COVID-19 treatment. This case shows the broad range of body sites that can be involved with thrombotic events with COVID including the subcutaneous tissue around the outer ear. This observation would be helpful in investigating or explaining the various otological symptoms of COVID-19.

A novel approach to myringotomy simulation.

OBJECTIVE: In the wake of the 2019 coronavirus disease pandemic, elective cases and opportunities for clinical application have decreased, and the need for useful simulation models has become more apparent for developing surgical skills. A novel myringotomy with ventilatory tube insertion simulation model was created. METHODS: Residents across all levels at our institution participated in the simulation. Participants were evaluated in terms of: time of procedure, microscope positioning, cerumen removal, identification of middle ear effusion type, canal wall trauma, tympanic membrane damage and tube placement. RESULTS: Eleven residents participated. Scores ranged from 14 to 34, out of a maximum of 40. The average score among junior and senior residents was 24 and 31, respectively. The simulation was felt to be representative of the operating theatre experience. CONCLUSION: This study demonstrates a low-cost simulation model that captures several important, nuanced aspects of myringotomy with tube insertion, often overlooked in previously reported simulations.

SELF-REPORTED OLFACTORY, GUSTATORY AND OTOLOGIC DYSFUNCTIONS AMONG COVID-19 POSITIVE ADULTS IN NIGERIA- A PRELIMINARY REPORT

INTRODUCTION: The pathophysiology of COVID-19 is evolving. We investigated self-reported sudden loss of sense of smell and taste, and otologic disorders among COVID-19 patients. METHODS: This was a case-control olfaction, gustation and otology study of COVID-19 RT-PCR tested adults. The study took place at the isolation centres for COVID-19 positive individuals in Abuja and Ibadan, among the epicentres of the disease in Nigeria. The participants were 46 COVID-19 positive adults and 46 COVID-19 negative adults. They responded to a validated online questionnaire-based on olfactory, gustatory and auditory loss. Chi-square tests and correlation analysis was done. Level of significance was at P<0.05. RESULTS: Among cases, sudden loss of smell, taste and hearing were reported by 14 (30.4%), 8 (17.4%) and 5 (10.9%) cases respectively during the COVID- 19 infection. First symptom was loss of smell in 7 (15.2%) and loss of taste in 2 (4.3%) cases. The controls did not present with any of the symptoms. There was no significant correlation between loss of smell and age (r = 0.023, p=0.879);sex (r = -0.132, p=0.382) and co-morbidities (r = -0.028, p = 0.857). Similarly, there was no significant correlation between loss of taste and age (r = 0.052, p = 0.732);sex (0.040, p = 0.792) and co-morbidities (r = -0.014, p = 0.925). CONCLUSION: Sudden loss of smell and taste are commoner among COVID - 19 positive adults than those without the infection in Nigeria. There is evidence of associated reduction in hearing acuity but further study with objective audiometric testing is recommended.

USING FLIPPED CLASSROOM FOR TEACHING PROCEDURAL SKILL IN RESIDENCY SPECIALLY DERMATOLOGY-A SYSTEMATIC REVIEW

Objective: To review the available literature investigating effectiveness of flipped classroom (FC) in context to teaching of procedural skills in residency in various medical fields especially in dermatology. Study Design: Systematic review. Place and Duration of Study: Flipped classroom meeting out inclusion criteria published in 9 years from 2012 to 2020. Methodology: Flipped classroom meeting out inclusion criteria published in 9 years from 2012 to 2020 were reviewed by the authors and co-authors as per their feasibility and discussion done by video conferencing by mobile software apps. Results: To review of 25 full-text articles. Strategic organization of course material, wise choice of pre-class activities, usage of Virtual learning environment, class time utilization tailored to learners needs, adherence to timelines, proper training of staff and proper evaluation;are required for successful implementation of flipped classroom. Students had positive perceptions about this technique. Conclusion: Flipped classroom is an effective teaching method for procedural skills training in post graduate medical training.

Primary presentation of sarcoidosis with profound bilateral sensorineural hearing loss.

We present a case of a 7-year-old Afro-Caribbean girl presenting with rapidly progressive bilateral sensorineural hearing loss. She was found to have an elevated Angiotensin converting enzyme (ACE) and mediastinal lymphadenopathy containing non-caseating granulomas with multinucleate giant cells, in keeping with sarcoidosis. Cranial imaging demonstrated labyrinthitis. She underwent urgent bilateral cochlear implantation with rehabilitation of hearing sufficient to restart education within 1 month.

Feasibility study of the Vitom 3D exoscope in ENT surgery using an animal model: relevance to coronavirus disease 2019.

OBJECTIVE: The application of a 4K display resolution three-dimensional exoscope system (Vitom 3D) was evaluated to determine the feasibility of adopting the system in ENT surgery in the coronavirus disease 2019 era and beyond. METHODS: Eighteen ENT surgeons performed structured otological tasks on fresh-frozen sheep heads using the Vitom 3D. Structured feedback of the participants' experience was analysed. RESULTS: Seventy-four per cent and 94 per cent of participants reported that the Vitom 3D was ergonomic and comfortable to use respectively. Whilst colour fidelity and image quality were very good, 50 per cent of participants reported image distortion and pixilation at the highest magnification. All participants agreed that there was an increased educational value to exoscope technology. Half the participants preferred the microscope over the Vitom 3D for fine otological work, which may reflect the learning curve. CONCLUSION: The Vitom 3D exoscope is a promising and viable alternative for performing otological surgery when using full personal protective equipment in the coronavirus disease 2019 era.

Radiological findings in spontaneous cerebrospinal fluid leaks of the temporal bone.

BACKGROUND AND OBJECTIVE: Spontaneous cerebrospinal fluid leak of the temporal bone is an emerging clinical entity for which prompt and accurate diagnosis is difficult given the subtle signs and symptoms that patients present with. This study sought to describe the key temporal bone abnormalities in patients with spontaneous cerebrospinal fluid leak. METHODS: A retrospective cohort study was conducted of adult patients with biochemically confirmed spontaneous cerebrospinal fluid leak. Demographics and radiological features identified on computed tomography imaging of the temporal bones and/or magnetic resonance imaging were analysed. RESULTS: Sixty-one patients with spontaneous cerebrospinal fluid leak were identified. Fifty-four patients (88.5 per cent) underwent both temporal bone computed tomography and magnetic resonance imaging. Despite imaging revealing bilateral defects in over 75 per cent of the cohort, only two patients presented with bilateral spontaneous cerebrospinal fluid leaks. Anterior tegmen mastoideum defects were most common, with an average size of 2.5 mm (range, 1-10 mm). CONCLUSION: Temporal bone computed tomography is sensitive for the identification of defects when suspicion exists. In the setting of an opacified middle ear and/or mastoid, close examination of the skull base is crucial given that this fluid is potentially cerebrospinal fluid.

The remote neuro-otology assessment - managing dizziness in the coronavirus disease 2019 era.

BACKGROUND: Coronavirus disease 2019 and other factors have driven interest in conducting remote consultations, but there has been little research on this topic in neuro-otology. With suitable preparation, neuro-otology patients with dizziness can have remote assessments that include elements of neuro-otological physical examination, with tailored management and onward pathways arranged. METHODS: This paper reports experience with remote consultation in over 700 neuro-otology patient consultations and suggests a systematic approach, illustrated by a clinical case report and data on 100 consultations. CONCLUSION: Remote consultations can play a role in neuro-otology clinics. Further research is needed to establish patient acceptability, diagnostic accuracy, safety and efficiency of remote models of care for this patient group.

Continuation of telemedicine in otolaryngology post-COVID-19: Applications by subspecialty.

OBJECTIVE: The purpose of this paper is to review the literature and compile key clinically relevant applications of telemedicine for use in otolaryngology relevant to the post-COVID-19 era. STUDY DESIGN: Systematic Literature Review. DATA SOURCES: Pubmed and Google Scholar. REVIEW METHODS: Pubmed and Google Scholar were queried using combined key words such as "telemedicine," "covid" and "otolaryngology." The searches were completed in March-August 2020. Additional queries were made with particular subspecialty phrases such as "rhinology" or "otology" to maximize yield of relevant titles. Relevant articles were selected for abstract review. Applicable abstracts were then selected for review of the full text. RESULTS: Initial search identified 279 results. These were screened for relevance and 100 abstracts were selected for review. Abstracts were excluded if they were not in English, not related to otolaryngology, or if the full text was unavailable for access. Of these, 37 articles were selected for complete review of the full text. CONCLUSION: The sudden healthcare closures during the COVID-19 pandemic resulted in a sharp increase in the use of telemedicine, particularly in subspecialty fields. Otolaryngologists are at a unique risk of infection resulting from the examination of the head and neck and aerosol-generating procedures due to the predilection of viral particles for the nasal cavities and pharynx. The COVID-19 pandemic may have served as a catalyst to implement telemedicine into clinical practice, however identifying ways to integrate telemedicine long term is key for a sustainable and viable practice in the post-COVID-19 era. Although many states are now finding themselves on the down-sloping side of their infection rate curve, many others remain at the apex. Additionally, the risk of future waves of this pandemic, or the onset of another pandemic, should not be overlooked. Practice modification guidelines that mitigate infection risk by utilizing telemedicine would be useful in these instances. Telemedicine can help to reduce infection spread by limiting unnecessary in-person interactions and help conserve personal protective equipment (PPE) by facilitating remote care with the added benefits of expanding care to broad geographic areas, limiting cost, time, and travel burden on patients and families, and enabling consistent follow up.

Use of a novel drape 'tent' as an infection prevention control measure for mastoid surgery.

BACKGROUND: Mastoid surgery is an aerosol-generating procedure that involves the use of a high-speed drill, which produces a mixture of water, bone, blood and tissue that may contain the viable coronavirus disease 2019 pathogen. This potentially puts the surgeon and other operating theatre personnel at risk of acquiring the severe acute respiratory syndrome coronavirus-2 from contact with droplets or aerosols. The use of an additional drape designed to limit the spread of droplets and aerosols has been described; such drapes include the 'Southampton Tent' and 'OtoTent'. OBJECTIVES: To evaluate the use of a novel drape 'tent' that has advantages over established 'tent' designs in terms of having: (1) a CE marking; (2) no requirement for modification during assembly; and (3) no obstruction to the surgical visual field. RESULTS AND CONCLUSION: During mastoid surgery, the dispersion of macroscopic droplets and other particulate matter was confined within the novel drape 'tent'. Use of this drape 'tent' had no adverse effects upon the surgeon's manual dexterity or efficiency, the view of the surgical field, or the sterility. Hence, our findings support its use during mastoid surgery in the coronavirus disease 2019 era.