Outcomes of coblation tonsillectomy versus bipolar electrocautery tonsillectomy in pediatric population

Background: Bipolar electrocautery tonsillectomy has been the preferred technique for many otolaryngologists, yet coblation tonsillectomy is gaining popularity in the current practice. This study aims at comparing both techniques in terms of pain, bleeding, and healing. Result(s): A total of 120 patients were randomly divided into two equal groups. Overall mean pain score associated with coblation tonsillectomy was statistically less than that caused by bipolar electrocautery throughout the follow-up period (p < 0.001). The difference in pain duration was statistically longer for the bipolar group. The incidence of postoperative hemorrhage-both reactionary and secondary-was statistically higher in the bipolar group. Coblation tonsillectomy showed statistically shorter duration of healing (p < 0.001). Conclusion(s): Coblation tonsillectomy is associated with less pain severity and shorter pain duration, fewer bleeding incidents, and more prompt healing.Copyright © 2022, The Author(s).

COVID-19 as a turning point in the need for specialized units for the sense of smell

Background: The unprecedented prevalence of olfactory disfunction (OD) by SARS-CoV- 2 has revealed the lack of specialized units dealing with sense of smell. The main objective of the study is to know the number of newly created olfactory units (OU) since the COVID-19 pandemic, as well as to evaluate the diagnosis, management and treatment of patients with OD. Method(s): Prospective cross-sectional study. Carried out by means of a survey with 20 items: having or not having an OU, demographic data, smell test, evolution and management of OD, data on treatments. The variables of the survey were approved by the rhinology commission of the Spanish society of ENT. The digital survey was distributed to all members of Spanish ENT and Allergy Societies. Result(s): A total of 16 responses were missing data, and further 12 responses were duplicated. Finally, 136 surveys were included. From them 82.4% answers were from otolaryngologists and 17.7% from allergists. The cohort of allergists and otolaryngologists was compared to ensure comparability of both samples. There were significant differences in the instrumental assessment of the olfaction, VAS and smell test (p = 0.016) was more common in otolaryngologists. Also, the prescription of olfactory rehabilitation (OR) (p < 0.001) was more common in otolaryngologists. The 40.5% (+/- 7.6) of all the existent OU were created after COVID-19 pandemics. The 33.9% (+/- 4.5) of the respondent have an OU now, while 22.3% (+/- 3.9) already had it before COVID-19 pandemics. It means that 17% of hospitals who did not have an OU before COVID-19, now they have it, while 82.8% are still lacking it. OR was prescribed for 1-3 months by 38%;3-6 months by 48.1% and > 6 months by 13.9%. Those with an OU prescribe OR during more time (p = 0.002) being the most frequent answer 3-6 months (69.4%) when they have OU while 1-3 months (52.4%) for those who do not have it. Conclusion(s): This study revealed that COVID-19 pandemic has stimulated the creation of OU and has demonstrated the utility of OU to deal with patients with OD, as their daily practice is more adapted to up-to- date clinical evidence between allergist and otolaryngologists.

Iatrogenic tracheal stenosis: another cause of persistent dyspnea after COVID-19

Introduction: During the COVID-19 pandemic, the number of patients who required admission to the intensive care unit (ICU) and prolonged intubation (ETI) or a tracheotomy (TT) due to severe ARDS has increased. Causes of persistent dyspnea after severe COVID-19 pneumonia include diffuse lung disease and pulmonary embolism. However, other causes of persistent dyspnea need to be ruled out in COVID-19 ICU-survivors, including iatrogenic tracheal stenosis (TS). Iatrogenic TS account for 50% of the 15-20 patients evaluated every year in the laryngotracheal multidisciplinary team (MDT) of our center. The management of these patients requires an individualized and multidisciplinary assessment, including Interventional Pulmonologists, Thoracic Surgeons and Otolaryngologists. The objective of this study was to describe the cases of iatrogenic TS after severe pneumonia due to COVID-19. Material(s) and Method(s): A descriptive study of the cases of iatrogenic TS in COVID-19 ICU-survivors evaluated at our center's MDT, from the end of the first wave to present. Result(s): A total of 10 patients were included, 70% were women, with a median age of 60 years [53.5-64.5]. The median ICU stay was 58.5 days [34-91]. All patients were intubated and 9 of them (90%) required TT, in 2 cases due to extubation failure. Symptoms at diagnosis included dyspnea in 3 (30%), stridor in 6 (60%) and 1 (10%) was asymptomatic. TS location was glottic in 2 (20%) and tracheal in 8 (80%). The main cause of TS was ring fracture secondary to TT (40%). Conclusion(s): Iatrogenic TS is a rare cause of dyspnea in COVID-19 ICU-survivors, but it must be considered in these patients given the high number of patients who required prolonged ETI or TT during the COVID-19 pandemic.

Telehealth in the times of SARS-CoV-2 infection for the otolaryngologist.

OBJECTIVE: In response to the American Academy of Otolaryngology - Head and Neck Surgery's recommendations to limit patient care activities in the times of SARS-CoV-2, many elective surgeries have been canceled without patient clinics transitioning to virtual visits. With regulations for telemedicine loosened, new possibilities for the practice of otolaryngology have opened. To address the uncertain duration of this pandemic, a review was conducted of current literature on use of telemedicine services in the current SARS-CoV-2 pandemic and in previous national emergencies to reveal the role telemedicine can play for otolaryngology practices. DATA SOURCES: Pubmed articles with an independent search query were utilized. METHODS: Literature review performed by one author searched for all published English-language literature on telehealth in the SARS-CoV-2 era. Articles were considered for discussion if they provided relevant developments for telemedicine in the context of the SARS-CoV-2 pandemic. RESULTS: Telemedicine can be up-scaled in the current SARS-CoV-2 pandemic where exposure containment is of the utmost priority. With patient interaction possible through virtual communication, telemedicine allows continued patient care while minimizing the risk of viral spread. In the realm of otolaryngology, telemedicine has been used in the past during disasters with other studies demonstrating high diagnostic concordance with inpatient visits. Many institutions have recognized the potential for such care as they begin utilize both virtual visits and in-person care during this pandemic. CONCLUSION: To limit the spread of SARS-CoV-2, we support the AAO-HNS recommendation for the adoption of novel ways to employ telemedicine in this era. Many emergency departments and health care systems have the infrastructure necessary for synchronous video telemedicine visits that can be leveraged to provide quality care with patients. With the continued need to socially distance, telemedicine can protect both physicians and patients from unnecessary exposure to the virus.

Factors related to wellness and burnout in academic otolaryngology: A pre- and Post-COVID-19 analysis.

Objectives: Describe demographic and professional factors predictive of burnout in academic otolaryngology before and during the COVID-19 pandemic. Methods: In 2018 and 2020, cross-sectional surveys on physician wellness and burnout were distributed to faculty members of a single academic institution's otolaryngology department. Faculty were dichotomized into low and high burnout groups for 2018 (n = 8 high burnout, 19%) and 2020 (n = 11 high burnout, 37%). To identify protective factors against burnout, three semi-structured interviews were conducted with faculty that reported no burnout. Results: Forty-two participants (59%) in 2018 and 30 out of 49 participants (62%) in 2020 completed the survey. In multivariate analysis of 2018 survey data, full and associate professors had significantly lower odds of high burnout (OR 0.06, 95% CI 0.00-0.53; p = .03). Female gender was associated with increased in odds of high burnout (OR 15.55, 95% CI 1.86-231.74; p = .02). However, academic rank and gender did not remain independent predictors of high burnout in the 2020 survey. We identified significant differences in drivers of burnout brought on by the pandemic, including a shift from a myriad of work-related stressors in 2018 to a focus on patientcare and family obligations in 2020. Interview analysis identified three themes in faculty who reported no burnout: (1) focus on helping others, (2) happiness over compensation as currency, and (3) gratitude for the ability to have an impact. Conclusion: Approximately 20% of faculty reported high burnout before the pandemic, and this proportion nearly doubled during the pandemic. The risk factors and themes identified in this study may help academic otolaryngologists prevent burnout. Lay Summary: Factors driving burnout among academic otolaryngologists during the COVID-19 pandemic transitioned away from research, conferences, and work outside business hours toward family and patient responsibilities. Females report higher burnout and full professors report lower burnout. Level of evidence: III.

The Impact of COVID-19 on Head and neck Surgical Specialties in Southwest England: Planning for Training Recovery

Introduction/Aims: The COVID-19 pandemic disrupted delivery of many surgical services and surgical training programmes. It is now clear that the most negative impact on training has been experienced by those in surgical specialties. We surveyed head and neck surgeons and report the impact of disrupted operating on training and discuss strategies for training recovery. Material(s) and Method(s): We disseminated a ten-question online survey to OMFS, ENT and Ophthalmology surgeons of multiple grades, working across 5 hospital sites in southwest England. We surveyed demographic aspects including age, gender, grade, and workplace. Questions were directed to analyse the impact of the pandemic on operating, training, surgical skills and CPD. Results/Statistics: The response rate was 70%. 96.55% of respondents' elective operating was less than pre-pandemic numbers. 86% reported PPE had made their operating more difficult. 37% of respondents reported feeling they have de-skilled and 27% felt their confidence had reduced. 54% reported compromised training opportunities. However, many felt they had learned new skills, with 70% responding they now had better virtual working and remote consulting skills. Conclusions/Clinical Relevance: Our multi-site survey quantitatively demonstrates the impact the pandemic has had on head and neck surgeons' operating and training. Training recovery is now a priority across all surgical specialties. We suggest a multifaceted approach to training recovery within OMFS, including use of simulation-based education. Copyright © 2022

Parosmia: A Significant Symptom In Covid-19 Recovering Patients

Anosmia is a total loss of the smell, hyposmia is a decrease in the sense of smell, parosmia is a distortion of the smell in the presence of an existing stimulus. Sudden smell loss is a specific early symptom of COVID-19, with an estimated prevalence of ~40% to 75%. Smell impairment affects physical and mental health, and dietary behavior. Thus, it is critical to understand the rate and time course of smell recovery. This study was done to observe the parosmia as a significant symptom in Covid-19 recovering patients during second wave in India. 102 subjects participated in this study. Both male and female adults were included in this study. Questions regarding features of loss of smell, parosmia and taste sensations in covid 19 patients were asked with help of Google forms. 27.77 % subjects had parosmia and 72.22 % subjects had regained normal smell sensation. While smell loss improves for many individuals who lost it due to COVID-19, the prevalence of parosmia increases substantially over time. Olfactory dysfunction is also associated with wider COVID-19 symptoms and may persist for many months after COVID-19 onset. If parosmia is detected, they should be referred to otolaryngologists for scent training. Copyright © 2022, Anka Publishers. All rights reserved.

Hearing Dysfunction in Sjogren's Syndrome

Background. Hearing dysfunction, caused by the involvement of the vestibulocochlear nerve or by direct damage on inner ear structures has been described in patients with Sjogren's Syndrome (SS). Previous studies evaluating the prevalence and incidence of hearing dysfunction in SS showed conflicting results, therefore, to date, the exact prevalence has not been extensively evaluated. Objectives. The aim of this study is to evaluate the prevalence of hearing involvement in patients with primary SS (pSS). Materials and methods. Patients with pSS (AECC criteria) with >=18 years of age attending a dedicated Sjogren's syndrome clinic were consecutively enrolled Auditory function was investigated by pure tone audiometry (PTA), It-Matrix test (Speech Reception Threshold in noise leading to 50% correct sentences-SRT) and the Hearing Handicap Inventory (HHI) during a baseline visit and at a follow up visit. A questionnaire of auto-evaluation of hearing loss impact on life was also administered to the patients. Results. Twenty-five patients with pSS (24 females) were enrolled in the study. The median age was 56.2 years (IQR 49-64) The mean disease duration was 3.7 years, 8 were treated with hydroxychloroquine (HCQ) and 1 with methotrexate. At baseline evaluation PTA revealed hearing loss in 17 patients (68%) with severity ranging from mild to severe. Fifteen patients (60%) presented mild hearing loss, 1(4%) moderate e 1 (4%) severe. The It-Matrix score ranged from -9.9 to 0.9 (median - 3.50). Median HHI score was 12.17 (min 0, max 68, SD 177.9). For Covid restrictions, a follow-up evaluation was available for 10 patients only. In these patients, a worsening of PTA and HHI was observed. Interestingly, the it-Matrix scores of patients with a stable disease showed an improvement. Conclusions. These preliminary findings suggest that hearing involvement is common in patients with SS and that it progresses over time. If confirmed on larger cohorts, these data will be useful for physicians in counseling patients about their disease and, in case of suspicious symptoms, an early evaluation by an otolaryngologist may prevent delay in diagnosis and allow an appropriate diagnostic evaluation and therapeutic intervention.

Prevalence, Recurrences, and COVID-19 Impact on Pediatric Epistaxis

Introduction: Pediatric epistaxis is highly prevalent, yet patient characteristics, frequency of office cauterizations, and outcomes have been minimally described. This study examined the epidemiology and prevalence of epistaxis and potential impact by COVID-19. Method(s): A retrospective summary was performed on all patients (0-18 years) seen/treated for epistaxis by pediatric otolaryngologists within a single health care system across northeast and southeast United States between January 1, 2013, and October 31, 2021. Demographics, geographics, medical history, and office and operating room cauterization were reviewed. Data were analyzed using chi2 and logistic regression. Result(s): Of 9770 unique patients, with 26,699 epistaxis encounters, 62% were male. Median age at first encounter was 8.5 years;50% of patients were White. Encounters were most frequent during the fall (September-November) and least frequent during winter (December-February) with no significant differences. The incidence of epistaxis has significantly increased since the onset of the COVID-19 pandemic (P<.001). Overall, 27% received a procedural intervention, 54% required more than a single visit. Logistic regression revealed age, ethnicity, and geographical region as independent predictors of receiving a procedure on the first encounter, with a model receiver-operating characteristic (ROC) curve with area=0.75 (95% CI, 0.73-0.76). Similarly, procedural intervention, history of allergies, and nasal steroid use were independent predictors of recurrent visits, with a model ROC curve with area=0.79 (95% CI, 0.78-0.80). Conclusion(s): The incidence of pediatric epistaxis is not significantly correlated with seasonality. However, there has been a significant increase in epistaxis encounters during the COVID-19 pandemic. Recurrent visits for pediatric epistaxis were significantly predicted by procedural intervention, allergies, and nasal steroid use.

Upper Airway Manifestations of SARS-CoV-2 Infection During New York City Omicron Wave: A Single-Institution Experience

Introduction: Studies have shown that COVID-19 viral glycoproteins bind to angiotensin-converting enzyme 2 (ACE2) receptors in the airway, causing downregulation of the ACE protein and leading to angioedema-like symptoms. Further, compared with previous variants, the Omicron variant of SARS-CoV-2 appears to replicate more readily in the upper airway than in the lungs. To our knowledge, this is the first case series to explore presentations involving the upper airway in patients with SARS-CoV-2 infection during the Omicron wave of the COVID-19 pandemic. Method(s): We reviewed a case series of adult patients who presented to a single New York City emergency department between December 2021 and January 2022 with acute upper airway symptoms that prompted otolaryngology consultation and who tested positive for SARS-CoV-2. Result(s): Between December 2021 and January 2022, there were at least 3 SARS-CoV-2-positive patients who presented to the New York-Presbyterian Hospital with upper airway conditions requiring evaluation by an otolaryngologist. Conditions included supraglottitis, tracheitis, and epiglottitis. Two patients had received the COVID vaccine;1 had not. One patient required intubation;2 were maintained on room air. One patient was admitted to the intensive care unit, 1 to the step-down unit, and 1 to the floor. Length of stay varied from 3 to 11 days, 1 for nonairway issues. All 3 had methicillinsusceptible/ methicillin-resistant Staphylococcus aureus nasal swabs;2 were positive. All had respiratory viral panels that were negative. One had a throat culture that was negative. All received antibiotics. Conclusion(s): To date, there have been no studies exploring the upper airway manifestations of SARS-CoV-2 infection in the Omicron wave. These data provide important clinical correlates that are highly relevant to otolaryngologists.

Cloud Nine: A Population Study of Sleep During the COVID-19 Pandemic

Introduction: In this study, we aimed to evaluate how the COVID-19 pandemic has affect sleep patterns. To do this, we used the Functional Outcomes of Sleep Questionnaire (FOSQ10) tool among the general US population. Method(s): A Qualtrics survey containing the FOSQ10 questions and additional demographics was created for Amazon MTurk, a crowdsourcing platform. Respondents aged 18 years and older completed the survey anonymously in October 2021. Two-way analysis of variance and 2-tailed t tests were used for analyses. Result(s): A total of 2474 responses were included. The 3 most prevalent sleep disorders were snoring (48% of respondents), insomnia (11% of respondents), and sleep apnea/mild/ moderate/severe (6% of respondents). The 3 most common services and/or procedures that people indicated interest in were sleep study (32% of respondents), nasal appliance (28% of respondents), or oral appliance (22% of respondents). The 3 most common social media platforms used before bed were Facebook (48% of respondents), Instagram (47% of respondents), and YouTube (39% of respondents). Individuals who had COVID-19 had a lower average FOSQ10 score than those who did not (27.0+/-6.4 [SD] vs 29.2+/-7.2), P<.0001. Individuals who snore had a lower average FOSQ10 score than those who do not (27.6+/-6.6 vs 29.4+/-7.4), P<.0001. Individuals who had a romantic partner or family member complain about their sleeping pattern (restlessness, snoring, etc) had a lower average FOSQ10 score than those who do not (27.1+/-6.5 vs 30.0+/-7.3), P<.0001. Individuals who have seen an otolaryngologist about snoring or any other sleep-related problems had a lower average FOSQ10 score than those who have not (26.7+/-6.0 vs 29.4+/-7.4), P<.0001. Conclusion(s): A higher score on the FOSQ10 was found to be associated with better sleep outcomes. It is an appropriate tool for assessing functional outcomes of sleep in the US population and can be used by otolaryngologists to better understand and treat patients with impaired sleep.

Otolaryngology Treatment and Surgical Planning via Telemedicine

Introduction: The objective of this study is to determine the likelihood of diagnosis and accuracy of treatment of various conditions via use of telemedicine services within an academic, multisubspecialty otolaryngology practice located in a COVID-19 hot spot. At the conclusion of this presentation, the participants should be able to understand the role that virtual care can play in otolaryngology, both in terms of diagnosis and management. Method(s): This retrospective cohort study included all telemedicine patient encounters with an otolaryngologist or advanced practice provider between March 17 and August 30, 2020. Pediatric and adult patients who completed a synchronous virtual visit (VV) were included. Patient demographics, new vs return patients, known and unknown visit diagnoses, treatment given and/or surgery scheduled, and recommended in-person follow-up were extracted. If in-person follow-up occurred, the diagnosis, whether scope was performed, and if in-person follow-up changed the diagnosis were extracted. A t test and chi2 analysis were utilized. Result(s): A total of 758 patients completed a VV;388 were new and 370 return patients. New patients were significantly younger than return patients (44.3 vs 48.2 years, P=.014). New patients with a known diagnosis were treated more often than return patients (80.6% vs 67.2%, P=.008). There was no significant difference between new and return patients in treatment given, recommendation for in-person follow-up, rate of in-person follow-up, rate of patients scoped, and if recommendations were made for surgery. Treatment was recommended in 71.1% of encounters, and surgery was recommended in 10.8% of encounters. The endocrine subgroup had the highest rate at 60.6% (CI, 42.1, 77.1) of recommending surgery. Conclusion(s): Telemedicine is an effective tool when used for diagnosis, as well as to recommend treatment and surgery when in-person visits are difficult or not possible.

A HARD PILL TO SWALLOW

SESSION TITLE: COVID-19 Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Epiglottitis is an inflammation of the epiglottis which can be life-threatening in the absence of prompt intervention. Although primarily a pediatric condition, streptococcus pneumonia has been identified as a common pathogen in adults. SARS-CoV 2 has been known to affect a multitude of systems including the upper respiratory tract, but rarely the epiglottis. CASE PRESENTATION: A 66-year-old female with a past history of hypertension, and hypothyroidism presented with acute onset pharyngodynia and dysphagia with a feeling of throat closing up due to swelling and difficulty speaking. She had a recent COVID-19 diagnosis and was doing well except for mild fatigue. Upon presentation, she was hemodynamically stable. Physical exam revealed posterior pharyngeal edema without any exudate, mildly edematous uvula, and no stridor. Laboratory data was pristine except for elevated inflammatory markers. Rapid streptococcal test and MRSA swab were negative. Sputum culture showed usual respiratory flora and blood cultures were negative. A neck CT showed diffuse edema without any evidence of abscess. Laryngoscopy performed by the ENT surgeon revealed diffuse edema including epiglottitis. Emergent intubation revealed supra and epiglottis edema sparing the vocal cords. The patient was given Decadron and Benadryl to help with the edema along with clindamycin and subsequently transferred to ICU for further care. She was treated with Ceftriaxone for 7 days due to a chest X-ray finding of pneumonia. As for COVID 19 treatment, she received a course of Remdesivir and Decadron. Decadron was given at an increased interval to reduce edema around the epiglottis. Her ICU course was complicated with hypotension requiring intermittent vasopressor support, and acute kidney injury from ischemic acute tubular necrosis which slowly improved. Repeat CT chest showed bibasilar consolidations with peripheral ground-glass opacities. In view of hospital-acquired pneumonia, she was started on Ertapenem. Her clinical condition improved and she was successfully extubated. She was shifted to the floors from where she was discharged without any further complications. DISCUSSION: There are only two other reported cases of COVID 19 epiglottitis. The patient's advanced age and obesity were non-modifiable risk factors, but the COVID-19 infection played a role. The virus can lead to excessive upregulation of the host inflammatory response through repeat epithelial and endothelial damage leading to a cytokine storm, which may be responsible for this presentation. A great level of attention is to be maintained while attending to these patients given the multitude of systems that can be affected. CONCLUSIONS: COVID-19 is a potential cause of life-threatening acute epiglottitis. Early suspicion and direct visualization of the epiglottis is the key to success for early management. Reference #1: Emberey J, Velala SS, Marshall B, et al. Acute Epiglottitis Due to COVID-19 Infection. Eur J Case Rep Intern Med. 2021;8(3):002280. Published 2021 Mar 3. doi:10.12890/2021_002280 Reference #2: Smith C, Mobarakai O, Sahra S, Twito J, Mobarakai N. Case report: Epiglottitis in the setting of COVID-19. IDCases. 2021;24:e01116. doi: 10.1016/j.idcr.2021.e01116. Epub 2021 Apr 7. PMID: 33842206;PMCID: PMC8025537. DISCLOSURES: No relevant relationships by Arunava Saha

TRAINING FOR THE MOTHERS OF CHILDREN WITH CLEFT USING INSTRUCTIONAL MANUALS

Background/Purpose: Infants with cleft lip and/or palate require special care from birth in order to adapt to the cleft and overcome insufficient suction, difficulties in breastfeeding, insufficient food intake, and malnutrition. Early nutritional intervention, as well as nutritional care and guidance, are extremely important for them to achieve their potential in terms of growth, development, and preparation for surgery. Mothers should receive training and have access to appropriate feeding assistance to optimize their children's nutrition, health, and survival rate. The purpose is to provide feeding assistance by training mothers, using the manuals prepared by our specialized multidisciplinary team. Methods/Description: Planning, preparation and dissemination of instruction/educational manuals that are accessible and easy to understand, by the team of otolaryngologists, pediatricians, nurses, nutritionists, speech-language therapist, dental professionals, and lactation specialists who prepared straightforward and fun manuals that have been used since May 2021, in treatment centers all over Brazil. Results: Breastfeeding Manual: the importance of breast milk;breast physiology, latching;various breastfeeding positions;expressing breast milk manually or using a pump;best nipple for each cleft, breastfeeding position;burping (eructation);types of milk formulas and dilution, hygiene, and preparation techniques. Manual on Introducing Food and Feeding in the Post-Surgical Feeding and Foods: introducing additional foods, food quality and quantity;techniques to offer food;child positioning;food consistency;care after lip surgery (cheiloplasty) and after palate surgery (palatoplasty), such as: raising the crib;using bracelets to prevent the child from touching his/ her mouth and thus hindering the healing process;when to change the food consistency;weaning from the bottle and pacifier, and the use of glasses and spoons;recipes. Manual Guide to Anthropometric Measurements: teaching mothers to check their children's weight, height, head, thoracic, and brachial circumference and to send this information to nutritionists/pediatricians, for monitoring and interventions, as needed. Conclusions: Since the onset of the COVID-19 pandemic, the need to provide training to the parents of patients with cleft has become increasingly evident, so as to provide nutritional care at home needed for the appropriate growth and development of infants, even with less frequent in-person appointments. Considering that cleft babies begin to be submitted to surgical procedures at 3 months old, nutritional care must include growth, development, and preparation for these surgeries. Providing support for the mothers is essential for them to overcome challenges and to adopt best practices in feeding their children. Training them to do that is certainly the best way. This work was supported by Smile Train, Inc.

Challenges in pediatric otolaryngology in the COVID-19 pandemic: insights from current protocols and management strategies

The incidence of COVID-19 infection in infants and children is low and most cases have only few (rhinitis, fever) or no symptoms. However, a high viral load may be present in the upper and lower airways thus imposing specific precautions for ENT surgeons taking care of children. In the next paragraphs, we will discuss some situations upon a background of available guidelines for outpatient and in-patient management.

An Invitation to Commentary on Using Telemedicine within Otolaryngology Practice during the Covid-19 Catastrophe

The COVID-19 epidemic had a significant impact on how otolaryngologists deliver care and treatment to their patients in the outpatient setting. Throughout this Public Health Emergency (PHE), maintaining a continuum of care with existing patients and establishing a relationship with potential patients is difficult. State and municipal governments have issued orders for the citizens to remain at homes and stay under shelters in several places to prevent the spread of COVID-19.Wide adaptability in providing services via remote communications technology has been allowed to avoid exposure concerns to healthcare professionals, patients, and the general public. The use of telehealth or online services will allow otolaryngologists to provide essential care to patients while reducing the pandemic's clinical and budgetary burden. It increases the continuum of care, lowers costs, and enhances patient self-management and overall results, according to studies, notably in the treatment of distinct disease states. [1]The considerable coding and billing challenges associated with deploying telehealth services are explained to encourage otolaryngologists to adopt this technology.

Treating COVID-19 patients with smell loss in the otolaryngology clinic: Approach, management and prognosis

A full year has passed since patients were first seen in their medical and otolaryngology clinics with reported acute onset and often profound smell and taste loss that were soon linked to the SARS-CoV-2 virus. While studies vary in their prevalence, roughly 50% of patients with COVID-19 are estimated to suffer from viral-induced chemosensory dysfunction with approximately 5-25% experiences some extent of persistent smell and/or taste loss. The widespread screening of COVID-19 has allowed for a heightened clinical awareness in the early onset of one's olfactory dysfunction with a known viral etiology. Despite the high spontaneous recovery rate, persistent smell loss and qualitative olfactory dysfunctions such as parosmias have developed in an unfortunate subset of COVID-19 patients. Thus, consideration for early onset therapy may be appropriate and physicians have the opportunity to recommend treatment options for acute and chronic COVID-19 associated olfactory loss. Preliminary studies have suggested efficacy with the use of olfactory training as well as topical and oral steroids for olfactory loss, and topical sodium citrate for qualitative olfactory symptoms. Early longitudinal data have also suggested that the increased severity of smell dysfunction and the female gender may predispose to long term olfactory loss. Perhaps equally as important as the therapeutic management of smell loss is the counseling provided and the understanding of the impacts of olfactory dysfunction on quality of life and mental health. In this symposium talk, we will review the literature and discuss the approach and management that an otolaryngologist might provide to patients suffering from acute and chronic COVID-19 related olfactory loss.