CSO (Canadian Society of Otolaryngology - Head & Neck Surgery) position paper on return to Otolaryngology - Head & Neck Surgery Clinic Practice during the COVID-19 pandemic in Canada.

The novel Coronavirus (COVID-19) has created a worldwide deadly pandemic that has become a major public health challenge. All semi-urgent and elective medical care has come to a halt to conserve capacity to care for patients during this pandemic. As the numbers of COVID-19 cases decrease across Canada, our healthcare system also began to reopen various facilities and medical offices. The aim for this document is to compile the current evidence and provide expert consensus on the safe return to clinic practice in Otolaryngology - Head & Neck Surgery. These recommendations will also summarize general precaution principles and practical tips for office across Canada to optimize patient and provider safety. Risk assessment and patient selection are crucial to minimizing exposure to COVID-19. Controversial topics such as COVID-19 mode of transmission, duration of exposure, personal protective equipment, and aerosol-generating procedures will be analyzed and discussed. Practical solutions of pre-visit office preparation, front office and examination room set-up, and check out procedures are explored. Specific considerations for audiology, pediatric population, and high risk AGMPs are also addressed. Given that the literature surrounding COVID-19 is rapidly evolving, these guidelines will serve to start our specialty back into practice over the next weeks to months and they may change as we learn more about this disease.

Prevention of central venous catheter-related coagulase-negative staphylococcal sepsis in neonates.

A randomized, double-blind, controlled trial was conducted to determine whether vancomycin added to parenteral alimentation solution given via a central venous catheter would decrease the incidence of catheter-related coagulase-negative staphylococcal sepsis. Seventy infants with a central venous catheter (CVC) in place were randomly selected to receive total parenteral nutrition--either the standard solution or a solution containing 25 micrograms of vancomycin per milliliter. Catheter-related sepsis was defined as the isolation of the same bacterial species from specimens of both peripheral and CVC blood with the concentration of bacteria at least tenfold greater in the specimen obtained from the CVC. Specimens from the CVCs were cultured on removal of the catheters to determine colonization. The colonization of catheters by coagulase-negative staphylococci was reduced from 40% to 22% (p = 0.03) in the vancomycin group; catheter-related sepsis was reduced from 15% to no cases (p = 0.004). Fewer infants required CVC reinsertion in the vancomycin-treated group (p = 0.02), who also regained birth weight earlier (13.4 vs 17.1 days (p = 0.014)). Adverse effects of vancomycin infusion were not observed. We conclude that vancomycin added to the solution used for total parenteral nutrition effectively reduces catheter-related sepsis in the neonatal intensive care unit and offers other potential benefits such as the need for fewer catheters and earlier weight gain. However, we do not recommend widespread implementation of this technique until there are data regarding the emergence of vancomycin-resistant organisms.

Prenatal sonographic evidence supporting an in utero developmental etiology of Möbius sequence.

Möbius sequence features masklike facies with sixth and seventh nerve palsy and frequently micrognathia thought to result from a neuromuscular deficiency in early movement of the mandible. Failure to thrive in infancy is commonly due to feeding and aspiration difficulties. We present the first description of prenatal sonographic findings associated with this lesion, which also support an in utero developmental etiology of this rare condition.

Stapes surgery: subjective and objective results revisited.

In 1980 we presented a retrospective review of one surgeon's experience with stapes surgery. The results were disappointing both from the standpoint of hearing results and patient satisfaction. Because of those findings we modified both indications for surgery and our surgical technique. A second subjective and objective review was carried out between 1980 and 1992. We are pleased to report that both the subjective and objective findings are markedly improved, but there is still room for further improvement and our surgical technique will again be modified.

Neonatal Trichosporon beigelii infection: report of a cluster of cases in a neonatal intensive care unit.

Trichosporon beigelii, a ubiquitous yeast found in soil, causes superficial dermatologic infections in normal hosts and rare cases of disseminated disease among immunocompromised patients. Neonatal cases are exceptionally rare. We report a cluster of cases of T. beigelii infections in a tertiary care hospital in Rochester, NY, during May to July, 1991. Three cases occurred in very low birth weight premature infants (23 to 25 weeks of gestation), two of whom died. The organism was isolated from urine alone in one case, skin and blood in one case and blood, tracheal aspirate and central venous catheter tip in one case. In a fourth, full term infant with respiratory distress syndrome T. beigelii was grown only from a femoral central venous catheter tip with no clinical evidence of infection. An epidemiologic investigation was performed and the mode of transmission in this outbreak was not identified, although cross-infection was suspected in the initial two cases. Our isolates were inhibited but not killed by usually achievable concentrations of amphotericin B. T. beigelii may cause outbreaks of serious infection in neonatal intensive care units, especially among premature infants.

Epistaxis: efficacy of arterial ligation and long-term outcome.

Epistaxis is the most common otolaryngologic emergency requiring hospital admission. Patients with this disorder are usually managed conservatively beginning with the simplest mode of treatment with surgical arterial ligation being reserved for cases of failed nasal packing. The purpose of this retrospective review was to evaluate the efficacy of arterial ligation and document all of the complications secondary to these procedures, especially the minor complications secondary to transantral internal maxillary artery (IMAX) ligation. A total of 402 patients admitted to the Vancouver General Hospital between 1980-1990 with a primary diagnosis of epistaxis were the basis for this review. The hospital charts of those patients who underwent arterial ligation were reviewed. A phone questionnaire was directed to this group. External carotid artery (ECA) ligation was associated with a high rate of rebleeding (9/20-45%) during the 10 year follow-up period. IMAX ligation was an effective procedure for controlling epistaxis with a small number of rebleeds (3/29-10%). Although few major complications were noted in the IMAX ligation group, frequent minor complications were noted on prolonged follow-up. Despite this, patient satisfaction was very good in the IMAX ligation group.

Acinic cell carcinoma of the parotid gland: review and management.

The purpose of this retrospective review is to study the management of a rare malignant tumor of the parotid gland, the acinic cell carcinoma. Incidence, pathology, clinical findings, and diagnosis are reviewed. Twenty-five patients were seen at the British Columbia Cancer Agency (BCAA) for initial treatment, recurrent disease or follow-up during the period 1958-1990. Twenty-two acinic cell carcinomas (ACC) occurred in the parotid gland. Surgical treatment regimens for parotid ACC ranged from local excision to radical excision. Local excision is not advised but superficial parotidectomy alone appears to have been adequate treatment for small superficial tumors. Eleven of 22 patients received radiotherapy. Indications for adjuvant postoperative radiotherapy are given. Nine patients with primary tumors treated with combined therapy are alive and disease-free with a mean follow-up of 10.7 years. Postoperative radiotherapy appears to be effective in eradicating microscopic residual disease although long-term follow-up is necessary to make these results clinically significant.

Deficits for representational memory induced by septal and cortical lesions (singly and combined) in rats.

A differentiation was made between dispositional memory and representational memory. A delayed-nonmatching-to-sample task in a T-maze operationalized this distinction. Experimental brain lesions in posterior septum and in prelimbic cortex resulted in amnesia for representational memories. The amnesia ameliorated as a function of continued reinforced postoperative testing. When lesions were placed in both structures in the same animals, amnesia for representational memories also occurred, and with further testing, the amnesia ameliorated as indicated by group data. However, examination of the behavioral performance and the lesions in individual animals revealed that when both lesions were adequate, choices remained at chance levels, results suggesting permanent amnesia for representational memories. That the lesion-induced amnesia was restricted to representational memory was indicated by the fact that the rats displayed no amnesia for dispositional memories regarding what to do in the maze. They did not act like naive animals, as they should if they had forgotten the dispositional memories necessary for successful T-maze performance.