The CSO-HNS is collecting information from multiple sources to try to catalog the information in one place for use by members. The information is changing rapidly and we will endeavour to post information but cannot guarantee the accuracy of the information. Please use your clinical judgement in following any of these sources.
Monitor COVID-19 Case Trajectories World-wide – DASH BOARD
Personal Protective Equipment (PPE)
Guidance for Health Care Workers Performing Aerosol Generating Medical Procedures during the COVID-19 Pandemic – PDF document
N95 mask reprocessing from the The Netherlands National Institute for Public Health and the Environment – PDF document
N95 mask alternative from Boston’s Children’s Hospital –youtu.be/Es_iY5WJdml
CDC recommendations on how to extend the life of N95 masks – https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html
Stanford Covid-19 Town Hall (the entire 2+ hour video is useful, for some discussion of N95 and PAPR, go to approximately 1:06 to 1:14 hours on the timeline) Available Streaming Online via ZOOM – https://stanford.zoom.us/rec/share/4o9bIJTU8F1LZIXKzHzPRqMHAdvLeaa80CcZqfdbnR0clnG_taBOr68Z2TMwNU-2
Download 480p (1.1 GB) https://stanfordmedicine.box.com/s/unke9g5pllmdmp09yeyiq2qgkif100qq
Personal Protective Measures in the Princess Margaret Head and Neck Cancer Clinic – https://www.entcanada.org/wp-content/uploads/Personal-Protective-Measures-in-the-PMH-Head-and-Neck-Cancer-Clinic-Mar24.pdf
Michael Garron Hospital video on proper technique for taking PPE on and off –https://dp3bdcel5emcu.cloudfront.net/fbf516c9-3c9a-4701-9fea-fa56a5dbe2b7/DonningAndDoffingPPE_Web2/story.html?980
Powered Air-Purifying Respirator (PAPR)
PAPRs are reusable respirators that are typically loose-fitting hooded or helmeted. They are equipped with a battery-powered blower to force air through a particle filter for the wearer to breath. They are capable of reducing airborne exposures at efficiencies that typically exceed the N95 and EHFR, using a high-efficiency particulate air filter (information from the Department of Health and Human Services, Centre for Disease Control and Prevention, United States).
CSO-HNS: Recommendations from the CSO-HNS Taskforce on Performance of Tracheotomy During the COVID-19 Pandemic – PDF document
United Kingdom: Guidance for Surgical Tracheostomy and Tracheostomy Tube Change During the COVID-19 Pandemic – https://www.entuk.org/tracheostomy-guidance-during-covid-19-pandemic
ENT UK Framework for Open Tracheostomy in COVID-19 Patients – PDF document
Wei WI et al. Safe tracheostomy for patients with severe acute respiratory syndrome*. Laryngoscope 2003:113;1777-9 – https://onlinelibrary.wiley.com/doi/full/10.1097/00005537-200310000-00022
*Three case reports during SARS in Hong Kong; the key points emphasized in doing the actual airway entry were paralyzing the patient with no ventilation occurring to avoid a “super spreader” event.
Sinus / Skull Base Surgery
Precautions for Endoscopic Transnasal Skull Base Surgery During the COVID-19 Pandemic* (Standford University School of Medicine, Department of Otolaryngology-Head and Neck Surgery and Neurosurgery) – PDF document
*Please note: The decision was made not to embargo this information given the urgent need to get this material out (to be published in Neurosurgery).
European Rhinologic Society – https://www.europeanrhinologicsociety.org/?page_id=2143
COVID-19 and Ear Surgery courtesy of R.K. Jackler, Stanford University – PDF document
Head & Neck Oncologic Surgery
- NCAL HN Oncological Surgery in COVID Era – PDF document
- AHNS COVID-19 Bulletin: How COVID-19 is Affecting our Head and Neck Community – PDF document
- Recommendations from the OHNS Department at University Health Network led by Ralph Gilbert in Toronto for head & neck oncologic procedures: (1) All procedures that include any instrumentation of the upper airway including the oral cavity and nasopharynx should be treated as high risk procedures and all staff in the operating room should be protected with PPE – For nursing and surgical staff this includes N95 masks, eye protection, gowns and gloves. Surgical staff may use loops if required for the surgical procedure. (2) All other procedures should be managed as per operating room standard. (3) Where possible we should work to minimize the number staff in the room during the aforementioned procedures, this includes residents and fellows who are not required for performance of the surgical procedure. (4) All patients that are scheduled for surgical procedures of the upper airway including the oral cavity will undergo COVID-19 screening 48hrs prior to the planned surgical procedure, should they test positive, their procedures will be deferred until screened negative. (5) COVID-19 screening can take place at a regional COVID-19 testing centre closest to the patient. (6) For high risk procedures as defined above; the department recommends that oral cavity and nasal sites be separated from the remainder of the surgical sites for procedures such as neck dissection and parotidectomy. Techniques include the application of adhesive and sterile drapes.
- Endocrine Surgery during the Covid-19 pandemic
The AHNS Endocrine Surgery Section felt that it might be useful to have some guidance on endocrine surgery cancellation given the Covid-19 pandemic. These are loosely adapted to those of the ESES. These are just suggestions as to which patients may need to move forward with surgery now. The specific decisions would be in the context of local hospital and community resources, directives and importantly surgeon judgment. The duration of postponement is not currently widely agreed upon. Also with any patient being brought to the OR now or in the future given spread possible from intubation of asymptomatic Covid -19 patients all patients should be considered for COVID-19 testing
- Life-threatening or severely symptomatic Graves’ that cannot be controlled medically
- Goiter causing airway compromise with airway symptoms and tracheal narrowing
- Thyroid cancers that are imminently threatening the life or the health of the patient such as those with short double timings or aggressive recurrences.
- Open biopsy to confirm a suspected diagnosis of anaplastic thyroid cancer or thyroid lymphoma in order to direct appropriate treatment.
- HPT with life-threatening hypercalcemia that cannot be controlled medically
- Endocrine disorders dangerous to the health of the mother or fetus that cannot be controlled medically
Brendan Stack AHNS Endocrine Surgery Section Vice Chair
Greg Randolph AHNS Endocrine Surgery Section Chair
Pediatric Otolaryngological Surgery
Message (March 23, 2020), President of the American Society of Pediatric Otolaryngology (ASPO) – https://www.entnet.org/sites/default/files/uploads/aspo_03-23-20.pdf
Experiences from Chinese Centres
- Handbook of COVID-19 Prevention and Treatment from The First Affiliated Hospital, Zhejiang University School of Medicine –http://www.asohns.org.au/CMS/Uploads/Handbook%20of%20COVID19%20Prevention%20and%20Treatment(1).pdf
- Wuhan Level 3 precautions video including PAPR, full hooded suites for COVID positive patients available at: https://www.youtube.com/watch?v=BSTDmkftc1I
Pandemic Planning Clinical Guidelines for Patients with Cancer from Cancer Care Ontario courtesy of Jon Irish, University of Toronto – PDF document
Other Society Information Resources
- American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) https://www.entnet.org/content/coronavirus-disease-2019-resources
- Australian Academy of Otolaryngology Head and Neck Surgery (ASOHNS) www.asohns.org.au
- ENT UK https://www.entuk.org/entuk-guidelines-changes-ent-during-covid-19-pandemic
- European Rhinologic Society – https://www.europeanrhinologicsociety.org/?page_id=2143
Loss of smell as a marker of COVID-19 https://www.entuk.org/sites/default/files/files/Loss%20of%20sense%20of%20smell%20as%20marker%20of%20COVID.pdf
South Korea’s ‘Phone Booth’ Coronavirus Tests (South China Morning Post; March 19, 2020) – https://www.scmp.com/video/coronavirus/3075969/south-korean-hospitals-phone-booth-coronavirus-tests
Self-Care and Stress Management During the COVID-19 Crisis – PDF document
MD Financial Management’s summary of new financial measures, organized by their relevance to medical students and residents, practising physicians, retired physicians, and family members –