The Laryngoscope最新文献

{"title":"Voice, Swallow, and Airway Impairment After Late Tracheostomy: Defining Features of COVID-19 Survivorship.","authors":"Martin B Brodsky, Amy Freeman-Sanderson, Michael J Brenner","doi":"10.1002/lary.29562","DOIUrl":"https://doi.org/10.1002/lary.29562","url":null,"abstract":"Dear Editor, We read the article by Rouhani and colleagues with great interest. Although recent studies have considered tracheostomy and optimal timing, this study is among the first to report primary data on voice, swallowing, and breathing outcomes in patients who underwent tracheostomy for COVID-19 respiratory failure. The study, which provides much needed patientand clinician-reported measures, underscores the critical role of multidisciplinary teamwork. It also raises pressing questions on how to reduce the incidence and severity of device-related pressure injury during intensive care unit (ICU) stay. What role did tracheostomy have in preventing or contributing to observed impairments? The answer is unclear, as several relevant data are not reported. Data on size of oral endotracheal tube prior to tracheostomy for all participants would provide further insight into whether observed injuries may have occurred from translaryngeal intubation before tracheostomy; tube size is a strong predictor of subglottic stenosis. Similarly, data regarding monitoring of cuff pressures could afford insight into whether cuff over-inflation may have induced tracheal ischemia. Still another consideration is whether pressure associated with prone ventilation contributed to laryngotracheal injury. Last, was there contribution from nasogastric tubes? Comparison against a matched cohort with similar duration of intubation without tracheostomy might help untangle the contributions from different airway devices. The timing of tracheostomy in this cohort reflects the tension between ensuring safety of healthcare professionals and risk of injury with protracted translaryngeal intubation. In this study, >92% of patients had tracheotomy beyond 15 days of oral intubation and >70% after 21 days (median duration = 24 days). With the absence of COVID-19, most patients undergo tracheostomy by day 12. Extended duration of oral intubation predisposes to many forms of laryngotracheal injury and attendant dysphonia, dysphagia, and dyspnea – all of which require the expertise of speech-language pathologists and otolaryngologists. Salient findings in this series are that 19% of patients had moderate to severe pathology on laryngeal exam; 54% demonstrated perceptual voice changes; and 27% required instrumental assessment and ongoing therapy for dysphagia – albeit with prevalence greatly reduced from acute assessment. Dyspnea appears particularly recalcitrant, with 23% of patients still experiencing difficulties even 2 months after hospital discharge. Speech-language pathologists and otolaryngologists have integral and complementary roles with the ICU team in caring for this population. The disciplines share in evaluating and treating patients with diverse injury and deconditioning following critical illness, and early intervention is key. We commend the authors for reporting these data and look forward to longer term outcomes.","PeriodicalId":400976,"journal":{"name":"The Laryngoscope","volume":" ","pages":"E2311"},"PeriodicalIF":2.6,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/lary.29562","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38912517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sialendoscopy and Sjogren's Disease: A Systematic Review.","authors":"Kimberly K Coca,&nbsp;M Boyd Gillespie,&nbsp;Nicholas A Beckmann,&nbsp;Rongshun Zhu,&nbsp;Tamara M Nelson,&nbsp;Robert L Witt","doi":"10.1002/lary.29233","DOIUrl":"https://doi.org/10.1002/lary.29233","url":null,"abstract":"<p><strong>Objectives/hypothesis: </strong>This study is a systematic review of the literature which seeks to estimate the expected treatment outcomes of a patient with Sjogren's syndrome (SS) undergoing therapeutic sialendoscopy.</p><p><strong>Study design: </strong>Systematic Review.</p><p><strong>Methods: </strong>PubMed, Scopus, and Cochrane library databases were used to search for studies published as of August 2020 regarding the treatment outcomes of SS with sialendoscopy. The key search terms included \"Sjogren's syndrome\" and \"sialendoscopy.\" Only studies in the English language involving more than one human patient were included. PRISMA guidelines were followed in study inclusion and data extraction. The primary outcome assessed was improvement in patient symptoms.</p><p><strong>Results: </strong>Six studies met criteria and were analyzed in this review, including 125 patients undergoing sialendoscopy of parotid and/or submandibular glands as well as 25 controls. Of these patients, 90% were female with an age range of 18 to 79 years. There was significant diversity in outcome reporting tools. The outcomes of symptom improvement were pooled qualitatively based on improvement noted in each study. Outcomes were defined as partial improvement if the measured outcomes improved and complete improvement if measured outcomes resolved entirely. Despite the limited number of studies on this topic, this meta-analysis suggests that a similar study of therapeutic sialendoscopy could expect to provide at least temporary improvement of symptoms 90% to 99% of the time.</p><p><strong>Conclusions: </strong>This review provides support for the application of sialendoscopy in the treatment of SS salivary disease. Larger studies with consistent outcome reporting tools and control groups are needed to validate these results and provide a consistent therapy protocol. Laryngoscope, 131:1474-1481, 2021.</p>","PeriodicalId":400976,"journal":{"name":"The Laryngoscope","volume":" ","pages":"1474-1481"},"PeriodicalIF":2.6,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/lary.29233","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38567621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Completion of Sublingual Immunotherapy.","authors":"Nanki Hura,&nbsp;Sophia Song,&nbsp;Rebecca J Kamil,&nbsp;Gerdline Pierre,&nbsp;Sandra Y Lin","doi":"10.1002/lary.29272","DOIUrl":"https://doi.org/10.1002/lary.29272","url":null,"abstract":"<p><strong>Objectives: </strong>Sublingual immunotherapy (SLIT) has emerged as an effective treatment alternative to subcutaneous immunotherapy (SCIT) given its improved safety profile and more convenient dosing. However, SLIT still relies on daily dosing for many years to optimize effectiveness. This study sought to investigate factors that influence patient completion of SLIT.</p><p><strong>Methods: </strong>We performed an institutional retrospective review of patients who received SLIT (2008-2020). Completion was defined as completing at least 36 months of SLIT. Patient demographics and characteristics, including the number of allergens treated, history of asthma and sinus surgery, number of clinic visits, and total time undergoing SLIT, were documented. Multivariate models were used to analyze predictors of SLIT completion. Subgroup analysis was performed among pediatric patients and patients who discontinued SLIT.</p><p><strong>Results: </strong>Of the 404 total patients, 249 (61.6%) discontinued, 47 (11.6%) completed, and 108 (26.7%) were currently undergoing SLIT. The mean duration of therapy was 11.2 months for those who discontinued and 49.4 months for patients who completed SLIT. The odds of SLIT completion were twice as high with each additional clinic visit (P < .001), and twice as high when the dosage was increased during therapy (P = .06). Pediatric patients younger than age 12 with a history of asthma were over five times more likely to complete therapy (P = .045). Patients with more clinic visits (P < .001) and higher associated costs (P = .003) were less likely to be lost to follow-up.</p><p><strong>Conclusion: </strong>Increasing the frequency of clinic visits, improving therapy availability, and mitigating concerns about clinical efficacy may increase patient completion of SLIT.</p><p><strong>Level of evidence: </strong>4 Laryngoscope, 131:E2111-E2115, 2021.</p>","PeriodicalId":400976,"journal":{"name":"The Laryngoscope","volume":" ","pages":"E2111-E2115"},"PeriodicalIF":2.6,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/lary.29272","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38593114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presenting Symptom as a Predictor of Clinical course in Juvenile Onset Recurrent Respiratory Papillomatosis.","authors":"Pamela Mudd,&nbsp;Emily Wikner,&nbsp;Md Sohel Rana,&nbsp;George Zalzal","doi":"10.1002/lary.29327","DOIUrl":"https://doi.org/10.1002/lary.29327","url":null,"abstract":"<p><strong>Objective/hypothesis: </strong>Determine if the presentation of voice versus airway symptoms at the time of diagnosis of juvenile recurrent respiratory papillomatosis (JORRP) correlates with treatment and outcomes.</p><p><strong>Study design: </strong>Original report, Retrospective review.</p><p><strong>Methods: </strong>Twenty year retrospective review of all patients with JORRP presenting at any time in treatment to a single tertiary children's hospital between 1997 and 2017.</p><p><strong>Results: </strong>Fifty-four patients presented with a diagnosis of JORRP during the 20 year study period. Of these, 32 were female and 22 were male. African American children made up the majority of the patients (65%), with 19% identifying as Caucasian, 9% Hispanic, and 7% Asian. Fifteen of the children presented initially to the ENT clinic (87% with hoarseness), 12 to the emergency department (92% with airway concerns), 11 to the voice clinic, and the remaining 12 at outside hospitals or clinics and care were transferred. Voice symptoms, namely hoarseness, was the presenting symptom in 31 (57%), airway symptoms, namely respiratory distress or stridor was predominate in 17 (32%), and the presenting symptom was unknown in six cases (11%). Children presenting with airway symptoms were younger at presentation (median 2.1 years, range 0.38-8.77 years) than those presenting with voice symptoms (median 6.7 years, range 0.98-15.13 years), and after adjusting for age underwent a greater number of surgeries in the first year to control disease.</p><p><strong>Conclusions: </strong>Patients who present with airway symptoms present younger and have an increased number of surgeries in the first year compared to those presenting with voice complaints.</p><p><strong>Level of evidence: </strong>4 Laryngoscope, 131:1670-1675, 2021.</p>","PeriodicalId":400976,"journal":{"name":"The Laryngoscope","volume":" ","pages":"1670-1675"},"PeriodicalIF":2.6,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/lary.29327","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38723209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Endoscopic Sinus Surgery Beneficial Post Lung Transplant in Cystic Fibrosis Patients?","authors":"Amy Hughes,&nbsp;Eelam A Adil","doi":"10.1002/lary.28916","DOIUrl":"https://doi.org/10.1002/lary.28916","url":null,"abstract":"BACKGROUND Cystic fibrosis (CF) is an autosomal recessive disorder caused by a genetic mutation in the gene which encodes the cystic fibrosis transmembrane conductance regulator (CFTR) protein. There are numerous known mutations of the CFTR gene with ΔF508 being the most common. A defect in the CFTR gene leads to impaired ion transport across cell membranes and results in tenacious secretions that cause significant aerodigestive morbidity. As a result of pulmonary injury, CF is the most common indication for pediatric lung transplantation in the United States. The paranasal sinuses are thought to be an upper airway bacterial reservoir of infection that can spread to the lower airway and cause lung allograft infection. Poor transplant outcomes are associated with bacterial colonization and infection. The purpose of this review is to evaluate the most recent evidence regarding the role of endoscopic sinus surgery (ESS) following lung transplantion in patients with CF.","PeriodicalId":400976,"journal":{"name":"The Laryngoscope","volume":" ","pages":"1446-1447"},"PeriodicalIF":2.6,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/lary.28916","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38142044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exome Sequencing for Isolated Congenital Hearing Loss: A Cost-Effectiveness Analysis.","authors":"Lilian Downie,&nbsp;David J Amor,&nbsp;Jane Halliday,&nbsp;Sharon Lewis,&nbsp;Melissa Martyn,&nbsp;Ilias Goranitis","doi":"10.1002/lary.29356","DOIUrl":"https://doi.org/10.1002/lary.29356","url":null,"abstract":"<p><strong>Objectives/hypothesis: </strong>To assess the relative cost-effectiveness of exome sequencing for isolated congenital deafness compared with standard care.</p><p><strong>Study design: </strong>Incremental cost-effectiveness and cost-benefit analyses were undertaken from the perspective of the Australian healthcare system using an 18-year time horizon.</p><p><strong>Methods: </strong>A decision tree was used to model the costs and outcomes associated with exome sequencing and standard care for infants presenting with isolated congenital deafness.</p><p><strong>Results: </strong>Exome sequencing resulted in an incremental cost of AU$1,000 per child and an additional 30 diagnoses per 100 children tested. The incremental cost-effectiveness ratio was AU$3,333 per additional diagnosis. The mean societal willingness to pay for exome sequencing was estimated at AU$4,600 per child tested relative to standard care, resulting in a positive net benefit of AU$3,600. Deterministic and probabilistic sensitivity analyses confirmed the cost-effectiveness of exome sequencing.</p><p><strong>Conclusions: </strong>Our findings demonstrate the cost-effectiveness of exome sequencing in congenital hearing loss, through increased diagnostic rate and consequent improved process of care by reducing or ceasing diagnostic investigation or facilitating targeted further investigation. We recommend equitable funding for exome sequencing in infants presenting with isolated congenital hearing loss.</p><p><strong>Level of evidence: </strong>N/A. Laryngoscope, 131:E2371-E2377, 2021.</p>","PeriodicalId":400976,"journal":{"name":"The Laryngoscope","volume":" ","pages":"E2371-E2377"},"PeriodicalIF":2.6,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/lary.29356","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38767858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Value of Third Cervical Vertebra Skeletal Muscle Index in Oral Cavity Cancer: A Retrospective Study.","authors":"Sheng-Wei Chang,&nbsp;Cheng-Ming Hsu,&nbsp;Yuan-Hsiung Tsai,&nbsp;Geng-He Chang,&nbsp;Ming-Shao Tsai,&nbsp;Ethan I Huang,&nbsp;Yao-Te Tsai","doi":"10.1002/lary.29390","DOIUrl":"https://doi.org/10.1002/lary.29390","url":null,"abstract":"<p><strong>Objectives/hypothesis: </strong>To assess the prognostic utility of third cervical vertebra skeletal muscle index (C3 SMI) measured from preoperative head and neck computed tomography (CT) in patients with oral cavity squamous cell carcinoma (OSCC).</p><p><strong>Study design: </strong>Retrospective study.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records of 125 patients who underwent primary curative surgery for OSCC between 2009 and 2017. Their preoperative C3 SMI was calculated by adjusting the C3 cross-sectional area delineated on head and neck CT by body height squared. A Cox proportional hazard model was employed to identify prognostic factors, and a novel nomogram based on C3 SMI was built for individualized survival prediction.</p><p><strong>Results: </strong>In Kaplan-Meier analysis, high C3 SMI was significantly associated with higher 5-year disease-free survival (DFS) and overall survival (OS) than low C3 SMI. In multivariate analysis, low C3 SMI was an independent risk factor for poor DFS and OS (hazard ratio [HR]: 2.197; 95% confidence interval [CI], 1.170-4.512, P = .032 and HR: 2.143; 95% CI, 1.232-3.728, P = .007, respectively). The concordance-index (C-index) of the nomogram based on C3 SMI was 0.814 for OS, higher than that of the nomogram based on tumor-node-metastasis staging alone (C-index = 0.731).</p><p><strong>Conclusions: </strong>C3 SMI might serve as a novel prognosticator in OSCC patients undergoing curative surgery, and the nomogram based on C3 SMI might provide good prognostic discrimination ability for individualized survival prediction.</p><p><strong>Level of evidence: </strong>IV Laryngoscope, 131:E2257-E2265, 2021.</p>","PeriodicalId":400976,"journal":{"name":"The Laryngoscope","volume":" ","pages":"E2257-E2265"},"PeriodicalIF":2.6,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/lary.29390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38810749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Narrative Review of Pharmacologic Treatments for COVID-19: Safety Considerations and Ototoxicity.","authors":"Christine Little,&nbsp;Maura K Cosetti","doi":"10.1002/lary.29424","DOIUrl":"https://doi.org/10.1002/lary.29424","url":null,"abstract":"<p><strong>Objective/hypothesis: </strong>The purpose of this review is to summarize evidence-based data regarding the ototoxic effects of potential COVID-19 therapeutics to treat patients suffering from SARS-CoV-2.</p><p><strong>Methods: </strong>Medications under investigation as novel therapeutics to treat COVID-19 were identified using the search term coronavirus therapeutics, COVID therapeutics, and SARS-CoV-2 therapeutics on ClinicalTrials.gov and the PubMed Database. A literature review was performed using the PubMed Database for each proposed COVID-19 therapeutic to identify relevant articles. Search criteria included Medical Subject Headings (MeSH) and key word search terms for ototoxicity, vestibulotoxicity, hearing disorders, and vertigo.</p><p><strong>Results: </strong>Six proposed COVID-19 therapeutics were identified as possessing ototoxic side effects including chloroquine and hydroxychloroquine, azithromycin, lopinavir-ritonavir, interferon, ribavirin, and ivermectin.</p><p><strong>Conclusions: </strong>Available evidence suggests that ototoxic effects may be improved or mitigated by stopping the offending agent. Recognition of hearing loss, tinnitus, or imbalance/vertigo is therefore crucial to facilitate early intervention and prevent long-term damage. Hospitals should consider the inclusion of audiologic monitoring protocols for patients receiving COVID-19 therapeutics with known ototoxicity, especially in high-risk patient groups such as the elderly and hearing impaired. Laryngoscope, 131:1626-1632, 2021.</p>","PeriodicalId":400976,"journal":{"name":"The Laryngoscope","volume":" ","pages":"1626-1632"},"PeriodicalIF":2.6,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/lary.29424","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38861511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of Glottic Gap and Voice Impairment in Presbyphonia.","authors":"Patrick O McGarey,&nbsp;Ryan Bitar,&nbsp;Charlotte K Hughes,&nbsp;Noah Hodson,&nbsp;Edward A Harris,&nbsp;Laura M Dominguez,&nbsp;Gregory R Dion,&nbsp;C Blake Simpson","doi":"10.1002/lary.29068","DOIUrl":"https://doi.org/10.1002/lary.29068","url":null,"abstract":"<p><strong>Objective/hypothesis: </strong>The objective of this study was to investigate the glottic gap area as a significant marker for the severity of presbyphonia as it relates to patient-reported outcome measures (Voice Handicap Index-10 [VHI-10]) and stroboscopic findings.</p><p><strong>Study design: </strong>Retrospective case-control study conducted in an academic tertiary voice center.</p><p><strong>Methods: </strong>Patients seen at a tertiary voice clinic who were diagnosed with presbyphonia without other organic laryngeal pathology from January 2014 to December 2017 were included. Clinical data and laryngeal videostroboscopy videos were collected. Still images at the point of vocal process approximation during adduction were captured, and the glottic gap area was measured using ImageJ. These were compared to a control cohort. Correlations were made using Wilcoxon rank sum test, Mann-Whitney U test, and Pearson correlation coefficients.</p><p><strong>Results: </strong>Thirty-three patients were included. Inter-rater reliability of glottic area measurement was strong (intraclass correlation coefficient = 0.73, P < .001). Compared to controls, presbyphonia patients had a larger glottic gap area (P < .001) and greater open-phase quotient on laryngeal videostroboscopy (P < .001). Larger glottic gap area did not correlate with patient-reported vocal function as measured by VHI-10 (P = .79) and did not correlate with presence of secondary muscle tension dysphonia (P = .99). In the presbyphonia cohort, the glottic gap area did not correlate with age (P = .29).</p><p><strong>Conclusions: </strong>Glottic gap area at the point of vocal process approximation during phonation can be reliably measured. Patients with presbyphonia have a larger glottic gap area and greater open-phase quotient on stroboscopy, but these do not correlate with patient-reported voice impairment or the presence of secondary muscle tension dysphonia (MTD). These data suggest that dysphonia severity in presbyphonia is not fully explained by a glottic gap or secondary MTD alone.</p><p><strong>Level of evidence: </strong>4 Laryngoscope, 131:1594-1598, 2021.</p>","PeriodicalId":400976,"journal":{"name":"The Laryngoscope","volume":" ","pages":"1594-1598"},"PeriodicalIF":2.6,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/lary.29068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38455600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the Safety and Science of COVID-19 Tracheostomy: Challenges and Opportunities.","authors":"Michael J Brenner,&nbsp;Christopher H Rassekh,&nbsp;Pavel Dulguerov","doi":"10.1002/lary.29512","DOIUrl":"https://doi.org/10.1002/lary.29512","url":null,"abstract":"In their report of 64 ventilated patients undergoing tracheostomy for Coronavirus Disease of 2019 (COVID-19) respiratory failure, Ahmed and colleagues provide valuable insights into clinical outcomes and surgeon risk. The findings emphasize how safety measures, patient selection, and data can improve care while mitigating harm. Their paper vividly illustrates the overwhelming concerns around healthcare professional safety that characterized the first wave of the pandemic. We discuss interval progress that has paved the way for data-driven, patientcentered tracheostomy care. As this cohort and others demonstrate, tracheotomy can be performed in COVID-19 patients with rates of viral transmission approaching zero, with personal protective equipment and protocols. While tracheostomy by 10 days has been associated with improved overall mortality and reduced length of stay, delaying tracheostomy during COVID-19 pandemic has not been associated with improved clinician safety. Furthermore, severe COVID-19 acute respiratory distress syndrome (ARDS) mirrors other forms of ARDS in pathophysiology, response to therapies, and clinical course, allowing decades of highlevel evidence to be applied to COVID-19 patients. Since the first wave, progress in noninvasive ventilation, assessment of patient readiness for tracheostomy, and multidisciplinary teamwork has improved care. Some patients who underwent invasive mechanical ventilation and tracheostomy in this series might today be managed with noninvasive ventilation, averting the morbidity of prolonged translaryngeal intubation. For patients requiring prolonged mechanical ventilation, a preoperative apnea trial can evaluate physiological reserve, reducing risks of derecruitment and aerosol generation. The improved survival in patients who had tracheostomy performed by the otolaryngology service likely reflects sound judgment in deferring tracheostomy in patients who were unstable. Understanding desires and goals of patients and family members is invaluable. The utility of COVID-19 tracheostomy is becoming clearer; tracheostomy mitigates risk of pressure-related injuries to the larynx and trachea that may impair speech, swallowing, and breathing. Tracheostomy also accelerates liberation from the ventilator, thereby alleviating muscle wasting, impaired cognition, and psychiatric morbidity that complicate severe COVID-19 survivorship. Nurses, respiratory care practitioners, speech language pathologists, and physicians all contribute to coordinated care. Safety outcomes, which were only provided for surgeons in this study, would ideally be tracked for all multidisciplinary team members. While randomized trials of tracheostomy in ventilated patients with COVID-19 remain elusive, data on tracheostomy timing, technique, and demographics continue to emerge. Prospective data collection through data registries, such as the Global Tracheostomy Collaborative (www.globaltrach.org), may further illuminate critical questions. ","PeriodicalId":400976,"journal":{"name":"The Laryngoscope","volume":" ","pages":"E2160-E2161"},"PeriodicalIF":2.6,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/lary.29512","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25482662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}