June 3, 2020 @ 9:00 p.m.

“Re-Introducing Laryngoscopy to Your OPD / Office During COVID-19”

Chair:  Dr. Karen Kost, Montreal, QC     Panelists:  CSOHNS Laryngology Taskforce

SESSION VIDEO: click here  Password: 4Z?NU101

June 10, 2020 @8:00 p.m.

“Otolaryngology Office/Clinic Preparedness Approach with Practical Tips”

Chair:  Dr. Yvonne Chan, Toronto, ON   Panelists:  CSOHNS Task Force

SESSION VIDEO: click here   Password: 5Y=v.&6x

Download session evaluation here.  Complete and return to entcanada2@csohns.org 

NEW:  CSO-HNS Position Paper on Sinus and Skull Base Surgery during the COVID-19 Pandemic (July 14, 2020) – PDF

CSO-HNS  Return to Otolaryngology-Head and Neck Surgery Clinical Practice During the COVID-19 Pandemic (Updated May 23, 2020) – PDF

CSO-HNS Safely Resuming Laryngoscopy in Canada (June 3, 2020)

• Preamble – PDF
• Laryngoscopy in Out Patient Department – PDF

SHARED HEALTH MANITOBA – Provincial Guidelines for Aerosol Generating Medical Procedures (June 10, 2020) – click here.

ONTARIO HEALTH – A Measured Approach for Surgeries and Procedures during the COVID-19 Pandemic (May 12, 2020) – PDF 

AMERICAN COLLEGE OF SURGEONS Post-COVID-19 Readiness Check List for Resuming Surgery (May 20, 2020) – LINK

Personal Protective Equipment (PPE) Use During the COVID-19 Pandemic (Recommendations on the use and conservation of PPE from Ontario Health – March 30, 2020) – PDF document

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.csohns.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

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).

NEW (08/31/20)  Letter to Editor:  “Tracheostomy in COVID-19 Patients:  Why Delay or Avoid?” (Sage Journals AAOHNS Foundation) – Link

University of Ottawa:  Evaluation of Virtual Reality Simulation Scenerios:  Tracheotomy Best Practice during the COVID Pandemic:

Intubated Tracheotomy: https://youtu.be/FlF5p_aHqBE

Awake Tracheotomy: https://youtu.be/YO9OcbupZD4

Survey: https://www.surveymonkey.ca/r/?sm=1hgpa5YDxPhOdfdI9dYjUw_3D_3D

Recommendations from the CSO-HNS Taskforce on Performance of Tracheotomy during the COVID-19 Pandemic – PDF document

Recommendations from the CSO-HNS Taskforce on Post-Operative Care following Tracheotomy During the COVID-19 Pandemic – PDF document REV (04/28/20)​

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.

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

• Canadian Association of Head and Neck Surgical Oncology (CAHNSO) Guidelines for Management of Head & Neck Cancer During the COVID-19 Pandemic – PDF document.

• 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

Thyroid:

• 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.

Parathyroid:

• HPT with life-threatening hypercalcemia that cannot be controlled medically

Pregnant patients:

• 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

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

• 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](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

• 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 – 

https://invested.mdm.ca/covid-19/canada-covid-19-financial-support-measures

https://capsule.mdm.ca/covid-19/mesures-canadiennes-aide-financiere-covid19

The Use of Povidone Iodine Nasal Spray and Mouthwash During the Current COVID-19 Pandemic May Protect Healthcare Workers and Reduce Cross Infection – https://ssrn.com 

The CMA is working with the Public Health Agency of Canada, provincial / territorial medical associations and the Council of Chief Medical Officiers of Health to share the most up-to-date and reliable resources with physicians and patients.  cma.ca/cma-update-coronavirus

Strategies to Manage Our Own Mental Health During the Pandemic, Dr. Jon Hunter, Psychiatrist, Sinai Health, Toronto – Zoom Grand Rounds 

(4/12/20) Public Health Ontario – COVID-19: Aerosal Generation from Coughs and Sneezes;  a document that complements the PHO’s previous list of aerosol generating medical procedures.  PDF document

www.entcanada.org/wp-content/uploads/PublicHealthOntario-covid-19-aerosol-generation-coughs-sneezesApr-12.pdf