Guidelines
Guidelines Summary
Coronavirus disease 2019 (COVID-19)
Bann et al compiled a set of recommendations for best pediatric otolaryngology practices with regard to the coronavirus disease 2019 (COVID-19) pandemic. These included the following for procedures involving the oral cavity, oropharynx, nasal cavity, or nasopharynx [25] :
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Whenever possible, defer procedures involving the nasal cavity, nasopharynx, oral cavity, or oropharynx, as these pose a high risk for COVID-19 owing to the high viral burden in these locations
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Whenever possible, preoperative COVID-19 testing should be administered to patients and caregivers prior to surgical intervention
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Employment of enhanced personal protective equipment (PPE), with a strong recommendation for the use of a powered air-purifying respirator (PAPR), should be undertaken with any patient with unknown, suspected, or positive COVID-19 status
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Limit the use of powered instrumentation, including microdebriders, to reduce aerosol generation
With regard to audiologic evaluation and otologic surgery, the recommendations include the following [25] :
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Perform routine newborn hearing screening and early intervention as indicated in the Joint Committee on Infant Hearing (JCIH) recommendations
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Defer tympanostomy tube placement for unilateral otitis media with effusion
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Although it should be prioritized, intervention for bilateral otitis media with effusion and hearing loss may be deferred based on the availability of COVID-19 testing
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Surgery involving the middle ear and mastoid, owing to their continuity with the upper aerodigestive tract, should be considered high risk for COVID-19 transmission
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Whenever possible, defer mastoidectomy, but if the surgery is required, employ enhanced PPE and avoid the use of high-speed drills
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Employment of a PAPR is strongly recommended when, in patients with unknown, suspected, or positive COVID-19 status, high-speed drills are required for otologic procedures
With regard to head and neck surgery and deep neck space infections, the recommendations include the following [25] :
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Defer surgical excision of benign neck masses
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A multidisciplinary tumor board should decide the most appropriate treatment modality for pediatric patients with solid tumors of the head and neck, including thyroid cancer, with the availability of local resources taken into account
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Prior to surgical intervention, medical management of infectious conditions should, whenever possible, be attempted; on admission, patients and caregivers should be tested for COVID-19 and strictly quarantined pending test results
With regard to craniomaxillofacial trauma, the guidelines include the following [25] :
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When urgent or emergent bedside procedures, including closure of facial lacerations, are required, patients should be presumed positive for COVID-19, even if they are asymptomatic; carry out procedures in a negative-pressure room using enhanced PPE
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Employ closed-reduction techniques, when possible, until preoperative COVID-19 testing is available
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Avoid the use of high-speed drills, to reduce aerosol formation
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When urgent or emergent surgical intervention is required, patients should be presumed positive for COVID-19, even if they are asymptomatic
Media Gallery
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Mastoiditis with subperiosteal abscess. Note the loss of the skin crease and the pointed abscess.
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Cortical mastoidectomy in a densely sclerosed mastoid.
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Preoperative preparation of the patient.
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Draping the surgical area.
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Injection of the area with 2% Xylocaine and 1:100,000 adrenaline to reduce bleeding.
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Marking the incision site.
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Placement of the incision, a few mm behind the postauricular sulcus.
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Deepening the incision down to the bone.
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Elevation of the periosteum to expose the mastoid cortex to the mastoid tip.
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Mastoid drilling in progress with simultaneous saline irrigation.
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Creation of the initial groove and the vertical line.
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Exposure of the antrum and exenteration of the mastoid air cells.
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Curetting the aditus to enlarge it.
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Further exposure.
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Healed postaural scar.
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Extent of cortical mastoidectomy in a well-pneumatized mastoid.
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