- Otolaryngologists that work with children are at high risk for infection as children frequently are asymptomatic when infected with COVID-19
- Additionally, otolaryngologists operate on areas with high levels of aerosol production which increase their risk factor
-Very few institutions worldwide are very equipped to perform presurgical screenings for patients due to lack of equipment for the pandemic
- Intubation of the airway is extremely high risk ad should only be performed if urgent procedures should be performed


Ohio State University, Columbus

- This paper discusses new guidelines and protocols for pediatric otolaryngologic (surgical procedures in the head and neck) procedures and the performance of microlaryngobronchoscopy (imaging performed with a small scope that views the larynx and bronchi) during the COVID-19 era
- This article is broken up into 3 sections pertaining to general risk and PPE for otolaryngologists, COVID-19 positive microlaryngobronchoscopy, and discussion over other procedures 

Practical insights for paediatric otolaryngology surgical cases and performing microlaryngobronchoscopy during the COVID-19 pandemic

Frauenfelder, C., Butler, C., Hartley, B., Cochrane, L., Jephson, C., Nash, R., Hewitt, R., Albert, D., Wyatt, M., & Hall, A. (2020). Practical insights for paediatric otolaryngology surgical cases and performing microlaryngobronchoscopy during the COVID-19 pandemic. International journal of pediatric otorhinolaryngology, 134, 110030. https://doi.org/10.1016/j.ijporl.2020.110030

URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142686/

General Risk and PPE for Otolaryngologists

- These cases take significantly longer time and preparation is key
- Procedure should be talked over and simulated repeatedly in order to ensure as smooth of a procedure as possible
- The overall team may for the procedure may need to be larger to ensure no contact is made with the COVID-19 positive patient and to limit contamination as much as possible
- Communication during the procedure may be more difficult including increased stress of procedure, this stresses the importance of good preparation
- Negative pressure operating theater environment is recommended 
- Anesthesia should be administered in the operating theatre itself in order to lower risk of contamination
- During the procedure, high attention should be paid to any and all medical abnormalities with the patient in order to choose proper equipment for the procedure


COVID-19 Positive Microlaryngobronchoscopy

- Paediatric tracheostomy is now a high risk procedure and should be delayed until after active COVID-19 disease has passed
- If tracheostomy cannot wait, all precautions should be taken in order to limit aerosol generation, there should be no leaks in the tube, tube changes should be limited, and humidification within the tube should be utilized to avoid crusting within the tube
- Non-urgent paediatric nasal or sinus surgeries should be postponed until after the pandemic
- In per-orbital cellulitis, it has been recommended that operation should only be considered if the infect threatens the vision of the patient or if the patient has developed an intracranial complication


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