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Otolaryngology COVID 19 Resources

last modified on: Tue, 04/09/2024 - 09:50

Note: last updated before 2022









Frequently Asked Questions

What are current recommendations for tracheostomy on known COVID + patients?

There are a variety of organizations, many related to Otolaryngology, who have published tracheostomy recommendations (including information on technique and timing for COVID-19 patients). The American Academy of Otolaryngology – Head and Neck Surgery Guidelines were notably last edited on 4/2/2020. They acknowledged that benefits of early tracheostomy in COVID-19 were unclear, though data is accumulating quickly. They recommend not performing a tracheostomy sooner than 2-3 weeks after intubation. Many institutions do not follow this guideline and there is considerable evidence that tracheostomy can shorten mechanical ventilation and ICU stays, decrease episodes of ventilator-associated pneumonia and allow for sedation weaning. All of which help in the setting of limited hospital and ICU beds. Risk to providers is increased and can be mitigated in part with proper PPE and technique. Ultimately timing and patient selection is a conversation between multiple services at each individual institution and guidelines do not apply to all patient situations.

Tracheotomy recommendations during the COVID-19 pandemic

What are the current recommendations for Anosmia associated with COVID-19?

It is widely recognized that anosmia and/or dysgeusia is one of the earliest signatures of COVID-19. These symptoms generally trigger COVID-19 testing per CDC recommendations. As with most aspects of COVID-19 treatment, recommendations change frequently. At present, for diagnosis UPSIT or other smell identification test should be performed. Flexible nasal endoscopy s also helpful in ruling out other causes of olfactory dysfunction. Topical steroids, Vitamin A, Omega 3 and olfactory retraining all may play a role in recovery. More information, including on prognosis, can be found on the Iowa Protocols.

Management of Loss of Sense of Smell (Anosmia) Associated with COVID-19 (SARS-CoV-2 Infection)

What are the implications for musicians?

The implications of COVID-19 aerosol spread are significant for musicians. Significant research is still being conducted but the University of Iowa has done extensive work surrounding guidelines for ventilation, distancing, and protocols for singers and wind instruments.

School of Music COVID-19 Policies

Wind Instrument Aerosol in Covid Era - COVID-19 and horns, trumpets, trombones, euphoniums, tubas, recorders, flutes, oboes, clarinets, saxophones and bassoons

What is our current understanding of PPE?

There are excellent resources both on understanding aerosols and N95 masks on the Protocols. Please refer to the CDC for current most up-to-date public health guidelines on PPE.

Bioaerosols, microdroplets, droplets and COVID-19 

N95 Respirators (HEPA or High-Efficiency-Particulate-Air Filter Respirators) as Personal Protective Equipment (PPE)

What can be done in clinic to mitigate risk of transfer of COVID-19?

While masks should be worn by both patients and providers, the University of Iowa has pioneered multiple techniques that have been shown to additionally decrease aerosol exposure.

Transnasal Laryngoscopy in COVID-19 Era

Transnasal injection to vocal fold in COVID-19 Era

Negative Pressure Face Shield (NPFS) for Transnasal Laryngoscopy to Mitigate Dispersion of Bioaerosol in COVID Era

Negative Pressure Face Shield (NPFS) for Transnasal Laryngoscopy KTP Laser Treatment of Hemorrhagic Polyp in COVID Era

Additionally: KTP Laser Treatment through Flexible Transnasal Laryngoscopy in the COVID Era Setup in Main Operating Room for RRP