Background The question of an optimal strategy and outcomes in COVID-19 tracheostomy has not been answered yet. The critical focus in our case study is to evaluate the outcomes of tracheostomy on intubated COVID-19 patients. Methods A multicentric prospective observational study of 1890 COVID-19 patients undergoing tracheostomy across 120 hospitals was conducted over 7 weeks in Spain (March 28 to May 15, 2020). Data were collected with an innovative approach: instant messaging via WhatsApp. Outcome measurements: complications, achieved weaning and decannulation and survival. Results We performed 1,461 surgical (81.3%) and 429 percutaneous tracheostomies. Median timing of tracheostomy was 12 days (4-42 days) since orotracheal intubation. A close follow-up of 1616/1890 (85.5%) patients at the cutoff time of 1-month follow-up showed that in 842 (52.1%) patients, weaning was achieved, while 391 (24.2%) were still under mechanical ventilation and 383 (23.7%) patients had died from COVID-19. Decannulation among those in whom weaning was successful (n = 842) was achieved in 683 (81%) patients. Conclusion To the best of our knowledge, this is the largest cohort of COVID-19 patients undergoing tracheostomy. The critical focus is the unprecedented amount of tracheostomies: 1890 in 7 weeks. Weaning could be achieved in over half of the patients with follow-up. Almost one out of four tracheotomized patients died from COVID-19.

Background The use of vascularized flap to reconstruct the skull base defects has dramatically changed the postoperative cerebrospinal fluid (CSF) leak rates allowing the expansion of endoscopic skull base procedures. At present, there is insufficient scientific evidence to permit identification of the optimal reconstruction technique after the endoscopic endonasal approach (EEA). Objective The main purpose of this article is to establish the risk factors for failure in the reconstruction after EEA and whether the use of a surgical reconstruction protocol can improve the surgical results. Material and Methods A retrospective cohort study was conducted in our institution, selecting patients that underwent EEA with intraoperative CSF leak. Two reconstructive protocols were defined based on different reconstructive techniques; both were vascularized but one monolayer and the other multilayer. A multivariate analysis was performed with outcome variable presentation of postoperative leak. Results One hundred one patients were included in the study. Patients reconstructed with protocol 1, with the diagnosis different to the pituitary adenoma and older than 45 years old had higher risk of presenting postoperative leak, and with statistically significant differences when we adjusted for the remaining variables. Conclusion The vascularized reconstructions after endoscopic endonasal skull base approaches have demonstrated to be able to obtain a low rate of postoperative CSF leak. The multilayer vascularized technique may provide a more evolved technique, even reducing the postoperative leak rates comparing with the monolayer vascularized one. The reconstructive protocol employed in each case, as well as age and histological diagnosis, is independent risk factor for presenting postoperative leak.

Introduction The aim of our study was to obtain data about the contagion rate among Otolaryngologists in Spanish ENT Departments and about the clinical outcomes in positive otolaryngologists. As a secondary objective, we aim to assess the rate of contagion in the first and the second Covid-19 wave in Spain among Otorhinolaryngologists and the regional distribution by ENT-Departments. Methods Study design and population: This is a prospective observational study in a cohort of 975 Otolaryngologists from 87 ENT Departments conducted from March 25 to November 17 in our collaborative group, COVID ORL ESP. COVID-19 polymerase chain reaction (PCR) was the diagnostic standard. Hospitalization and/or intensive care admission and mortality was recorded as non-identified data. Results Data collected from 975 otolaryngologist from 87 Departments resulted in 157 (16.5%) otolaryngologists testing positive for SARS-CoV-19 by RT-PCR. Important geographic differences in contagion are reported. A total of 136 (86.6%) otolaryngologists were tested positive during the first wave and 21 (13.3%) during the second wave. At the last cut-off point of the study only 30/87 ENT Departments (34.5%) remained COVID19-free and 5 Departments reported more than 50% staff members testing positive. The majority of positive tested otolaryngologists (126/157; 80.2%) had only mild or no symptoms, 17 developed moderate symptoms (10.8%) and 3 had pneumonia not requiring hospitalization (2%). Five colleagues were admitted at hospital, 4 required ICU (2.5%) and 2 colleges died from COVID-19. Conclusions During the first wave of the SARS-CoV-19 pandemic otolaryngologists in Spain have been overall the group suffering the highest rate of contagion, particularly during the first month. Subsequently, the Spanish Ministry of Health should include otorhinolaryngologists as a high-risk group in airborne pandemics.

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skriver: This atlas offers a complete review of all endoscopic approaches available for the repair of nasoseptal perforations, following damage that may occur through trauma, infection, drug abuse, or as a result of endoscopic skull base surgery. Approaches are explained step by step using brilliant photographs from fresh cadaver dissections. Key Features: Internationally renowned specialists from Europe and the United States as editors and contributors Full-color photos of fresh cadaver dissections illustrate all steps for each approach Specific anatomic landmarks as revealed during each step are detailed, providing confidence in spatial orientation Includes risks and potential complications as well as methods to reduce them Videos of cadaver dissections and live surgery Nasoseptal Perforations: Endoscopic Repair Techniques will be an important resource for residents, fellows, and surgeons in otolaryngology, plastic and reconstructive surgery, and craniomaxillofacial surgery.

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Alobid et al 1 recently published a study titled "The impact of atopy, sinus opacification, and nasal patency on quality of life in patients with severe nasal polyposis" in the April 2006 issue of Otolaryngology-Head and Neck Surgery. Because I am concerned about the role of atopy in nasal polyposis, I read the article very carefully. That article is very well-written, but a controversial point needs to be explained. Table 2 shows a statistically significant (P Ͻ 0.05) correlation between the computed tomographic scan score and the presence of atopy in patients with nasal polyposis, but the authors of that article state the opposite in the Results and Discussion sections. If the information in Table 2 is accurate, nasal polyposis is more extensive in atopic patients than in non atopic patients. If that is not so, the ways in which atopy worsens the effect of nasal polyposis on the patient's quality of life should be discussed. I also think that assessing the correlation of the serum levels of eosinophils and total immunoglobulin E with the severity of nasal polyposis would be of benefit to readers.The prevalence of atopy in patients with nasal polyposis varies from 10 to 64 percent, 2 and the role of atopy in the etiopathogenesis of nasal polyposis is controversial. Studies evaluating the effect of atopy on the severity of nasal polyposis are very limited. However, it is well-known that atopy leads to high recurrence rates and a poor outcome of endoscopic sinus surgery. 3 In this respect, the role of atopy in patients with nasal polyposis needs to be well-established.