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Background: A subset of patients with COVID-19 require intensive respiratory care and tracheostomy. Several guidelines on tracheostomy procedures and care of tracheostomized patients have been introduced. In addition to these guidelines, further details of the procedure and perioperative care would be helpful. The purpose of this study is to describe our experience and tracheostomy protocol for patients with MERS or COVID-19. Materials and Methods: Thirteen patients with MERS were admitted to the ICU, 9 (69.2%) of whom underwent surgical tracheostomy. During the COVID-19 outbreak, surgical tracheostomy was performed in one of seven patients with COVID-19. We reviewed related documents and collected information through interviews with healthcare workers who had participated in designing a tracheostomy protocol. Results: Compared with previous guidelines, our protocol consisted of enhanced PPE, simplified procedures (no limitation in the use of electrocautery and wound suction, no stay suture, and delayed cannula change) and a validated screening strategy for healthcare workers. Our protocol allowed for all associated healthcare workers to continue their routine clinical work and daily life. It guaranteed safe return to general patient care without any related complications or nosocomial transmission during the MERS and COVID-19 outbreaks. Conclusion: Our protocol and experience with tracheostomies for MERS and COVID-19 may be helpful to other healthcare workers in building an institutional protocol optimized for their own COVID-19 situation.

Objectives: To confirm the feasibility of personal sound amplification products (PSAPs), the study was conducted for three purposes: 1) to investigate electroacoustic characteristics of PSAPs, 2) to identify whether PSAPs provide adequate gain and output for three common hearing loss configurations, and 3) to compare the benefit of one representative PSAP (RPSAP) to a conventional hearing aid (HA) based on clinical hearing outcomes as a pilot study.Methods: The study consisted of three phases: electroacoustic analysis, simulated real-ear measurements (REMs), and clinical hearing experiments. Electroacoustic analysis and simulated REMs were performed in three basic (BeethoSOL, EarJJang, and Geniesori2) and three high-end PSAPs (Hearing Able, Olive Smart Ear, and SoriIn) using the Aurical Hearing Instrument Test box with a 2cc coupler. With regards to electroacoustic analysis, four electroacoustic characteristics (maximum output sound pressure level at 90 dB SPL, frequency range, equivalent input noise, and total harmonic distortion) were investigated. By simulated REMs, the appropriate level of the six PSAPs for three common hearing loss configurations (mild-to-moderate high-frequency hearing loss, moderate to moderately severe sloping hearing loss, and moderate flat hearing loss) was determined. Clinical experiments were carried out for the purpose of comparing the performance of RPSAP to HA. Before conducting clinical experiments, both RPSAP and HA were fitted by audiologists using REMs. Clinical experiments were administered using functional gain, a word recognition test, and the Korean version of the Hearing in Noise Test in six participants with bilateral moderate sensorineural hearing loss. Results: With regards to electroacoustic analysis, two high-end devices met all tolerances. In the case of simulated REMs, one basic and two high-end PSAPs showed appropriate level for three common hearing loss configurations. As for the clinical experiments, the RPSAP showed better performances than unaided, but slightly worse than HA under all test conditions.Conclusion: Our results demonstrated that certain PSAPs met all specified tolerances for electroacoustic analysis and had ability to approximate prescriptive targets in a well-controlled laboratory condition. The pilot clinical experiments explored the possibility that RPSAP could be served as a hearing assistive device for patients with moderate hearing loss.