COVID-19 Infection and Its Influence in Otorhinolaryngology-Head and Neck Surgery

Abstract

Introduction The novel coronavirus disease 2019 pandemic has rapidly spread worldwide, challenging healthcare resources and communities to an unprecedent degree. Simultaneously, the amount of clinical and scientific information released has overwhelmed journal platforms. Objectives This review aims to summarize the available diagnostic tools and current guidelines to safely assist patients while limiting the exposure of otolaryngologists during this pandemic. Data Synthesis Key articles were retrieved from the following databases: PubMed, Lancet, Springer Nature, BioMed Central, JAMA network and MEDLINE, as well as updated documents from the Spanish Ministry of Health, World Health Organization, Centers for Disease Control and Prevention, Spanish Association of Surgeons, ENT-UK, American College of Surgeons, and American Academy of Otolaryngology-Head and Neck Surgery. The terms used for the search were: COVID-19, Test COVID, Surgery in COVID, 2019-nCoV, ‘coronavirus’, and SARS-CoV-2. A total of 10,245 papers were retrieved. The inclusion criteria for the review included: COVID-19 testing (n = 531), society guidelines for otolaryngology-head and neck surgery patient care in the outpatient clinic (n = 10) and surgical (n = 18) settings. Studies not related to COVID-19 diagnosis were excluded. Conclusion Healthcare institutions around the world are outlining their own protocols regarding laboratory testing and personnel protective equipment usage based upon medical societies recommendations during the COVID-19 pandemic. We have summarized the available laboratory tests and their respective sensitivity and specificity. Moreover, clinical guidelines from different societies were reviewed and summarized to facilitate guidance for otolaryngologists in the operating room and in the clinical settings.

Coronavirus infection: An immunologists' perspective

“…SARS‐CoV‐2 has an R0 of 2.2‐2.6, implying that each infected individual has the potential to infect 2.2 other people 8‐10 . One key issue is that the virus is detectable by molecular biology early in the nostrils and saliva; however, antigens are reported later at the onset of symptoms 11 . The lag time in detectable antigen can be critical in the pathogenesis and multiorgan infection.…”

“…In the nose, the immune system involves local antibodies' and innate immune cells that may elicit an adaptative immune response 19 . The induction of the adaptative immune response depends on antigen expression, which is low at the early stages of the viral infection 11 . In the oropharyngeal cavity, the innate immune response is prevalent, complement, neutrophils and macrophages, and antibodies, essentially IgA, bactericidal peptides and enzymes that control mostly bacterial infections 19 .…”

“…[8][9][10] One key issue is that the virus is detectable by molecular biology early in the nostrils and saliva; however, antigens are reported later at the onset of symptoms. 11 The lag time in detectable antigen can be critical in the pathogenesis and multiorgan infection. Even though most SARS-CoV-2-infected persons are asymptomatic, around 20% of the patients may have severe manifestations, and 5 to 10% require intensive care.…”

Appropriateness for SARS-CoV-2 vaccination for otolaryngologist and head and neck surgeons in case of pregnancy, breastfeeding, or childbearing potential: Yo-IFOS and CEORL-HNS joint clinical consensus statement

“…This risk is increased in case of emergency procedures such as management of major epistaxis or airway obstruction. In these situations, the practitioner does not have time to perform and wait for the result of a nasal swab [ 6 ].…”

IAO Systematic Review Award 2021

“… 1 In 2021, it was awarded to the three best systematic and/or literature reviews that were published in the journal in the year 2020 ( Table 1 ). 2 3 4 This award was established to encourage the submission of high-quality systematic review articles.…”