Proposal of a timing strategy for cholesteatoma surgery during the COVID-19 pandemic

Abstract

Purpose The COVID-19 infection is an aggressive viral illness with high risk of transmission during otolaryngology examination and surgery. Cholesteatoma is known for its potential to cause complications and scheduling of surgery during the pandemic must be done carefully. The majority of otological surgeries may be classified as elective and postponed at this time (e.g., stapedotomy, tympanoplasty); whereas, others are emergencies (e.g., complicated acute otitis media, complicated cholesteatoma with cerebral or Bezold's abscess, meningitis, sinus thrombosis) and require immediate intervention. What is the ideal time for the surgical management of Cholesteatoma during the COVID-19 pandemic? Methods Senior otologic surgeons from six teaching hospitals from various countries affected by the COVID-19 from around the world met remotely to make recommendations on reorganizing schedules for the treatment of cholesteatoma which has a risk of severe morbidity and mortality. The recommendations are based on their experiences and on available literature. Results Due to the high risk of infecting the surgical staff it is prudent to stop all elective ear surgeries and plan cholesteatoma surgery after careful selection of patients, based on the extent of the disease and available resources. Specific precautions including use of appropriate personal protection equipment should be followed when operating on all patients during the pandemic. To facilitate the decision-making in the management of cholesteatoma, timing for surgery can be divided into two categories with 3 and 2 sub-groups based on disease severity. Conclusions Evidence on the timing of surgery of patients with cholesteatoma during the COVID-19 pandemic is lacking. This manuscript contains practical tips on how cholesteatoma surgery can be reorganized during this pandemic.

Assessment of health equity consideration in masking/PPE policies to contain COVID-19 using PROGRESS-plus framework: a systematic review

“…Most of the policy documents focused on “occupation” component of the PROGRESS-plus and included populations at higher risk of contracting COVID-19 such as healthcare workers, essential workers, transportation workers etc. Specifically, 85.79% ( n = 163) of the included policy documents had “occupation” as an equity component [ 23 , 25 – 27 , 29 – 32 , 34 – 37 , 40 , 42 – 46 , 48 , 49 , 51 , 53 , 54 , 58 , 60 , 62 – 68 , 70 – 74 , 76 – 81 , 83 , 85 – 88 , 90 , 91 , 93 , 96 – 99 , 101 – 109 , 112 , 113 , 115 – 117 , 119 – 121 , 123 – 126 , 128 , 130 , 131 , 133 – 136 , 138 , 139 , 142 – 164 , 166 – 171 , 173 – 184 , 186 – 190 , 192 – 195 , 197 – 204 , 206 , 207 , 210 , 211 ,…”

Quantification and Comparison of Droplet Formation During Endoscopic and Microscopic Ear Surgery: A Cadaveric Model

“… 2 , 3 Therefore, adequate management of nonemergency cases and especially the protection of surgeons and operating room personnel should be of the highest priority. 12 , 13 Moreover, no reliable diagnostic tests are actually widely available, which may impede the reliability of preoperative testing. Additionally, a negative test may lead to decreased adherence to wear personal protective equipment by the medical staff with possible spread of the virus due to false-negative test results.…”

Delays in surgery for cholesteatoma due to COVID-19: is there an impact on rates of recidivism and major complications?

“…Cholesteatoma surgery may still be an emergency. Cases complicated by a cerebral abscess, meningitis, facial palsy or a Bezold abscess will require immediate intervention [14]. In other cases, the presence of tegmen dehiscence or lateral canal fistulae will require surgical prioritisation.…”

“…One unquestionable result will be increased waiting times in an already stretched healthcare system. These pressures have led to recent recommendations on the categorisation of cholesteatoma cases and the subsequent prioritisation in terms of surgical intervention [14].…”