To outline a set of recommendations on the management of pediatric cases who requiring airway surgery in the context of COVID 19 pandemic. A set of recommendations have been prepared based on National and International published scientific literature and recent updates on COVID 19. These has been implemented in our tertiary care centre. Due to the evolving nature of COVID 19 and existing knowledge gaps, these recommendations may have to be revised periodically. The incidence of COVID 19 is very low (1–5%) in the pediatric age group with relatively good prognosis. Pediatric airway surgeries should be restricted to emergency cases only. The decision of postponement of the surgical cases should be taken by the team of senior pediatric airway surgeons. Flexible laryngoscopy should be avoided. Foreign body cases should undergo a computed tomography scan to avoid diagnostic bronchoscopies. All the measures should be taken to prevent direct contact of aerosol so powered instruments should not be used unless mandatory. Protective draping method should be adopted to prevent aerosol exposure. As paediatric airway surgeries are aerosol generating procedure where the risk of contracting COVID 19 by the surgeons and support staff is very high, we suggest recommendations to prevent the contact with infected aerosol. We assure these recommendations are easy to follow and can impact good quality outcome during this pandemic crisis.

Otitis media with effusion (OME) is a common condition affecting children. It is one of the most common causes for reduced hearing in pediatric age group leading to various learning disabilities including delayed speech development. The aim of this study was to find out various epidemiological characteristics and risk factors for developing OME and various treatment modalities depending on the clinical features and their outcomes in urban pediatric population. A prospective comparative study was done in 100 children taken 50 as cases and 50 as controls for a period of 2 years. The risk factors, common presenting features and the examination and investigational findings (tympanometry) of the study condition were compared among the cases and controls. Among the 50 cases, 28 children were treated medically and 22 underwent surgical treatment in the form of Myringotomy and Grommet insertion. The patients were followed up-to 6 months in both groups.

To review the changing indications, decannulation rates, complications and mortality in pediatric tracheotomies. Medical records of children who underwent primary or revision tracheotomy from April 2003 to December 2015 were retrospectively analyzed. Patient characteristics including age, sex, preoperative diagnosis and indications for tracheotomy. The complications, mortality and decannulation rates for the tracheotomies were studied. There were 101 patients who underwent tracheotomy over a period of 13 years. Out of these, complete data was available for 99 patients. There were 61 males and 38 females and the age of children who underwent tracheotomy on an average ranged from 2 months to 16 years. The indications were divided into five categories: airway obstruction, cardiopulmonary, craniofacial, neurological, and trauma. Out of the 99 patients, 92 patients underwent an elective tracheotomy while only 7 patients underwent an emergency tracheotomy. Fifty-eight patients could be successfully decannulated. 13 patients in our study died during the course of treatment, however, none of the deaths could be directly attributed to the tracheotomy. Three patients developed peristomal granulations requiring intervention, 1 patient had a severe stomal infection, and one patient had a tracheocutaneous fistula requiring surgical closure. Over the last few decades, widespread use of vaccinations and improved pediatric and neonatal intensive care has revolutionized child healthcare in developing countries like ours. This impact is reflected in our finding that neurological impairment has displaced obstructive airway (of infective etiology) as the most common indication for pediatric tracheotomy in the present era.

We all are aware of COVID 19 pandemic. As the numbers are increasing, the critical care demand is also increasing. Tracheostomy is one of the commonest procedures which has been performed on COVID positive ventilated patients. It is important to understand and follow the utmost safe practices for the patient and the health care workers for such aerosol generating procedures. The aim of this study is to identify the lacunae in tracheostomy practices during this COVID times and suggest a systematic approach for the safe practices. An online questionnaire survey-based study was performed in September 2020. The target population was practicing otolaryngologists of India with various years of experience. The aim of the study was to evaluate the lacunae in tracheostomy safe practices and to create a systematic approach for the safety of health care workers. Data compilation and analysis was done by using Microsoft Excel. A systematic COVID TIDE tracheostomy safe practices approach was designed after reviewing various tracheostomy guidelines and recommendations. Total 114 otolaryngologists responded with a complete survey report. 72.2% responders were not up to date with their knowledge of tracheostomy safe practices. 79.8% were not performing this procedure in a negative pressure room. 15.8% were not aware of the personal protective equipment level they are using. Only 56.1% survey responders were holding the ventilation before tracheal incision. Overall, 94.7% responders were keen to know about the safe approach of tracheostomy in COVID positive patients. Tracheostomy is an aerosol generating procedure, lacunae in the knowledge can cause major risk to health care professionals. Finally, in such crises, consideration should be taken for simulation exercises, dedicated airway teams and a systematic COVID TIDE approach to improve the safety of the staff and patients.

Rigid bronchoscopy for foreign body removal from lungs can cause life threatening complications like tension pneumothorax. A timely diagnosis and active management can prevent devastating events. A two years old child who developed tension pneumothorax after rigid bronchoscopy for foreign body removal was survived successfully because of multidisciplinary active management.