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.

Design and Setting. A retrospective study was conducted on all 2WW referrals made to our tertiary head and neck centre in a 12-month period. Methods. Sensitivity, specificity, and PPV of presenting complaints in H&N cancer diagnosis using Excel® and the statistical package SPSS®. Results. The sensitivity and specificity of 2005 NICE guidelines in detecting H&N cancers were 91.2% and 59%, respectively; their PPV was 9%. The sensitivity and specificity of 2015 NICE guidelines were 75.4% and 71%, respectively; their PPV was 10.3%. Eight out of 85 patients who presented with unilateral sore throat for more than 4 weeks, with or without otalgia and normal otoscopy, had H&N cancer (PPV 9.5%). Conclusions. Although the 2015 NICE guidelines have a high rate in detecting H&N cancers, consideration of reincluding unilateral sore throat in the referral criteria might be necessary.

A woman in her 70s presented to a tertiary otorhinolaryngology outpatient department with a 25-year history of right-sided subcutaneous neck lesion that had steadily grown over the preceding 6 months, now with skin involvement. The patient was asymptomatic except for some mild tenderness. The 3 × 3 cm mass lay fixed to deep tissues adjacent to the sternocleidomastoid muscle, though no associated lymphadenopathy was found on palpation, with imaging confirming no regional or distant metastases. Biopsy confirmed the lesion to be primary cutaneous adenoid cystic carcinoma, a malignancy not previously described as a primary on the neck, which was treated by wide local excision after multidisciplinary team discussion. The lesion was completely excised with negative margins, and after surveillance over 3 years, the patient is still well with no signs of recurrence.