COVID-19 and Total Laryngectomy—A Report of Two Cases

Abstract

Objective: To date, no cases have been reported on the effects of COVID-19 in laryngectomees. Case Presentation: We herein presented two clinical cases of laryngectomized patients affected by COVID-19, detailing their clinical course and complications. Discussion: In our experience, permanent tracheostomy did not significantly affect the choice of treatment. However, dedicated devices and repeated tracheal toilettes may be needed to deal with oxygen-therapy-related tracheal crusting. Conclusion: In conclusion, laryngectomees should be considered a vulnerable population that may be at risk for worse outcomes of COVID-19 due to anatomical changes in their airways. The role of the ENT specialist is to guide airway management and inform the support-staff regarding specific needs of these patients.

Covid‐19 laryngectomized patients care, on field experience, and considerations

“…This is why both Nasopharyngeal/Oropharyngeal and tracheal stoma swabs remain crucial for diagnosis. [13][14][15] Total laryngectomy patients are considered "super spreaders", in fact they can generate a greater infected aerosol through the tracheostoma, and this was confirmed by our patients experience since they showed a remarkably higher capability to spread COVID-19 infection to nearby family members, but also to healthcare operators wearing PPE, compared to nonTL individuals. Therefore, Max Hennessy et al recommend the use of enhanced PPE to assist those patients, and we completely agree.…”

“…The presence of tracheoesophageal prothesis (TEP) and its related fistula, connecting trachea, and esophagus, is important to be taken in account since infection to trachea might spread to the pharynx and vice versa. This is why both Nasopharyngeal/Oropharyngeal and tracheal stoma swabs remain crucial for diagnosis 13‐15 …”

Self-care and clinical management of persons with laryngectomy during COVID-19 pandemic: a narrative review

“…One patient’s pulmonary health progressively deteriorated leading to demise following 8 days of hospitalization. On the contrary, the other patient remained clinically stable and was discharged following 24 days of hospitalization [ 24 ].…”

“…Due to the structure altered airway with limited humidification function, persons with laryngectomy more likely to develop tracheal crusting especially when oxygen therapy is required [ 24 ].…”

“…Two of the case reports were from Italy [ 24 , 25 ] and one each from Scotland [ 23 ] and the USA [ 22 ].…”