YO‐IFOS Guidelines for Pediatric ENT Surgery during COVID‐19: An Overview of Recommendations

Abstract

Objective/Hypothesis: To review the literature on pediatric ENT COVID-19 guidelines worldwide, in particular, surgical practice during the pandemic, and to establish a comprehensive set of recommendations.Study Design: Review. Methods: A comprehensive literature review through an independent electronic search of the COVID-19 pandemic in PubMed, Medline, Google, and Google Scholar was performed on April 26-30, 2020. Resources identified comprised of published papers, national and international pediatric ENT society guidelines.Results: Fourteen guidelines fit the inclusion criteria. Key statements were formulated and graded: 1) Strong recommendation (reported by 9 or more/14); 2) Fair recommendation (7-8/14); 3) Weak recommendation (5-6/14); and 4) Expert opinion (2-4/14). Any single source suggestion was included as a comment. Highly scored recommendations included definition of urgent/emergent cases that required surgery; surgery for acute airway obstruction; prompt diagnosis of suspected cancer; and surgical intervention for sepsis following initial first-line medical management. Other well scored recommendations included senior faculty to perform the surgery; the use of open approaches rather than endoscopic ones; and avoidance of powered instruments that would aerosolize virus-loaded tissue. A tracheostomy should be performed on a case by case basis where key technical modifications become necessary.Conclusions: The COVID-19 pandemic will have a profound short and long-term impact on pediatric ENT practice. During this rapidly evolving climate, guidelines have been based on local practice and expert opinion. Until evidence-based practice in the COVID era is established, a comprehensive set of recommendations for pediatric ENT surgical practice based on a review of currently available literature and guidelines, is therefore, appropriate.

Impact of the COVID-19 pandemic on paediatric otolaryngology: a nationwide study

“…Although some national and international societies developed guidelines and recommendations focused on paediatric ORL during the first year of pandemic 20 , 21 , they may be subject to change considering the constant evolution of the situation 22 , and an update is surely warranted. As reported by this study, although the reduction of outpatients and surgical procedures was significant and the pathway toward pre-pandemic normality is still long, data from a long-term perspective are more encouraging than those published at the beginning of 2020 1 , 2 .…”

Recommendations from the Italian Society of Otolaryngology for clinical management during the SARS-CoV-2 pandemic

“…Cochlear implant in children with hearing loss following meningitis (high risk of cochlear ossification) is classified as a semi-urgent procedure 21 .…”

“…ENT specialists caring for paediatric patients must adapt to changes of the COVID-19 era and reconsider many routine management strategies 20 , 21 :…”

The COVID‐19 pandemic first wave in Sweden: A national registry study of the effects on pediatric anesthesia and surgery

“…Unfortunately, there is a lack of comparative data concerning pediatric ENT surgery, but several reports from adult or mixed ENT departments are reporting similar reductions 11‐13 . In an attempt to avoid unnecessary cancelations and thereby risking long term negative effects in patients, international guidelines have quickly been established to restart pediatric ENT surgery worldwide, but we are not aware of any such measures from professional organizations in Sweden 14 …”

“…[11][12][13] In an attempt to avoid unnecessary cancelations and thereby risking long term negative effects in patients, international guidelines have quickly been established to restart pediatric ENT surgery worldwide, but we are not aware of any such measures from professional organizations in Sweden. 14…”