Head and Neck Practice in the COVID-19 Pandemics Today: A Rapid Systematic Review

THIEME 518 Systematic Review SPECIAL ARTICLE COVID - 19 Head and Neck Practice in the COVID-19 Pandemics Today: A Rapid Systematic Review Flavio Carneiro Hojaij1 Júlia Adriana Kasmirski2 Lucas Albuquerque Chinelatto2 Gustavo Henrique Pereira Boog2 2 João Vitor Ziroldo Lopes Vitor Macedo Brito Medeiros2 1 Department of Surgery, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil 2 Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil Address for correspondence Lucas Chinelatto, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Arnaldo, 455, São Paulo 01246903, Brazil (e-mail: ). Int Arch Otorhinolaryngol 2020;24(4):e518–e526. Abstract Keywords ► head and neck ► otorhinolaryngology ► COVID-19 ► surgery ► SARS-CoV-2 Introduction Head and neck specialists and otorhinolaryngologists are greatly exposed to coronavirus disease 2019 (COVID-19) transmission in their everyday praxis. Many articles are being published regarding medical staff protection and patient management during the pandemic. Objective To provide an easy access to and a trustful review of the main aspects that have changed in the head and neck surgery and otorhinolaryngology practice due to the COVID-19 pandemic. Data Synthesis The search terms used were: (head and neck or otorhinolaryngology or ORL or thyroid) AND (severe acute respiratory syndrome coronavirus 2 [SARS-COV-2] or COVID-19 or CORONAVIRUS). The results were limited to the year of 2020. Articles were read in English, Portuguese, French, German, and Spanish or translated from Chinese. All included articles were read by at least two authors. Thirty-five articles were included. Most articles suggest postponing elective surgeries, with exception to cancer surgeries, which should be evaluated separately. Twenty-five articles recommended some kind of screening prior to surgery, using polymerase chain reaction (PCR) tests and epidemiological data. Extra precautions, such as use of personal protective equipment (PPE), are suggested for both tracheostomies and endoscopies. Fifteen articles give recommendation on how to use telemedicine. Conclusion The use of PPE (N95 or powered air-purifying respirator [PAPR]) during procedures should be mandatory. Patients should be evaluated about their COVID-19 status before hospital admission. Cancer should be treated. Tracheostomy tube cuff should be inflated inside the tracheal incision. All COVID-19 precautions should be kept until there is a validated antiviral treatment or an available vaccine. Introduction The coronavirus disease 2019 (COVID-19) pandemic started in China, and, in March 11th, it was declared a pandemic.1 From its first registered case up to now—May 26th—5,404,512 con- received June 3, 2020 accepted June 25, 2020 DOI https://doi.org/ 10.1055/s-0040-1715506. ISSN 1809-9777. firmed cases were registered and 343,514 patients have died.2 The pandemic not only represents a threat to each country’s health system infection control, but to all aspects of its healthcare, as workforces are being transferred to COVID-19 combat areas, and many usual clinical workflows have changed Copyright © 2020 by Thieme Revinter Publicações Ltda, Rio de Janeiro, Brazil Head and Neck Practice in the COVID-19 Pandemics Today in an effort to achieve pandemic control.3 This represent an indirect impact in people’s health, as it affects different medical specialties. In many hospitals, elective treatments have been canceled to avoid exposing patients and medical staff to unnecessary risks.4,5 Even so, emergency and urgent procedures were still being performed with extra precaution. Elective surgeries, when considered time-sensitive, were also, in many cases, still performed after medical group evaluation.6 In many areas, a patient-to-patient approach was also suggested with the use of telemedicine, which offers a way to maintain medical support for regular situations as well as allowing the staff to analyze the patient’s condition and to evaluate surgery necessity without bringing risk of infection for both professional and patient.7,8 In otorhinolaryngology and in head and neck surgery, professionals are at a greater risk of infection. Many usual clinical procedures, such as laryngoscopy, generate a great volume of aerosol, which can lead to great exposure to high virus concentration area.9 At the same time, many patients, even without symptoms, may carry the virus, presenting a threat to professionals and incapacitating the continuity of many procedures, even for those asymptomatic individual.10 Many elective surgeries, on the other hand, are cancerrelated, and, therefore, the evaluation of their urgency in the pandemic scenario becomes very challenging.11 Our review proposes to organize the current knowledge on the specific characteristics for otorhinolaryngology. Our objective is to bring together the main recommendations regarding surgery indication, use of protective equipment during procedures, endoscopy precautions, and telemedicine application. Methods We performed a systematic literature review based on online search in the following databases: PubMed of the National Center for Biotechnology (NCBI), Scientific Electronic Library Online, and Scopus. The terms used in the search for any correspondence were (head and neck or otorhinolaryngology or ORL or thyroid) AND (severe acute respiratory syndrome coronavirus 2 [SARS-COV-2] or COVID-19 or coronavirus). Search results were limited to articles from the year 2020. Duplicates were excluded using the EndNote X9 application (Clarivate Analytics, Philadelphia, PA, USA) and Rayyan platform (Qatar Computing Research Institute, Doha, Ad-Dawhah, Qtar). The authors selected the articles for full reading according to the content of the title and abstract, evaluating if they were related to the scope of the present work. Before reading all the articles selected by title and abstract, we also included articles that contained surgical recommendations related to otorhinolaryngological surgery or head and neck surgery from another review made by the same group.12 EndNote was used again to exclude duplicates. All selected articles were read in full by two authors. Articles were read in their original language if in Portuguese, English, French, Spanish, or German. Chinese articles were translated using online websites. Articles in other languages were Hojaij et al. excluded. After full-reading, articles were included if they brought opinions or information on any of the following topics: (a) postponement of procedures; (b) performance of endoscopic exams; (c) use of telemedicine, and (d) thyroid cancer management. In cases of disagreement between the two authors about the relevance of the study, all authors discussed the inclusion of the reference. Manual search was also performed during the manuscript writing to add relevant papers published during the period of elaboration of the present article. Articl (...truncated)