• Covid-19: face masks can be devastating for people with hearing loss but alternatives are available.

      Poostchi, Ali; Kuet, Mong-Loon; Richardson, PS; Patel, MK (2020-08)
      Chodosh and colleagues and Grote and Izagaren highlight an important matter but overlook the use of face shields, hoods, and other clear barriers that decrease disease transmission, facilitate lip reading, and reduce muffling. Face shields are also easier to manufacture, clean, and reuse. They protect the user’s eyes and are more acceptable than masks in a paediatric setting. The suggestion to adopt masks with clear windows is premature given the lack of evidence that they are more effective than face shields. Using a laser particle counter, we found that face masks and Perspex barriers had similar efficacy in reducing airborne and droplet transmission across a slit lamp. When a higher level of protection is required, clear ventilated hoods can be used and these have been successfully trialled with a view to widespread adoption. The authors have identified a salient problem to which cost effective and viable solutions are available and can be readily applied.
    • Efficacy of slit lamp breath shields

      Poostchi, Ali; Kuet, Mong-Loon; Pegg, Kate; Richardson, PS; Patel, MK (2020-05)
      The use of enlarged breath shields has been suggested as part of a wide range of infection control measures implemented during the COVID-19 pandemic. Breath shields have long been a standard feature of slit lamps and act as a physical barrier between the examiner and subject but there is an absence of evidence on their effectiveness in reducing droplet transmission and respiratory infections.
    • Novel technique using surgical scrub sponges to protect the nose and face during prone ventilation for coronavirus disease 2019.

      Stubington, TJ; Mansuri, MS (2020-07)
      Background: Coronavirus disease 2019 is an international pandemic. One of the features is acute respiratory distress syndrome, and proning has been identified as beneficial for a subset of patients. However, proning is associated with pressure-related side effects, including injury to the nose and face. Method: This paper describes a pressure-relieving technique using surgical scrub sponges. This technique was derived based on previous methods used in patients following rhinectomy. Conclusion: The increased use of prone ventilation has resulted in a number of referrals to the ENT team with concerns regarding nasal pressure damage. The described technique, which is straightforward and uses readily available materials, has proven effective in relieving pressure in a small number of patients.
    • Tracheotomy in COVID-19 patients: Optimizing patient selection and identifying prognostic indicators.

      Stubington, TJ; Mallick, AS; Reddy, C; Mansuri, MS (2020-05)
      BACKGROUND: Tracheotomy, through its ability to wean patients off ventilation, can shorten ICU length of stay and in doing so increase ICU bed capacity, crucial for saving lives during the COVID-19 pandemic. To date, there is a paucity of patient selection criteria and prognosticators to facilitate decision making and enhance precious ICU capacity. METHODS: Prospective study of COVID-19 patients undergoing tracheotomy (n = 12) over a 4-week period (March-April 2020). Association between preoperative and postoperative ventilation requirements and outcomes (ICU stay, time to decannulation, and death) were examined. RESULTS: Patients who sustained FiO2  ≤ 50% and PEEP ≤ 8 cm H2 O in the 24 hours pretracheotomy exhibited a favorable outcome. Those whose requirements remained below these thresholds post-tracheotomy could be safely stepped down after 48 hours. CONCLUSION: Sustained FiO2  ≤ 50% and PEEP ≤ 8 cm H2 O in the 48 hours post-tracheotomy are strong predictive factors for a good outcome, raising the potential for these patients to be stepped down early, thus increasing ICU capacity.