Paediatric Otorhinolaryngology and COVID-19

1. Introduction Martin Bailey, London, ESPO Secretary General

2. General update about SARS-Cov-2 in childrenAdam Finn, Bristol

3. Consultations: remaining indications and specific precautions Marc Pellicer, Barcelona

4. Precautions regarding medical treatments in paediatric ENTFrançois Simon, Paris

5. Hearing tests: remaining indications Luisa Monteiro, Lisbon

6. Surgery: preop assessment, remaining indications and specific precautionsAri de Rowe, Tel Aviv

7. Recovery Mike Saunders, Bristol

8. Conclusion Vincent Couloigner, Paris

Paediatric Otorhinolaryngology and COVID-19

1. Introduction

Martin Bailey

ESPO Secretary-General

formerly ENT Surgeon

Great Ormond Street Hospital London

Paediatric Otorhinolaryngology and COVID-19

2. General update about SARS-Cov-2 in children:

Adam Finn

Professor of Paediatrics

University of Bristol UK

Bristol Royal Hospital for Children

Paediatric Otorhinolaryngology and COVID-19

3. Consultations : remaining indications and specific precautions, especially regarding flexible naso-endoscopy and laryngoscopy:

Marc Pellicer

ENT Pediatric Consultant

Vall d’Hebron University Hospital

Barcelona, Spain

Paediatric Otorhinolaryngology and COVID-19

4. Precautions regarding medical treatments in pediatric ENT

François Simon

paediatric ENT

Necker - Children's hospital

University of Paris, France

Paediatric Otorhinolaryngology and COVID-19

5. Hearing tests: remaining indications:

Luisa Monteiro

Consultant ENT Surgeon

Head of ENT Department Hospital dos LusíadasLisbon, Portugal

Paediatric Otorhinolaryngology and COVID-19

6. Surgery: preop assessment, remaining indications and specific precautions

Ari de Rowe

Director of Pediatric Otolaryngology

Dana-DwekChildren’s Hospital

Sourasky Medical Center

Tel Aviv

Paediatric Otorhinolaryngology and COVID-19

BAPO surgical prioritisation during the coronavirus pandemic

Priority Airway, head and neck Nose ears

1a emergencyWithin 24 hours

Microlaryngoscopy / tracheostomy#Acute airway obstructionFB removal- Button battery, sharp FBAirway foreign body causing airwayobstruction

FB removal - Buttonbattery

FB removal - Buttonbattery

1b urgent –up to 72 hours

Mastoidectomy/grommet – acute mastoiditis with complications not responding to medical treatment

External drainage of orbital abscess not responding tomedical treatment or showingvisual compromise

Mastoidectomy/grommet – acute mastoiditis with complications not responding to medicaltreatment

2 up to one month

Neck biopsy for suspected malignancyTracheostomy for weaning purposes in PICUwhere all other options for progression have beenexhaustedThyroidectomy for medically uncontrolledThyrotoxicosis

Mastoid exploration -cholesteatoma withcomplications including labyrinthine fistula

3 up to 3 months

Microlaryngoscopy for progressive airway conditions incl. RRP, subglottic stenosisProphylactic thyroidectomy in medium and lower risk MEN2 patients

Examination under anaesthesiaof middle ear - medicallyuncontrolled CSOM

4 over 3 months

Laryngotracheal reconstructionAdenotonsillectomy - OSA and recurrent tonsillitisNeck surgery - benign and congenital neck lesions not causing airway obstruction

GrommetsMyringoplastyMastoidectomy

https://www.espo.eu.com/news/covid-19-information/

https://www.entuk.org/covid-19

Recovery

Mike Saunders

President Elect BAPO

Paediatric ENT Surgeon

Bristol Royal Hospital for Children

United Kingdom

Paediatric Otorhinolaryngology and COVID-19

Considerations

• ENT staff remain at increased risk from Covid-19 and MUST be protected

• Further peaks, second and third waves seem likely over the next few months

• Return to pre-pandemic practice a long way off

Drivers to increase patient flow

• Increasing burden of elective and semi-urgent cases on waiting list

• Financial impact of activity reduction on hospitals and physicians - depending on healthcare system

• Need to train juniors

• Need to maintain skills for existing surgeons

One solution will not suit everyone

Must be based on national and co-ordinated local planning

What can we do?

Outpatients

Increase telephone or video consultation where possible

Ensure clinic space is safe – e.g. separate room for AGPs, separate entrance, exit, reduce waiting areas

Adequate and correct PPE is vital

Outpatients|: 2

•Ensure that staff are properly protected

•PRIORITISE waiting lists

•Limit accompanying persons

•Pre- visit screening?

Surgical activity

• Base on clinical need – essential to prioritise waiting lists

• What operations can we do safely? (adeno-tonsillectomy?)

• Pre-admission screening. When? What? (history, swab, CT chest,)

• Pre-admission isolation. How long?

• Screening and isolation of accompanying person?

Exiting the pandemic (ENT UK)https://www.entuk.org/sites/default/files/Exiting%20the%20pandemic.pdf

Thank you

Conclusion

Vincent Couloigner

Chairman of the ESPO Education & Training Committee

Service d’ORL Pédiatrique

Hôpital Necker Enfants Malades

Paris

Paediatric Otorhinolaryngology and COVID-19

Paediatric Otorhinolaryngology and COVID-19

Thank You

13-16 February 2021

15th Congress of the European Society of Pediatric Otorhinolaryngology

Transfers, Bridges and Frontiers in Pediatric Otorhinolaryngology

Paediatric Otorhinolaryngology and COVID-19