1
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820931804. doi: 10.1177/0194599820931804. Online ahead of print.
Artificial Intelligence Applications in Otology: A State of the Art Review
Eunice You 1, Vincent Lin 2, Tamara Mijovic 3, Antoine Eskander 2, Matthew G Crowson 2
Affiliations expand
PMID: 32513061 DOI: 10.1177/0194599820931804
Abstract
Objective: Recent advances in artificial intelligence (AI) are driving innovative new health care solutions. We aim to review the state of the art of AI in otology and provide a discussion of work underway, current limitations, and future directions.

Data sources: Two comprehensive databases, MEDLINE and EMBASE, were mined using a directed search strategy to identify all articles that applied AI to otology.

Review methods: An initial abstract and title screening was completed. Exclusion criteria included nonavailable abstract and full text, language, and nonrelevance. References of included studies and relevant review articles were cross-checked to identify additional studies.

Conclusion: The database search identified 1374 articles. Abstract and title screening resulted in full-text retrieval of 96 articles. A total of N = 38 articles were retained. Applications of AI technologies involved the optimization of hearing aid technology (n = 5; 13% of all articles), speech enhancement technologies (n = 4; 11%), diagnosis and management of vestibular disorders (n = 11; 29%), prediction of sensorineural hearing loss outcomes (n = 9; 24%), interpretation of automatic brainstem responses (n = 5; 13%), and imaging modalities and image-processing techniques (n = 4; 10%). Publication counts of the included articles from each decade demonstrated a marked increase in interest in AI in recent years.

Implications for practice: This review highlights several applications of AI that otologists and otolaryngologists alike should be aware of given the possibility of implementation in mainstream clinical practice. Although there remain significant ethical and regulatory challenges, AI powered systems offer great potential to shape how healthcare systems of the future operate and clinicians are key stakeholders in this process.

Keywords: artificial intelligence; machine learning; otology.

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2
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820932126. doi: 10.1177/0194599820932126. Online ahead of print.
Revaluation of Otolaryngologic Procedures With 10- And 90-Day Global Periods in the Medicare Physician Fee Schedule
Vinay K Rathi 1 2, Ashley L Miller 1 3, Urjeet A Patel 4, Mark A Varvares 1 3, Regan W Bergmark 3 5 6 7, Roy Xiao 1 3, Matthew R Naunheim 1 3
Affiliations expand
PMID: 32513053 DOI: 10.1177/0194599820932126
Abstract
A recent investigation by the Centers for Medicare and Medicaid Services (CMS) suggests that physicians provide fewer postoperative visits (POVs) than expected for procedures with 10- and 90-day global periods. CMS is now contemplating revaluation of these procedures, which could result in lower Medicare payments to otolaryngologists. To estimate the impact of such reform on otolaryngologic procedures, we conducted a secondary subgroup analysis of CMS-contracted research, which used claims-based estimates of POVs to revalue procedures with 10- and 90-day global periods. Among the top 10 highest volume procedures performed in 2018, the proportion of median physician-reported to CMS-expected POVs ranged between 0.0% (myringotomy ± ventilation tube insertion, mouth biopsy, and complex wound repair) and 40.0% (total thyroidectomy). The top 5 procedures accounted for nearly three-quarters ($6.2 million and $8.6 million; 72.6%) of the estimated Medicare payment reduction. Further study is necessary to guide the development of equitable and effective payment reform.

Keywords: CMS; Medicare; RUC; RVU; global period; physician fee schedule; relative value units.

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3
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820931820. doi: 10.1177/0194599820931820. Online ahead of print.
Taste and Smell Impairment in COVID-19: An AAO-HNS Anosmia Reporting Tool-Based Comparative Study
İbrahim Sayin 1, Kadriye Kart Yaşar 2, Zahide Mine Yazici 1
Affiliations expand
PMID: 32513096 DOI: 10.1177/0194599820931820
Abstract
Objective: To identify the taste and smell impairment in coronavirus disease 2019 (COVID-19)-positive subjects and compare the findings with COVID-19-negative subjects using the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Anosmia Reporting Tool.

Setting: Tertiary referral center/COVID-19 pandemic hospital.

Study design: Comparative study.

Subjects and methods: After power analysis, 128 subjects were divided into 2 groups according to real-time polymerase chain reaction (RT-PCR) COVID-19 testing results. Subjects were called via telephone, and the AAO-HNS Anosmia Reporting Tool was used to collect responses.

Results: The mean age of the study group was 38.63 ± 10.08 years. At the time of sampling, rhinorrhea was significantly high in the COVID-19-negative group, whereas those complaints described as "other" were significantly high in the COVID-19-positive group. There was a significant difference in the smell/taste impairment rates of the groups (n = 46% [71.9%] for the COVID-19-positive group vs n = 17 [26.6%] for the COVID-19-negative group, P = .001). For subjects with a smell impairment, anosmia rates did not differ between the groups. The rates of hyposmia and parosmia were significantly high in the COVID-19-positive group. For the subjects with taste impairment, ageusia rates did not differ between groups. The rate of hypogeusia and dysgeusia was significantly high in the COVID-19-positive group. Logistic regression analysis indicates that smell/taste impairment in COVID-19-positive subjects increases the odds ratio by 6.956 (95% CI, 3.16-15.29) times.

Conclusion: COVID-19-positive subjects are strongly associated with smell/taste impairment.

Keywords: COVID-19; anosmia; chemosensory; coronavirus; dysgeusia.

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4
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820934370. doi: 10.1177/0194599820934370. Online ahead of print.
Impact of the COVID-19 Global Pandemic on the Otolaryngology Fellowship Application Process
B Ryan Nesemeier 1, Nicole L Lebo 1, Cecelia E Schmalbach 2, Kaitlyn J Barnes 1, Dominic Vernon 1, Jonathan Y Ting 1, Taha Z Shipchandler 1
Affiliations expand
PMID: 32515682 DOI: 10.1177/0194599820934370
Abstract
On March 11, 2020, the World Health Organization declared coronavirus disease 2019 a global pandemic. In addition to massive social disruption, this pandemic affected the traditional fellowship interview season for otolaryngology subspecialties, including head and neck surgical oncology, facial plastic and reconstructive surgery, laryngology, rhinology, neurotology, and pediatric otolaryngology. The impact on the fellowship interview process, from the standpoint of the institution and the applicant, necessitated the use of alternative interview processes. This change may alter the future of how interviews and the match proceed for years to come, with nontraditional methods of interviewing becoming a mainstay. While the impact this pandemic has on the fellowship match process is not yet fully realized, this commentary aims to discuss the challenges faced on both sides of the equation and to offer solutions during these unprecedented times.

Keywords: COVID-19; ENT; fellowship; interview; videoconference.

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5
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820930669. doi: 10.1177/0194599820930669. Online ahead of print.
Quantitative Analysis of Saccade Gain in Video Head Impulse Testing
Zhuangzhuang Li 1 2, Haiyan Wang 3, Hui Wang 1 2, Dongzhen Yu 1 2
Affiliations expand
PMID: 32513047 DOI: 10.1177/0194599820930669
Abstract
Objective: To quantitatively analyze corrective saccade (CS) gain and further characterize the specific relationship between vestibulo-ocular reflex (VOR) gain and CS gain in patients with vestibular loss and healthy controls.

Study design: Prospective combined with retrospective study.

Setting: Affiliated Sixth People's Hospital, Shanghai Jiao Tong University.

Subjects and methods: Forty patients with unilateral vestibular loss and 40 participants with normal vestibular function were subjected to video head impulse testing (vHIT). The analysis of the horizontal semicircular canal VOR and CS gains was based on individual head impulses.

Results: The patient group had significantly higher CS gain and lower VOR gain than the control group (P < .001). While there was no significant correlation between VOR and CS gains in the control group after adjusting for age and sex (P = .689), VOR gain negatively correlated with CS gain in the patient group (r = -0.853, P < .001). The specific relationship between VOR and CS gains was characterized as y = -1.17x + 1.12 (x: VOR gain, y: CS gain; r 2 = 0.732, P < .001) in the patient group.

Conclusions: In healthy participants, CS was not correlated with VOR gain, suggesting that CS is not due to VOR hypofunction. In patients with unilateral vestibular loss, CS was closely associated with VOR gain and can almost correct gaze position errors required for visual stabilization. CS gain could be an important indicator to diagnose vestibular loss and help physicians identify abnormal vHIT curves caused by artifacts and irregular practices.

Keywords: VOR gain; corrective saccade (CS) gain; vestibular loss; vestibular-ocular reflex (VOR); video head impulse test (vHIT).

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6
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820931087. doi: 10.1177/0194599820931087. Online ahead of print.
Impact of Alcohol Consumption on Snoring and Sleep Apnea: A Systematic Review and Meta-analysis
Christian Burgos-Sanchez 1, Nolan N Jones 1, Michael Avillion 2, Steven J Gibson 1, Jagatkumar A Patel 3, John Neighbors 4, Soroush Zaghi 5, Macario Camacho 2
Affiliations expand
PMID: 32513091 DOI: 10.1177/0194599820931087
Abstract
Objective: To systematically review the international literature for studies evaluating the effect of alcohol consumption on the occurrence and severity of snoring and obstructive sleep apnea and to use the available data to perform a meta-analysis.

Data sources: MEDLINE, Embase, The Cochrane Library, CINAHL/EBASCO, and Scopus.

Review methods: The protocol was registered in PROSPERO in March 2018. Following PRISMA guidelines, 2 independent researchers conducted a search from their inception through July 2018. Polysomnography (PSG) data were collected for sleep stages, apnea-hypopnea index (AHI), respiratory disturbance index, and/or lowest oxygen saturation (LSAT). Data concerning the frequency and severity of snoring intensity and sleep architecture were also collected. Only studies with PSG data were evaluated, with exclusion of studies with home sleep testing data. A multivariate regression and pooled analysis with forest plot was performed.

Results: A total of 1266 manuscripts were screened, and 13 manuscripts with 279 patients met inclusion criteria. Pooled analysis of AHI for control versus alcohol consumption revealed a mean difference (MD) of 3.98 events per hour (95% CI, 3.27 to 4.68; P < .001). Pooled analysis of LSAT for control versus alcohol consumption revealed an MD of -2.72% (95% CI, -3.69 to -1.76; Z score, 5.53; P < .00001).

Conclusion: Alcohol consumption is associated with worsening severity of snoring, altered sleep architecture, AHI, as well as lowest oxygen saturation among patients susceptible to snoring and obstructive sleep apnea.

Keywords: alcohol; ethanol; meta-analysis; obstructive sleep apnea; snoring; systematic review.

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7
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820933179. doi: 10.1177/0194599820933179. Online ahead of print.
The Pandemic Effect: Raising the Bar for Ethics, Empathy, and Professional Collegiality
G Richard Holt 1
Affiliations expand
PMID: 32513064 DOI: 10.1177/0194599820933179
Abstract
The widespread, tragic loss of life and the dedication of health care professionals have characterized the severe acute respiratory syndrome coronavirus 2 pandemic. While we mourn the loss of so many Americans to this novel virus, we also much acknowledge the positive effects to our profession, which are not insignificant. We have witnessed our larger community of otolaryngologist-head and neck surgeons pulling together in a manner not heretofore observed by this author. From the local level of practitioners to our national societies, there has been an amazing effort of collegial unity to develop the most clinically relevant guidelines for providing patient care with maximal safety, in the face of little scientific knowledge or experience with this virus. In addition, we as a specialty and individual otolaryngologists have, through our shared experiences, raised the bar for empathy, ethics, and professional interaction during these difficult times. We must reflect upon our professional growth and capture this renewal of altruism that lives at the heart of our calling.

Keywords: collegiality; empathy; medical ethics; pandemic; professionalism.

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8
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820934775. doi: 10.1177/0194599820934775. Online ahead of print.
Addressing the Impact of COVID-19 on the Residency Application Process Through a Virtual Subinternship
Janice L Farlow 1, Emily J Marchiano 1, Ilana P Fischer 1, Jeffrey S Moyer 1, Marc C Thorne 1, Lauren A Bohm 1
Affiliations expand
PMID: 32513054 DOI: 10.1177/0194599820934775
Abstract
Senior medical students are facing an unparalleled experiential gap left by COVID-19 restrictions. Due to a shared commitment to safety, equity, and well-being, away rotations are actively being discouraged or even prohibited. As a result, students transitioning to residency encounter reduced clinical training experiences and decreased access to advising, mentorship, and research opportunities. In addition, limited exposure to residency life across subspecialties and institutions poses unique challenges during the current residency application cycle. The otolaryngology-head and neck surgery community has met these unprecedented challenges by producing diverse electronic resources for specialty-specific clinical education, as well as discussing ways to increase access to advising. In this commentary, we review these initiatives and propose an institutional virtual event as a platform for meeting goals previously achieved by visiting subinternships.

Keywords: COVID-19; SARS-CoV-2; away rotation; coronavirus; medical education; medical student; otolaryngology; residency; subinternship.

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9
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820932534. doi: 10.1177/0194599820932534. Online ahead of print.
Outcomes of Dog Bite Avulsion Injury Reconstruction With Urinary Bladder Matrix
Adrian A Ong 1, Ryan Nagy 2, Michelle R Fincham 3, Mark L Nagy 1
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PMID: 32513056 DOI: 10.1177/0194599820932534
Abstract
Dog bite avulsion injuries of the head and neck are difficult to manage in pediatric patients. This study assesses the outcomes of using porcine urinary bladder extracellular matrix (UBM) for reconstruction of these complete avulsion injuries. Five male pediatric patients underwent reconstruction using UBM. Two (40%) patients underwent reconstruction of the nose; the other 3 patients underwent reconstruction of the forehead, forehead/glabella, and auricle. The average size of the avulsion defect was 7.0 ± 2.4 cm2. No patient developed wound dehiscence, graft loss, or wound infection. Four (80%) patients received pulsed dye laser treatment to improve wound cosmesis. Use of UBM is a safe and effective reconstructive option after dog bite avulsion injuries of the head and neck. Given the advantages of convenient availability and avoidance of donor site morbidity, UBM can be considered for reconstruction of posttraumatic avulsion injuries or Mohs defects.

Keywords: dog bite; facial trauma; head and neck reconstruction; urinary bladder extracellular matrix.

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10
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820932127. doi: 10.1177/0194599820932127. Online ahead of print.
A Lesson on Human Factors in Airway Management Learnt From the Death of George Washington
Ahmad K Abou-Foul 1
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PMID: 32513057 DOI: 10.1177/0194599820932127
Abstract
On December 14, 1799, 3 prominent physicians-Craik, Brown, and Dick-gathered to examine America's first president, George Washington. He was complaining of severe throat symptoms and was being treated with bloodletting, blistering, and enemas. Dick advised performing an immediate tracheotomy to secure the airway. Both Craik and Brown were not keen on trying tracheotomy and overruled that proposal. Washington was not involved in making that decision. He most likely had acute epiglottitis that proved to be fatal at the end. If Dick had prevailed, a tracheotomy could have saved Washington's life. Human factors analysis of these events shows that his physicians were totally fixated on repeating futile treatments and could not comprehend the need for a radical alternative, like tracheotomy. That was aggravated by an impaired situational awareness and significant resistance to change. Leadership model was also based on hierarchy instead of competency, which might have also contributed to Washington's death.

Keywords: George Washington; acute epiglottitis; human factors; nontechnical skills; tracheostomy.

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11
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820930662. doi: 10.1177/0194599820930662. Online ahead of print.
Creation of a New Educational Podcast: "Headmirror's ENT in a Nutshell"
Jason H Barnes 1, Garret Choby 1, Alyssa J Smith 1, Patrick Kiessling 2, John P Marinelli 3, Sarah Bowe 3, Matthew L Carlson 1
Affiliations expand
PMID: 32513092 DOI: 10.1177/0194599820930662
Abstract
Podcasts are online digital audio programs that are disseminated via online subscription that are easily accessible through computers or smartphones. Increasingly, residents and medical students are prioritizing podcasts for asynchronous medical education due to ease of use, convenience (eg, use while exercising or commuting), and repeatability. Some trainees have found podcasts more useful than traditional didactic lectures. Given the increasing requirements of social distancing and the need for distance medical education platforms, podcast production can serve as a useful tool to complement resident and medical student education and is a resource that will remain accessible in perpetuity. An otolaryngology specialty podcast, "Headmirror's ENT in a Nutshell," was created to augment asynchronous learning and address the acute need for distance learning opportunities. Over the first 7 weeks of production, 50 episodes were created. Episodes were posted on www.headmirror.com, with subscription services available through Apple Podcast, Spotify, and other platforms.

Keywords: asynchronous learning; graduate medical education; podcast.

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12
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820934769. doi: 10.1177/0194599820934769. Online ahead of print.
Persistent Smell Loss Following Undetectable SARS-CoV-2
Carol H Yan 1, Divya P Prajapati 1 2, Michele L Ritter 3, Adam S DeConde 1
Affiliations expand
PMID: 32513065 DOI: 10.1177/0194599820934769
Abstract
The association of smell and taste loss with COVID-19 has been well demonstrated with high prevalence rates. In certain cases, chemosensory loss may be the only symptom of COVID-19 and may linger while other symptoms have resolved. The significance of persistent smell and taste loss and its relationship to ongoing viral shedding has yet to be investigated. In this cross-sectional study, of the 316 laboratory test-confirmed COVID-19 cases at our institution, 46 had subsequent test-based confirmation of viral clearance with 2 consecutive negative RT-PCR test results (reverse transcriptase polymerase chain reaction). Olfactory dysfunction was reported by 50% of the patients (23 of 46), with 78% (18 of 23) having subjective persistent smell loss despite negative RT-PCR test results. These preliminary data demonstrate the persistence of self-reported smell loss despite otherwise clinical resolution and undetectable nasal viral RNA.

Keywords: COVID-19; SARS-CoV-2; health care policy; health care workers; smell loss.

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13
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820934777. doi: 10.1177/0194599820934777. Online ahead of print.
Patient-Worn Enhanced Protection Face Shield for Flexible Endoscopy
Jack B Anon 1, Carter Denne 2, Darcy Rees 3
Affiliations expand
PMID: 32513045 DOI: 10.1177/0194599820934777
Abstract
Objectives: The primary objective of this study was to compare the protection afforded by a standard face shield design with a new enhanced design in a controlled setting.

Methods: This study was exempted from review by institutional review board waiver. A flexible fiberoptic endoscopy was placed through stellate openings in the standard face shield and the enhanced face shield. A series of simulated coughs were created with bursts of fluorescein dye through an atomizer tip placed within the test participant's mouth. Ultraviolet lighting illuminated the test area, and areas of dye splatter were noted.

Results: Fluorescein dye is easily aerosolized along the lateral inferior aspect of a standard shield with significant contamination of the surrounds. The enhanced face shield maintained a barrier to the aerosolized dye.

Discussion: Face shields, rather than face masks, should be considered a preferred alternative for the public and for health care professionals alike, as they address many of the personal protective equipment concerns especially during the COVID-19 pandemic. Otolaryngologists are at high risk from aerosol-generating procedures, such as flexible fiberoptic endoscopy, even when wearing personal protective equipment. Here we describe a uniquely designed face shield to be worn by the patient as another layer of protection for the environment and for medical personnel.

Implications for practice: During the course of a flexible fiberoptic endoscopy, medical personnel are safely isolated from potential infectious particles with a newly designed face shield.

Keywords: COVID-19; aerosolization; face shield; flexible endoscopy.

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14
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820931077. doi: 10.1177/0194599820931077. Online ahead of print.
Surgical Closure of Tracheoesophageal Puncture Without a Flap Interposition
João Fonseca Neves 1, Ana Rita Nobre 2, Edite Portugal 2, Francisco Branquinho 2
Affiliations expand
PMID: 32513063 DOI: 10.1177/0194599820931077
Abstract
Tracheoesophageal puncture for voice prosthesis placement is often used in vocal rehabilitation of patients undergoing total laryngectomy. Although its closure can occur spontaneously, some patients require a surgical procedure. We propose a surgical technique, without flap interposition, that begins with careful separation of the esophagus and trachea and identification of the site of tracheoesophageal fistula. After continuous suture closure of the esophagus, the anterior segment of the first tracheal rings is vertically incised to facilitate tracheal closure in a suture without tension. Finally, a small pectoral skin flap is made and mobilized to suture to the free edges of the sectioned tracheal rings, thus reducing the risk of tracheal stenosis. Four patients underwent this procedure with uneventful postoperative evolution and permanent closure of the fistula.

Keywords: pectoralis flap; surgical procedure; tracheoesophageal fistula.

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15
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820933599. doi: 10.1177/0194599820933599. Online ahead of print.
A Multimodal Multi-Institutional Solution to Remote Medical Student Education for Otolaryngology During COVID-19
Jeremy S Ruthberg 1, Humzah A Quereshy 1, Shadi Ahmadmehrabi 2, Stephen Trudeau 1, Emaan Chaudry 3, Bryan Hair 2, Alan Kominsky 4, Todd D Otteson 5, Paul C Bryson 2 4, Sarah E Mowry 5
Affiliations expand
PMID: 32515642 DOI: 10.1177/0194599820933599
Abstract
During the coronavirus 2019 pandemic, there has been a surge in production of remote learning materials for continued otolaryngology resident education. Medical students traditionally rely on elective and away subinternship experiences for exposure to the specialty. Delays and cancellation of clinical rotations have forced medical students to pursue opportunities outside of the traditional learning paradigm. In this commentary, we discuss the multi-institutional development of a robust syllabus for medical students using a multimodal collection of resources. Medical students collaborated with faculty and residents from 2 major academic centers to identify essential otolaryngology topics. High-quality, publicly available, and open-access content from multiple sources were incorporated into a curriculum that appeals to a variety of learners. Multimodal remote education strategies can be used as a foundation for further innovation aimed at developing tomorrow's otolaryngologists.

Keywords: COVID-19; acting internship; medical education; multimodal; otolaryngology; remote education.

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16
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820935850. doi: 10.1177/0194599820935850. Online ahead of print.
A Second Pandemic? Perspective on Information Overload in the COVID-19 Era
Taher S Valika 1 2, Sarah E Maurrasse 1 2, Lara Reichert 1 2
Affiliations expand
PMID: 32513072 DOI: 10.1177/0194599820935850
Abstract
The outbreak of COVID-19 has affected the globe in previously unimaginable ways, with far-reaching economic and social implications. It has also led to an outpouring of daily, ever-changing information. To assess the amount of data that were emerging, a PubMed search related to COVID-19 was performed. Nearly 8000 articles have been published since the virus was defined 4 months ago. This number has grown exponentially every month, potentially hindering our ability to discern what is scientifically important. Unlike previous global pandemics, we exist in a world of instantaneous access. Information, accurate or otherwise, is flowing from one side of the world to the other via word of mouth, social media, news, and medical journals. Changes in practice guidelines should be based on high-quality, well-powered research. Our job as health care providers is to mitigate misinformation and provide reassurance to prevent a second pandemic of misinformation.

Keywords: COVID-19; health data; information.

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17
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820935419. doi: 10.1177/0194599820935419. Online ahead of print.
Family-Centered Information Dissemination: A Multidisciplinary Virtual COVID-19 "Town Hall"
Asitha D L Jayawardena 1, Sarah Romano 1, Kevin Callans 1, M Shannon Fracchia 2, Christopher J Hartnick 1
Affiliations expand
PMID: 32513062 DOI: 10.1177/0194599820935419
Abstract
Significant misinformation about COVID-19 has been spread on the internet. Parents of children with complex aerodigestive problems have a hard time understanding the information they encounter on the internet and the news media and interpreting how it relates to their child's complex needs. Our multidisciplinary team, at the suggestion of a parent, hosted 3 virtual "town halls" in which families could ask questions directly of pediatric otolaryngology, pediatric pulmonology and case management in order to efficiently obtain factual evidence-based up-to-date advice. The information discussed at the town halls was then annotated and disseminated via active, parent-run aerodigestive social media forums. The information disseminated via the town halls reached 4787 Facebook participants.

Keywords: COVID-19; information dissemination; pediatric aerodigestive; pediatric airway.

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18
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820934761. doi: 10.1177/0194599820934761. Online ahead of print.
Comment on "The Prevalence of Olfactory and Gustatory Dysfunction in COVID-19 Patients: A Systematic Review and Meta-analysis"
Andrea Lovato, Angelo Antonini, Cosimo de Filippis
PMID: 32513055 DOI: 10.1177/0194599820934761
supplementary info
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19
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820934776. doi: 10.1177/0194599820934776. Online ahead of print.
Pediatric, Family-Centered, "At-Home" Otologic Physical Examination in the COVID-19 Era
Asitha D L Jayawardena 1, Leila A Mankarious 1, Donald G Keamy Jr 1, Michael S Cohen 1
Affiliations expand
PMID: 32513060 DOI: 10.1177/0194599820934776
Abstract
SARS-CoV-2, the novel coronavirus resulting in the present COVID-19 pandemic, has increased the otolaryngologist's reliance on telemedicine to manage outpatient pathology. The nature of telemedicine, however, limits a provider's ability to obtain a comprehensive physical examination, specifically of the tympanic membrane. Various smartphone-based otoscopic attachments are now available that facilitate patient-obtained otoscopic image capture of the tympanic membrane. Here, we present 3 cases in which a patient-purchased, over-the-counter otoscope was utilized to alter otologic management during the time of social distancing. Further research is necessary to improve our understanding the safety and efficacy of patient-based "at-home" otoscopic examination and to optimize the use of these devices.

Keywords: COVID-19; family-centered care; otoendoscope; patient-centered care; portable otoendoscopy; smartphone technology.

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20
Otolaryngol Head Neck Surg
. 2020 Jun 9;194599820933605. doi: 10.1177/0194599820933605. Online ahead of print.
Disparate Nasopharyngeal and Tracheal COVID-19 Diagnostic Test Results in a Patient With a Total Laryngectomy
Tirth R Patel 1, Joshua E Teitcher 2, Bobby A Tajudeen 1, Peter C Revenaugh 1
Affiliations expand
PMID: 32513036 DOI: 10.1177/0194599820933605
Abstract
No abstract available
Keywords: COVID-19; coronavirus; laryngectomy.

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