Coronavirus – BAHNO Guidelines, NTSP and ENT-UK Advice

UPDATE May 17

BLA, ENTUK and RCSLT have produced new guidelines as services slowly return to normal. Of particular note is the statement:

“As voice prosthesis care is considered an AGP, full PPE will be required with post procedure cleaning / decontamination procedures in line with PHE guidance and local infection prevention control.”
(AGP – aerosol generating procedure)

Patients need to be aware of the impact of the coronavirus pandemic on the way their hospital will deliver care. On March 25th the British Association of Head and Neck Oncologists published this:

BAHNO recognises that the management of many patients with cancer will have to be modified during the current COVID-19 crisis.  One particular group that may cause management dilemmas are those with voice prostheses.

Reinsertion of tracheooesophageal puncture (TEP) voice prostheses

  • Attendance at hospital out-patient and Emergency Departments should be avoided
  • Contact patients by telephone/video call/email now with advice on altered service
  • Functioning voice prostheses should not be replaced however old
  • Central leakage should be managed by thickened fluids or plug first
  • If TEP fistula closing a new prosthesis should not be inserted
  • Prostheses may be reinserted to prevent aspiration but not for voice
  • If prosthesis requires changing consider a dummy valve which will avoid the risk of further central leakage until safe services are resumed.

Cyrus Kerawala

The National Tracheostomy Safety Project (NTSP_UK) has published some advice for laryngectomees and tracheostomees

NTSP Advice for patients with a tracheostomy in the Coronavirus pandemic

ENT UK Patient FAQ COVID-19                     March 30th 2020

Background

This document has been prepared in response to the numerous patient and professional queries received through social media and direct phone contact. It is intended to support the ENT UK documents produced and is aimed at the layperson. It is presented in a Q&A format.

Questions and answers

Q: I have a new cough but no other symptoms; should I isolate from the rest of my family?

A: Yes. As per present guidelines, you should self-isolate from rest of your family who should also be isolating at home as per present UK government instructions.

Q: I have lost my sense of smell but otherwise feel fine. Do I have COVID-19 and should I self-isolate from family?

A: It is reasonable to assume that the new loss sense of smell (anosmia) is COVID-19-related and you should follow guidelines for self-isolation from the rest of your family group.

Q: I have lost my sense of smell. When is it likely to come back?

A: Reports from other countries such as Italy seems to suggest that COVID-19-related loss to your sense of smell should return within 7-14 days. It is of course possible that the loss is due to other causes such as sinusitis, or other viral infections, but those also have good rates of recovery.

Q: I normally take nasal steroid sprays and have now lost my sense of smell. Can I continue taking them?

A: Yes, you can. There is some evidence that oral steroids can make the severity of COVID19 infections worse, so although oral steroids have previously been used in people with new symptoms of anosmia, we would not recommend these at the present time.

Q: I am a key worker without direct patient contact, but live with others with pre-existing conditions. Can I still go to work?

A: Yes, you can. As long as neither you nor any member of the household is experiencing any symptoms, you may go to work and observe all social distancing rules on your journey.

Q: If I think I have had COVID-19, can I stop self-isolating from family after 7 days, even if I don’t feel back to normal?

A: Yes, you can. However, if you have deteriorating symptoms, particularly increased shortness of breath, and you are struggling to breathe, you should seek medical advice via 111 or, if very unwell, presenting to hospital.

Q: I am meant to have an ENT operation. Will I still be able to have it?

A: Not at the present time. Most, if not all, elective operations have ceased for the time being so unless you are due to have a cancer-related operation, it is very likely that your operation will be postponed to a later date.

Q: I am meant to have an ENT outpatient appointment. Will this still go ahead?

A: Not at the present time. You may still be contacted by phone to have a virtual/phone consultation, but it is very unlikely that you will be attending clinic. If your appointment is cancelled, it will be rebooked for a later time.

 

Acknowledgements Thank you to Prof Carl Philpott and Prof Claire Hopkins, as well as the ENT UK executive committee for their input and guidance. References 1. ENT UK advice for patients with new-onset anosmia during COVID 2. Initial guidance for head and neck cancer management during Covid-19 Nara Orban Consultant ENT Surgeon Ass Hon Sec, ENT UK.

ENT UK at The Royal College of Surgeons of England 35-43 Lincoln’s Inn Fields London WC2A 3PE Tel: 020 7404 8373 | Email: entuk@entuk.org | Web: www.entuk.org

Laryngectomees and Coronavirus

 

NALC has sought assistance from its medical advisors to produce advice for our community in the difficult situation facing us, with a possible coronavirus epidemic.

SPECIFIC ADVICE

We want to highlight two essential ways the risk of contracting the virus can be reduced. Laryngectomees differ from others with the only route into the lungs being through the stoma.

  • Laryngectomees should make use of a heat and moisture exchanger (HME) to cover the stoma. There is a variety available, including some with sophisticated filtration properties, such as the Provox Micron.
  • The advice from Public Health England (PHE) about hand washing should be followed carefully (see below). Occluding the stoma to allow for valve speech usually involves use of the hands and there may also be a need during the day to use the hands to remove the HME to clear mucous from the stoma.

GENERAL ADVICE

  • Avoid touching your eyes, nose, mouth or stoma area as much as possible. It may take practice, touching the face is often done inadvertently.
  • Wash your hands regularly through the day with soap and water for around 20 seconds or use alcohol-based hand gel.
  • Stop shaking hands or kissing as a greeting. It is also thought keeping a distance of around 2 metres from others reduces the chance of infection.
  • The benefits of using a face mask are not clear, except that if an infected person wears one the risks of spreading the infection are reduced.
  • Cover coughs and sneezes with a tissue or your elbow.

IF YOU FEEL UNWELL – updated regularly

If you live alone stay at home for 7 days if you have either:

  • a high temperature – you feel hot to touch on your chest or back
  • a new, continuous cough – this means you’ve started coughing repeatedly
    Do not go to a GP surgery, pharmacy or hospital.
    (Please see post on March 30 with ENT-UK about other symptoms)

If one person in a household displays symptoms the others also need to isolate but for 14 days, to allow time for symptoms to show.

  CONTACT NHS 111 online if

  • you feel you cannot cope with your symptoms at home
  • your condition gets worse
  • your symptoms do not get better after 7 days      111 Online

Telephone call 111 if you cannot get help online.

OTHER

  • If you take regular prescription medication ensure you have a good supply.
  • It has been recommended that some people isolate themselves, for example if they have been in contact with someone diagnosed with coronavirus. To do this a two week supply of food would be needed, but no more than this.

The American physician, and laryngectomee, Dr Itzhak Brook has written about coronavirus on his blog

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