新型冠状病毒感染疫情期间定点收治医院耳鼻咽喉科门诊的防控管理

新型冠状病毒感染疫情期间,作为定点收治医院的耳鼻咽喉科门诊实施有效防控措施,做到医务人员的科学防护,就诊患者的规范防护,防护物资的精细管理,消毒措施的系统全面,发热患者的应急处置,取得良好的防疫效果,无医院内交叉感染。     

耳鼻咽喉科的医院感染分析及预防

10年间我院耳鼻咽喉科共收住院患者4128例，发生医院感染的232例，医院感染的发生，对一些疾病的预后常有较大影响。耳鼻咽喉科手术有其本身的许多特点，如术腔与粘膜腔相通，易受唾液等机体分泌物的污染等，较易发生医院感染。本文将本科医院感染经细菌学检查确诊、临床资料完整的232例总结分析如下。     

内镜影像系统在耳鼻咽喉科见习教学中的应用

目的 探讨内镜影像系统在耳鼻咽喉科见习教学中的应用效果。方法 将50名见习学生随机分为实验组和对照组,实验组学生在传统教学基础上采用内镜影像系统辅助教学,对照组采用传统教学,统计理论考试成绩并进行问卷调查。结果 实验组理论成绩高于对照组（P<0.05）,实验组学生对教学方法的满意度、学习兴趣、教学内容的理解力及学习效率等各方面均高于对照组。结论 运用内镜影像系统辅助耳鼻咽喉科见习教学是一种较好的教学手段,可以进一步推广应用。     

耳鼻咽喉科临床见习教学改革与实践

目的探讨耳鼻咽喉科临床见习课的教学方法。方法对2001级七年制临床医学专业30人和五年制临床医学专业98人耳鼻咽喉科学临床见习课的教学经验进行总结,对如何提高耳鼻咽喉科临床见习课教学质量和效率进行分析和回顾。结果通过开展研究性教学和学习探索与实践,极大地增强了学生的学习兴趣,提高了见习课教学的质量和效率,提高和培养了学生的创新思维、临床观察和分析解决问题的能力。结论只有不断对耳鼻咽喉科学临床见习课教学方法和教学手段进行改革和创新,才能确保临床见习课教学质量,取得良好的教学效果。     

新型冠状病毒防控期间耳鼻咽喉头颈外科急症手术诊疗建议

2019新型冠状病毒(2019 novel coronavirus,2019-nCoV)感染已被纳入《中华人民共和国传染病防护法》规定的乙类传染病,并采取甲类传染病预防控制措施。耳鼻咽喉头颈外科急症食管异物、呼吸道异物、鼻出血、喉阻塞合并呼吸困难及头颈部外伤发病率相对较高,部分可迅速危及生命的急症需紧急手术。本文根据新型冠状病毒肺炎诊疗方案(试行第五版),在疫情蔓延地区结合华中科技大学同济医学院附属协和医院耳鼻咽喉科急诊手术处理的经验,现总结制订了新型冠状病毒防控期间耳鼻咽喉头颈外科急症手术诊疗建议,以期在新型冠状病毒防控期间提高耳鼻咽喉头颈外科急症的救治成功率及减少或避免围手术期医护人员新型冠状病毒感染可能。     

COVID-19防控期间疫情非高发地区综合医院耳鼻咽喉头颈外科病房诊疗实践

新型冠状病毒病(COVID-19)疫情防控形势持续严峻,耳鼻咽喉头颈外科同道既要防控疫情同时还要更好开展必要的病房日常诊疗工作,杜绝医护人员感染。绵阳地区的COVID-19疫情有其自身特点,结合科室在这方面的经验举措,分享"疫情防控+诊疗工作"的病房诊疗实践经验,期望对湖北以外疫情非高发地区的耳鼻咽喉头颈外科同道有所帮助。     

疫情防控常态化下耳鼻咽喉科住院医师规范化培训管理及教学实践探讨

住院医师规范化培训（以下简称住培）是国家医疗改革的重要举措之一,目前常态化疫情防控给耳鼻咽喉科住院医师规范化培训（以下简称住培）基地的管理也带来了新的挑战。本文从专业基地对住培生的管理角度出发,围绕住培管理制度与措施、培训内容及培训模式调整、考核管理、维护住培生心理健康等方面为切入点,总结新型冠状病毒肺炎疫情之下专科住培基地管理和教学实践中遇到的问题和解决方法,为进一步有效提升疫情防控常态下住培的教学质量和管理效果提供参考。     

内镜为耳鼻咽喉科教学带来的思考

临床实习是医学教育的重要组成部分,是以临床实践为主,对学生的基础理论、基本知识、基本技能进行综合训练的重要环节,是理论知识转向实际应用,完成教学计划所规定的培养目标的最后教学阶段,也是医学生成长为合格医生的起点.在专科实习中,耳鼻咽喉科是一个较重要的学科,对于学生来说,实习时间短,内容多且复杂,是难度较大的学科.     

新型冠状病毒肺炎疫情期间中医(中西医结合)耳鼻咽喉科诊疗工作专家建议

【前言】在新型冠状病毒肺炎疫情期间,由于一些医院咽拭子核酸检测取样项目由耳鼻咽喉科统一承担,故耳鼻咽喉科是密切接触感染源的高风险职业暴露科室。本建议着重强调专科操作规范,为积极做好新型冠状病毒肺炎的防控工作,降低该疾病在医疗机构内传播风险,保证疾病暴发期中医(中西医结合)耳鼻咽喉科诊疗工作有序开展,由中华中医药学会耳鼻咽喉科分会、中国中医药信息学会耳鼻喉科分会、世界中医药学会联合会耳鼻喉口腔科专业委员会、中国中医药研究促进会耳鼻咽喉科专业委员会组织专家联合制定,并积极采纳四川省耳鼻咽喉头颈外科学会意见,参考《新型冠状病毒肺炎诊疗方案(试行第六版)》、《医疗机构内新型冠状病毒感染预防与控制技术指南(第一版)》以及相关文献,结合耳鼻咽喉科当前工作特点提出建议,供各有关人员结合当地实际情况参考。     

新型冠状病毒肺炎与耳鼻咽喉科诊疗的相关研究

2019年末,我国湖北省武汉市暴发了新型冠状病毒肺炎（COVID-19）并在短时间内迅速波及全国。COVID-19患者病情变化迅速,常累及多个器官,需要多学科协作进行综合性诊疗。虽然患者最常见的临床表现为发热、乏力及干咳,但临床数据分析显示有部分患者可以鼻塞、咽痛、嗅觉障碍等耳鼻咽喉科相关症状就诊。同时在标准诊疗方案中也涉及到耳鼻咽喉科的相关内容,故充分认识耳鼻咽喉科与COVID-19诊治的相关性,有助于提高对该疾病的认识与掌握。本文从耳鼻咽喉科角度出发,对二者之间的相关性作一综述,为COVID-19诊断及治疗过程中的耳鼻咽喉科相关问题提供参考。     

COVID-19 and ENT Pediatric otolaryngology during the COVID-19 pandemic. Guidelines of the French Association of Pediatric Otorhinolaryngology (AFOP) and French Society of Otorhinolaryngology (SFORL)

ObjectiveJoint guidelines of the French Pediatric Otolaryngology Society (AFOP) and of the French Society of otorhinolaryngology–head and neck surgery (SFORL) on the management of paediatric otolaryngology patients in the context of the COVID-19 pandemic.MethodsA nation-wide workgroup drew guidelines based on clinical experience, national and local recommendations and scientific literature. Proposals may have to be updated on a day-to-day basis.ResultsIn children, incidence of symptomatic COVID-19 (1–5%) is low and of good prognosis. The indications for nasal flexible endoscopy should be drastically limited. If undertaken, full Personal Protective Equipment (PPE) including FFP2 masks are required, as well as use of a sheath. Saline nose wash done by caregivers other than parents at home should require PPE. Unless foreign body tracheobronchial aspiration is clinically obvious, CT-scan should be performed to confirm indication of endoscopy. Surgical indications should be limited to emergencies and to cases that cannot be delayed beyond 2 months (especially endonasal, endopharyngeal laryngo-tracheobronchial procedures). Postponement should ideally be a group decision and recorded as such in the medical file. Surgical techniques should be adapted to limit the risk of viral dissemination in the air, avoiding the use of drills, microdebriders, monopolar cautery or lasers. Continuous suction should be placed near the operating field. In case of confirmed Covid-19 cases, or suspected cases (or in some centres systematically), PPE with FFP2 mask should be worn by all staff members present in the operating room.     

新型冠状病毒肺炎患者合并鼻部症状临床分析及诊疗建议

目的调查新型冠状病毒肺炎（COVID-19）患者鼻部相关症状及其临床特点。方法收集2020年2月10日—3月20日华中科技大学同济医院327例确诊COVID-19患者的病例资料,采集鼻塞、流涕、嗅觉改变等鼻部相关症状、全身伴随症状及基础疾病等情况,分析其临床特点。结果在327例纳入研究的COVID-19患者中,轻型、普通型、重型、危重型病例分别为33例（10.1%）、62例（19.0%）、146例（44.6%）、86例（26.3%）;54例（16.5%）COVID-19患者合并鼻部相关症状,按不同症状发生的总例数统计,其中鼻塞35例（10.7%）、鼻腔干燥29例（8.9%）和嗅觉下降21例（6.4%）,鼻痒 17例（5.2％）、喷嚏16例（4.9％）、鼻出血14例（4.3％）和流清涕11例（3.4％）。在各不同病情分型患者间,鼻部症状的发生率没有统计学意义（P>0.05)。192例（58.7%）COVID 19患者有高血压、糖尿病等基础疾病存在,经过积极的综合治疗244例（74.6%）痊愈出院。结论COVID-19患者除了发热、咳嗽、咳痰等症状之外,鼻塞、嗅觉下降等鼻腔局部症状并不少见。鼻部疾病的治疗不仅可以改善患者生活质量,同时可以提高患者的治疗效果。因此,临床医师不能忽视COVID-19患者鼻部疾病的处理     

COVID-19 and ENT Surgery

In Otorhinolaryngology – Head and Neck Surgery, clinical examination and invasive procedures on the respiratory tract and on airway-connected cavities, such as paranasal sinuses and the middle ear, expose people to direct transmission of SARS-CoV-2 by inhalation or ocular projection of contaminated droplets, and to indirect transmission by contact with contaminated hands, objects or surfaces. Estimating an R₀ of COVID-19 at around 3 justified postponing non-urgent face-to-face consultations and expanding the use of teleconsultation in order to limit the risks of SARS-CoV-2 infection of patients or health workers and comply with the lockdown. The health authority recommends cancellation of all medical or surgical activities, which are not urgent as long as this does not involve a loss of chance for the patient. The purpose of this cancellation is to significantly increase critical care capacity, prioritise the reception of patients with COVID-19, prioritise the allocation of staff and provision of the equipment necessary for their medical or surgical management, and contribute to the smooth running of downstream critical care within their establishment. Another goal is to reduce the risks of patient contamination within healthcare facilities. This document provides guidance on how to proceed with and adapt ENT surgery in the current pandemic context, as well as on the management of postponed operations. This best practice advice must of course be adapted in each region according to the development of the epidemic and pre-existing arrangements. Their local application can only be decided within the framework of collaboration between the ENT teams, the operational hygiene units and all the other specialties concerned.     

Best practice recommendations: ENT consultations during the COVID-19 pandemic

These best practice recommendations for ENT consultations during the COVID-19 pandemic have been drawn up because ENT examinations and treatments are at risk of contamination by the SARS-Cov-2 virus in certain instances. Thus, ENT specialists are among the professionals who are most exposed to this infection. During the pandemic, insofar as an asymptomatic patient may be infected and contagious, the same precautions must be employed whether the patient is ill with, suspected of having, or without any clinical evidence of COVID-19 infection. According to the scientific data available, the examinations and procedures potentially exposing to projections/aerosolizations of organic material of human origin are considered to be at risk of staff contamination. For ENT examinations and procedures without exposure to such projections/aerosolizations, the professional is advised to a long sleeve clean outfit, a surgical mask and gloves in case of contact with the patient's mucosa. ENT examinations and procedures with exposure to these projections/aerosolizations require the so-called “airborne”, “contact”, and “droplets” additional precautions: FFP2/N95 respiratory protection device, eye protection, disposable headwear and long sleeve overgown.     

Impact of the COVID-19 epidemic on ENT surgical volume

PurposeThe purpose of this study was to assess the impact of the COVID-19 pandemic on the surgical volume of three ENT departments in Ile-de-France, a region severely affected by the epidemic.Materials and methodsThe number and nature of surgeries was collected from three university hospital ENT departments from 17/03/2020 to 17/04/2020 and from 18/03/2019 to 18/04/2019. Centre 1 is a general adult ENT department specialized in otology, centre 2 is a general adult ENT department specialized in cancer and centre 3 is a paediatric ENT department. Comparative analysis of the decreased surgical volume was conducted between 2019 and 2020.ObjectiveTo analyse the reduction of ENT surgical volume.ResultsThe three centres operated on 540 patients in 2019, versus 89 in 2020, i.e. an 84% decrease: 89% in Centre 1, 61% in Centre 2, and 95% in the paediatric centre. Otological surgery decreased by 97%, endonasal surgery decreased by 91%, head and neck surgery decreased by 54%, plastic surgery decreased by 82%, and transoral surgery decreased by 85%. The number of surgical operations for skin cancer decreased (24 vs. 9), while the total number of head and neck cancer surgeries remained stable (18 vs. 22). The number of planned tracheostomies increased from 8 to 22.ConclusionThe number of ENT surgeries decreased by 84% during the first month of the COVID-19 epidemic. This decreased surgical volume mainly concerned functional surgery, while the level of cancer surgery remained stable. Hospital units will need to absorb a marked excess surgical volume after the epidemic.     

SARS-CoV-2 and hearing: An audiometric analysis of COVID-19 hospitalized patients

PurposeCOVID-19 associated hearing loss is still an ongoing matter of debate. No original studies exist on audiological effects of SARS-CoV-2 infection in hospitalized patients. The main objective was to determine whether SARS-CoV-2 may affect auditory function in clinically ill COVID-19 patients.Materials and methodsCOVID-19 patients with moderate-severe disease and without prior history of hearing abnormalities were enrolled from a tertiary referral center, and matched with controls. Participants performed an audiometric evaluation, and thresholds were compared.Results120 ears from 60 patients were enrolled. Patients with COVID-19 showed worse mean auditory thresholds starting from 1000 Hz through higher frequencies, when compared to controls (1000 Hz: 18.52 ± 5.49 dB HL in controls vs 25.36 ± 6.79 dB HL in COVID-19, p < 0.001; 2000Hz: 17.50 ± 5.57 dB HL in controls vs 21.96 ± 7.05 dB HL in COVID-19, p = 0.010; 3000Hz: 17.97 ± 8.07 dB HL in controls vs 25 ± 9.38 dB HL in COVID-19, p = 0.003; 4000 Hz: 20.16 ± 10.12 dB HL in controls vs 29.55 ± 11.26 dB HL in COVID-19, p = 0.001; 8000 Hz: 31.09 ± 12.75 dB HL in controls vs 40.71 ± 19.40 dB HL in COVID-19, p = 0.030; Pure Tone Average: 20.42 ± 4.29 dB HL in controls vs 24.85 ± 5.62 dB HL in COVID-19, p = 0.001). Statistical significance persisted after adjusting for confounders such as age, gender and various comorbidities (p < 0.05).ConclusionsSARS-CoV-2 may affect hearing in COVID-19 patients with moderate-severe disease. Results are in line with the previous suggested effects of COVID-19 on auditory system. This study is expected to encourage further research on this topic.     

Percutaneous tracheostomy simulation training for ENT physicians in the treatment of COVID-19-positive patients

Tracheostomy in COVID-19-related severe acute respiratory syndrome is at high risk of viral dissemination. The percutaneous dilatation technique could reduce this risk, being performed at the bedside and minimising airway opening. In the COVID-19 context, however, with precarious respiratory status, it requires specific preparation. We designed a 3-hour training module, and here provide a step-by-step schedule, including video analysis, a demonstration of the kit, the recommended precautions related to COVID-19, and several simulation scenarios of increasing difficulty, using a high-tech mannequin. A low-tech procedural simulator was also developed for practicing the steps of the procedure. Our experience (3 sessions with 14 participants) highlighted the difficult points of the procedure in the COVID-19 context, and defined a checklist for clinical practice and an assessment grid. This type of simulation helps to prepare teams for a potentially delicate technical act.     

新冠肺炎危重型患者气管切开术初步经验与体会(附1例报告)

新型冠状病毒肺炎(新冠肺炎,COVID-19)是指由2019新型冠状病毒(新冠病毒,2019-nCoV)感染导致的肺炎。新冠病毒传播途径主要为呼吸道飞沫传播和接触传播,并存在气溶胶传播可能。由于肺部严重感染易导致急性呼吸窘迫综合征,新冠肺炎危重型患者气管切开术可作为一种救治手段,但术中可能会产生大量的病毒飞沫通过气道扩散在空气中形成气溶胶,增加院内感染风险。本文根据国家卫健委新冠肺炎相关诊疗方案和措施,结合我院的1例危重型患者在重症监护隔离病区行气管切开术的经验,探讨危重型新冠肺炎患者气管切开的必要性、手术方式、术前准备、术中操作、术后护理及医护防护措施等相关问题。     

Treatment of sleep apnea by ENT specialists during the COVID-19 pandemic

The treatment of sleep disorders has been strongly impacted by the COVID-19 pandemic. When the lockdown is over, resumption of usual patient care will require precautions to limit the risk of contamination for patients and caregivers. In this document, the French Association of Otorhinolaryngology and Sleep disorders (AFSORL) and the French Society of Otorhinolaryngology (SFORL) put forward a summary of the measures for continuing the treatment of sleep apnoea syndrome in these new practice conditions. Emphasis is placed on teleconsultation, methods of nocturnal sleep studies, the conditions for treatment by continuous positive airway pressure (CPAP) ventilation, and the postponement of more invasive treatments.     

Consensus statement. Corticosteroid therapy in ENT in the context of the COVID-19 pandemic

This consensus statement about the indications and modalities of corticosteroid treatment in the context of the COVID-19 pandemic was jointly written by experts from the French Association of Otology and Oto-Neurology (AFON) and from the French Society of Otorhinolaryngology, Head and Neck Surgery (SFORL). There is currently not enough data in favour of danger or benefit from corticosteroids in COVID-19, so until this matter is resolved it is advisable to limit their indications to the most serious clinical pictures for which it is well established that this type of treatment has a positive impact on the progression of symptoms. In Grade V and VI Bell's palsy according to the House-Brackmann grading system, a week's course of oral corticosteroids is recommended. Corticosteroid therapy is also recommended in cases of sudden hearing loss of more than 60 dB, either in the form of intratympanic injections or a week's course of oral medication. In rhinology, there is no indication for systemic corticosteroid therapy in the current situation. However, patients are advised to continue with their local corticosteroid therapy in the form of a nasal spray or by inhalation. Treatments with corticosteroid nasal sprays can still be prescribed if there is no alternative. Finally, systemic or local corticosteroid therapy is not indicated for bacterial ENT infections.