Search

Objective Describe current practices and challenges in personal protective equipment (PPE) use among US otolaryngologists during the COVID-19 pandemic. Study design Online survey. Setting Academic and non-academic healthcare institutions. Subjects and methods Subjects included US otolaryngology physicians. Emails were sent on April 17, 2020 to program coordinators at 121 residency programs, who were requested to forward the email to program directors for distribution. Further recruitment occurred through snowball recruitment. The survey was closed on June 15, 2020. Results Sixty-one participants completed the survey. 95.1% reported routine access to full PPE (N95 ± powered air purifying respirator [PAPR], gown, gloves, eye protection) for aerosol-generating procedures (AGPs) in COVID-19 patients, while 68.9% had routine access to full PPE for AGPs in patients without confirmed COVID-19. 88.5% had routine access to full PPE for potential aerosol-generating procedures (pAGPs) in COVID patients, while 80.3% had routine access to full PPE for pAGPs in patients without confirmed COVID. All participants felt that they “always” or “usually” had necessary PPE to safely perform procedures and surgeries on COVID patients. 83.6% received N95 fitting in the past year, and 93.4% reported adequate PPE training. Conclusion The majority of participants reported routine access to full PPE for AGPs and pAGPs in all patients, regardless of COVID status. There was a high perception of security, as well as adequate N95 fitting and PPE training. Areas for improvement include: optimizing PPE availability for AGPs in patients without confirmed COVID and wider recognition of otolaryngologic procedures as high risk for aerosolization.

Necrotizing (malignant) otitis externa (NOE) is a rare and invasive infection originating in the external acoustic meatus seen most commonly in diabetes and other immunocompromised states. After a protracted course, disease can smolder and extend into the mastoid, skull base, dural sinuses, and intracranially. We present a case of NOE complicated by mastoiditis, dural sinus thrombosis, and Bezold's abscess in an uncontrolled diabetic presenting with a prolonged course of facial nerve palsy. We stress the importance of maintaining a high index of clinical suspicion for NOE in diabetic patients and offering timely, aggressive treatment to mitigate its complications.