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Introducción: La infección por SARS-CoV-2 tiene una elevada incidencia entre profesionales sanitarios, especialmente otorrinolaringólogos (ORL). Objetivo del estudio: El objetivo de este estudio fue recoger aspectos organizativos, de seguridad y de protección de los otorrinolaringólogos durante el pico de la pandemia por coronavirus 2019 (COVID-19) en España. Diseño/ Material y métodos: Estudio transversal con una encuesta por correo electrónico a los socios otorrinolaringólogos de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC). Resultados: Respondieron 408 profesionales. La atención a pacientes con COVID-19 representó más del 25% de la actividad asistencial para el 24,4% de los encuestados. 213 encuestados (52,6%) respondieron que algún compañero había guardado cuarentena o dado positivo en el test. El número de facultativos diagnosticados COVID-19 o que guardó cuarentena por síntomas compatibles osciló entre 1 y 12 por hospital (media 2,2; mediana 2) vinculándose una mayor incidencia en las regiones con mayor incidencia de coronavirus (62,1% vs 41,8%; p

Background Optimal timing for tracheotomy for critically ill COVID‐19 patients requiring invasive mechanical ventilation (IMV) is not established. Methods Multicenter prospective cohort including all COVID‐19 patients admitted to intensive care units (ICUs) in 36 hospitals who required tracheotomy during first pandemic wave. With a target emulation trial framework, we studied the causal effects of early (7–10 days) versus late (>10 days) tracheotomy (LT) on time from tracheotomy to weaning, postoperative mortality, and tracheotomy complications. Results Of 696 patients, 20.4% received early tracheotomy (ET). ET was associated with faster weaning (hazard ratio [HR] [95% confidence interval, CI]: 1.25 [1.00–1.56]) without differences in mortality (HR [95% CI]: 0.85 [0.60–1.21]) or complications (adjusted rate ratio [95% CI]: 0.56 [0.23–1.33]). Conclusions ET had a similar or lower post‐tracheotomy weaning time than LT, potentially shortening IMV and ICU stays, without changing complication or mortality rates in COVID‐19 patients.

Resumen Introduccion La lesion del nervio facial continua siendo la complicacion mas grave de la cirugia de la glandula parotida. Debido a la creciente evidencia sobre las ventajas del uso de la monitorizacion intraoperatoria del nervio facial, se distribuyo una encuesta entre los miembros de la Sociedad Espanola de Otorrinolaringologia y Cirugia de Cabeza y Cuello con el objetivo de determinar los patrones de uso en nuestro medio. Material y metodos Se distribuyo un cuestionario que incluia 12 preguntas separadas en 3 secciones en formato e-mail a traves del correo oficial de la Sociedad Espanola de Otorrinolaringologia y Cirugia de Cabeza y Cuello. La primera seccion de preguntas evaluaba las caracteristicas demograficas, la segunda seccion estaba relacionada con el patron de uso de los sistemas de monitorizacion intraoperatoria del nervio facial y la tercera seccion se referia a los litigios relacionados con la paralisis facial. Resultados Se enviaron un total 1.544 cuestionarios anonimos. Recibimos un total de 255 encuestas, para una tasa de respuesta global del 16,5%. De estos, 233 (91,3%) realizaban cirugia de glandula parotida y 94% usaban monitorizacion intraoperatoria del nervio facial. Un 94% de los encuestado usaba la monitorizacion intraoperatoria del nervio facial si realizaba menos de 10 parotidectomias por ano y un 93,8% si realizaban mas de 10 parotidectomias por ano (OR, 1,02; IC del 95%, 0,68-1,45; p = 0,991). Conclusion Nuestros datos demuestran que la mayoria de los otorrinolaringologos y cirujanos de cabeza y cuello en Espana estan empleando la monitorizacion del nervio facial durante la cirugia de la glandula parotida. Casi todos coinciden en que esto busca mejorar las medidas de seguridad quirurgica y consideran que la monitorizacion del nervio facial es util para prevenir lesiones inadvertidas.

Introduction Facial nerve injury remains the most severe complication of parotid gland surgery. Due to the increasing evidence about the advantage of the use of intraoperative facial nerve monitoring, a survey was distributed among members of the Spanish Society of Otorhinolaryngology-Head and Neck Surgery with the objective of determining patterns of its use. Material and methods A questionnaire which included 12 separate questions in 3 sections was distributed via email through the official email of the Spanish Society of Otorhinolaryngology-Head and Neck Surgery. The first section of questions was in relation to demographic characteristics, the second section was related to the pattern of monitoring use and the third section referred to litigation related to facial palsy. Results 1544 anonymous questionnaires were emailed. 255 surveys were returned, giving an overall response rate of 16.5%. From these, 233 (91.3%) respondents perform parotid gland surgery. Two-hundred nineteen (94%) respondents use intraoperative facial nerve monitoring. Of the respondents,94% used intraoperative facial nerve monitoring if in their current practice they performed fewer than 10 parotidectomies per year and 93.8% if they performed more than 10 (OR, 1.02; 95% CI, 0.68−1.45; p = .991). With regard to lawsuits, just 3 (1.2%) of the respondents had a history of a parotid gland surgery–associated lawsuit and in just one case the facial nerve monitor was not used. Conclusion Our data demonstrate that most otolaryngologists in Spain use intraoperative facial nerve monitoring during parotid gland surgery. Almost all of them use it to improve patient safety and consider that facial nerve monitoring should be helpful preventing inadvertent injury.

espanolLa enfermedad por el SARS CoV-2 (COVID-19) ha provocado millones de casos desde que se declarase el estado de pandemia por la Organizacion Mundial de la Salud (OMS) en marzo de 2020, cambiando las practicas medicas y quirurgicas habituales. Los sanitarios representan un importante porcentaje de la poblacion general contagiada. Entre ellos, destaca el especial riesgo de infeccion en otorrinolaringologos y cirujanos de cabeza y cuello (ORL), debido a la cercania a la via aerea superior y al riesgo de generacion de bioaerosoles durante los procedimientos. El objetivo de este articulo es la elaboracion de un documento de practica otorrinolaringologica segura durante la pandemia COVID19, basado en una recopilacion de la mejor evidencia adaptada al riesgo de transmision, segun la combinacion de los resultados de los indicadores de riesgo establecidos por el Ministerio de Sanidad, Consumo y Bienestar Social (MSCBS). El presente documento es fruto de la colaboracion de las comisiones cientificas y del comite COVID-19 de la SEORLCCC. EnglishThe SARS CoV-2 (COVID-19) disease has caused millions of cases since the pandemic status was declared by the World Health Organization (WHO) in March 2020, changing the usual medical and surgical practices. Doctors and nurses represent a significant percentage of the general population infected. Among them, the special risk of infection in otorhinolaryngologists and head and neck surgeons (ENT) stands out, due to the proximity to the upper airway and the risk of generation of bioaerosols during procedures. The objective of this article is to prepare a document on safe otorhinolaryngological practice during the COVID19 pandemic, based on a compilation of the best evidence adapted to the risk of transmission, according to the combination of the results of the risk indicators established by the Ministry of Health, Consumption and Social Welfare (MSCBS). This document is the result of the collaboration of the scientific commissions and the COVID-19 committee of the SEORLCCC.

Antecedentes y objetivo: En la infección por SARS-CoV-2 la pérdida repentina del olfato y/o gusto han sido descritas como síntomas iniciales. El objetivo principal de este estudio es conocer la prevalencia de estos síntomas en España. Materiales y métodos: Estudio prospectivo de pacientes con COVID-19 confirmado mediante RT-PCR en España. Se utilizaron los cuestionarios traducidos y validados. Resultados: Un total de 1043 pacientes COVID-19 leve. Edad media de 39 ± 12 años. 826 pacientes (79,2%) refirieron algún grado de alteración del olfato, 662 (63,4%) pérdida total y 164 (15,7%) parcial. 718 pacientes (68,8%) notaron alteración del gusto. Hubo una asociación significativa entre ambos trastornos (p

Contains fulltext : 220257.pdf (Publisher’s version ) (Closed access) The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice. We completed a modified Delphi consensus process of three rounds with 40 international experts in head and neck cancer surgical, radiation, and medical oncology, representing 35 international professional societies and national clinical trial groups. Endorsed by 39 societies and professional bodies, these consensus practice recommendations aim to decrease inconsistency of practice, reduce uncertainty in care, and provide reassurance for clinicians worldwide for head and neck surgical oncology in the context of the COVID-19 pandemic and in the setting of acute severe resource constraint and high risk of infection to patients and staff.

The appearance of a new coronavirus disease called COVID-19 at the end of 2019 and its pandemic expansion in the world has changed the usual practice of medicine, and has had great impact in the field of Otorhinolaryngology and Head and Neck Surgery (OHNS). The aim of this document is to review the available evidence and propose strategies and recommendations for the medical-surgical practice of OHNS, which allow establishing the usual activity, adapting the safety and efficacy standards to the current pandemic situation. Therefore, it is required to identify and classify patients according to criteria of infectious-immunological status, and to establish recommendations for protection in consultations, hospitalization and the operating room, which avoid the transmission of the disease to other users and healthcare personnel, in the specific context of the development of our specialty. This document is the result of the collaboration of all the scientific commissions of Spanish OHNS society and therefore might help other OHNS to develop their work during COVID-19 pandemic.

Background and objectives: Training in surgical specialties has declined during the COVID-19 pandemic. A study was carried out to further analyze the impact of the COVID-19 pandemic on specific aspects of clinical, training, and research activities performed by the otolaryngology residents in Spain. Methods: A cross-sectional qualitative study was conducted during the last two weeks of February 2021. The study consisted of an online survey taken by otolaryngology residents who had undertaken one-year continuing training from February 15, 2020, to February 15, 2021, and consisted of 26 questions exploring the impact of the COVID-19 on the health of the ENT residents and training activities. Categorical variables were reported as frequency and percentage. When indicated, Pearsońs Chi-square test (χ2) with Yates's correction and Pearson's correlation coefficient (r) were used. Results: 143 completed surveys were received from 264 residents (54.17%). 36 residents (25.2%) have suffered from the disease due to SARS-CoV-2. Most of them only developed mild symptoms (86.1%), with 3 requiring hospitalization (8.3%). The origin of infection was unknown in all reported cases and the need for confinement was principally due to either attending an asymptomatic patient in 9 cases (6.3%) or to being supposedly in close contact with an asymptomatic person in 22 (15.4%). 60.1% of the residents surveyed reported having lost more than 6 months of their training period, and in 18.8% of cases, it was as high as 10 and 12 months. There has been a reduction of more than 75% of what was planned in surgical training (P < .05) of tympanoplasty, mastoidectomy, stapedectomy, cochlear implants, endoscopic sinonasal and anterior skull base surgery, septoplasty and turbinoplasty. Conclusions: The decline in ENT activity and residents having to assist in other COVID-19 units during the most critical moments of the pandemic, has caused the main reduction in their training capacity. Contagion mainly occurred through contact with asymptomatic carriers during patient care and through supposedly close contact with asymptomatic carriers. Virtual activities have been widely accepted, but they have not completely replaced all residents' training needs. Measures should be implemented to recover lost training, especially surgical practical learning in otology and rhinology. Antecedentes y objetivos: La pandemia COVID-19 ha alterado todas las actividades sanitarias, entre ellas la formación especializada de los residentes. Se llevó a cabo un estudio para analizar en profundidad el impacto de la pandemia COVID-19 en aspectos específicos de las actividades clínicas, formativas e investigadoras que realizan los residentes de otorrinolaringología (ORL) en España durante un año completo de formación. Métodos: Se realizó un estudio cualitativo transversal durante las últimas dos semanas de febrero de 2021. El estudio consistió en una encuesta en línea realizada por residentes de ORL que habían realizado un año continuado de formación desde el 15 de febrero de 2020 al 15 de febrero de 2021 y consistió en 26 preguntas que exploraban el impacto del COVID-19 en la salud de los residentes de ORL, en su dedicación laboral y en las actividades de formación. Las variables categóricas se informaron como frecuencia y porcentaje. Cuando se indicó, se utilizó la prueba chi-cuadrado de Pearson con la corrección de Yates y el coeficiente de correlación de Pearson (r). Resultados: Se recibieron 143 encuestas cumplimentadas de 264 residentes (54,17%). Treinta y seis residentes (25,2%) habían padecido la enfermedad por SARS-CoV-2. La mayoría de ellos solo desarrollaron síntomas leves (86,1%) y 3 requirieron hospitalización (8,3%). Los residentes encuestados que resultaron positivos para SARS-CoV-2 no fueron capaces de identificar la fuente de su contagio y la necesidad de confinamiento se debió principalmente a la atención de un paciente asintomático en 9 casos (6,3%) o al contacto estrecho con un asintomático en situaciones no identificadas distintas de la atención sanitaria en 22 (15,4%). El 60,1% de los residentes encuestados reportaron haber perdido más de 6 meses de su período de formación, y en el 18,8% de los casos llegaron a 10 y 12 meses. Se ha producido una reducción de más del 75% de lo previsto en formación quirúrgica (p < 0,05) de timpanoplastia, mastoidectomía, estapedectomía, implantes cocleares, cirugía endoscópica nasosinusal y de base de cráneo anterior, septoplastia y turbinoplastia. Conclusiones: El descenso de la actividad ORL y la necesidad de prestar asistencia en otros servicios y unidades durante los momentos más críticos de la pandemia han causado la principal reducción de su capacidad de formación. El contagio fundamentalmente ocurrió por el contacto con portadores asintomáticos durante la atención a pacientes y por contacto estrecho con portadores asintomáticos. Las actividades virtuales han sido ampliamente aceptadas, pero no han reemplazado por completo las necesidades de formación de todos los residentes. Se deberán implementar medidas para recuperar la formación perdida, especialmente el aprendizaje práctico quirúrgico en otología y rinología.

Resumen El hipoparatiroidismo es la complicacion mas frecuente tras la tiroidectomia total. Se define por la presencia de hipocalcemia con unos niveles de hormona paratiroidea (PTH) bajos o inadecuadamente normales. La hipocalcemia aguda es una complicacion potencialmente grave. Su tratamiento se basa, segun la gravedad del cuadro, en la administracion de calcio por via oral o intravenosa, pudiendo requerir asimismo calcitriol oral. El riesgo de hipocalcemia sintomatica tras una tiroidectomia es muy bajo si la PTH postoperatoria desciende menos del 80% respecto de la preoperatoria. Estos pacientes podrian ser dados de alta sin tratamiento, aunque los umbrales son variables entre laboratorios y recomendamos extremar la vigilancia en los casos de riesgo aumentado (enfermedad de Graves, grandes bocios, reintervenciones o constancia de la extirpacion de alguna paratiroides). El tratamiento a largo plazo busca controlar los sintomas manteniendo la calcemia en el limite bajo de la normalidad, vigilando el producto calcio-fosforo y la aparicion de hipercalciuria.

Hypoparathyroidism is the most common complication after total or completion thyroidectomy. It is defined as the presence of hypocalcemia accompanied by low or inappropriately normal parathyroid hormone (PTH) levels. Acute hypocalcemia is a potential lethal complication. Hypocalcemia treatment is based on endovenous or oral calcium supplements as well as oral calcitriol, depending on the severity of the symptoms. The risk of clinical hypocalcemia after bilateral thyroidectomy is considered very low if postoperative intact PTH decrease less than 80% with respect to preoperative levels. These patients could be discharged home without treatment, although this threshold may vary between institutions, and we recommend close surveillance in cases with increased risk (Graves disease, large goiters, reinterventions or evidence of parathyroid gland removal). Long-term treatment objectives are to control the symptoms and to keep serum calcium levels at the lower limit of the normal range, while preserving the calcium phosphate product and avoiding hypercalciuria.

Resumen La laringectomia total permanece como tratamiento fundamental para el carcinoma de laringe localmente avanzado asociandose a una mayor supervivencia. Sin embargo, supone para el paciente una serie de cambios, como la incapacidad de comunicarse verbalmente, la respiracion o el cambio estetico, que inciden en su calidad de vida y obligan a su rehabilitacion integral. El presente documento ha sido elaborado por el grupo de trabajo de rehabilitacion del paciente laringectomizado de la Comision de Cabeza y Cuello y Base de Craneo de la Sociedad Espanola de Otorrinolaringologia y Cirugia de Cabeza y Cuello con el objeto de unificar las recomendaciones sobre materiales, tecnicas y medidas que aunen la rehabilitacion integral del paciente sometido a una laringectomia total para la mejora de su calidad de vida y esta destinado a especialistas en otorrinolaringologia, a profesionales relacionados con el cuidado del paciente laringectomizado total y tambien a los propios pacientes. Las recomendaciones del documento tienen como objetivo mejorar la atencion del paciente al cual se le ha realizado una laringectomia total teniendo en cuenta las necesidades de personal y material, las consideraciones sobre los procedimientos necesarios antes de la cirugia, durante el propio acto quirurgico y tras el alta hospitalaria del paciente. Se dan tambien recomendaciones especificas sobre los tipos de rehabilitacion y seguimiento de la misma, asi como la necesidad de llevar un registro de dichas actividades. Las recomendaciones expuestas pretenden ayudar a los profesionales sanitarios relacionados con el tratamiento de los pacientes laringectomizados totales a llevar a cabo la tarea de hacer que la vida de estos pacientes sea lo mas parecida posible a la vida que llevaban antes de realizarse una laringectomia total.

Advances in oncological head and neck surgery evidenced in the last decades have been linked to the progression in the reconstruction capacity of the defects resulting from resection of advanced tumors, allowing the improvement of both esthetic and functional results, as well as decrease the rate of postoperative complications in rescue surgery. To understand the situation of head and neck reconstruction across the country. a questionnaire about the current state of head and neck reconstructive surgery in Spain in otorhinolaryngology and head and neck surgery departments was distributed via email. Eighty (25.5%) of 313 ENT departments in Spain carry out some type of reconstruction in oncological surgery of the head and neck. Forty-four (55%) departments use regional pedicled flaps as a single reconstruction strategy, while 36 (45%) departments also employed the use of microvascular free flaps. Fifty-six (70%) departments perform 10 or less regional pedicled flaps per year, while 21 (29.6%) perform 10 or more flaps per year, with an average of 9.91 ± 11.73 flaps/year (min. 2, max. 40). Seven (8.75%) departments perform 10 or more free flaps a year, while the other 29 (36.25%) perform 10 or less, with an average of 4.96 ± 5.1 free flaps microvascular year (min. 2, max 20). In our country, head and neck cancer surgeries are performed in a tertiary level hospital and patients benefit from the reconstruction of post-surgical defects, through the use of regional pedicled or microvascular free flaps.

BackgroundTraining in surgical specialties has declined during the COVID-19 pandemic. A study was carried out to further analyze the impact of the COVID-19 pandemic on specific aspects of clinical, training, and research activities performed by the otolaryngology residents in Spain.MethodsA cross-sectional qualitative study was conducted during the last two weeks of February 2021. The study consisted of an online survey taken by otolaryngology residents who had undertaken one-year continuing training from February 15, 2020 to February 15, 2021 and consisted of 26 questions exploring the impact of the COVID-19 on the health of the ENT residents and training activities. Categorical variables were reported as frequency and percentage. When indicated, Pearson´s Chi-square test (c2) with Yates´s correction and Pearson's correlation coefficient (r) were used.Results143 completed surveys were received from 264 Residents (54.17%). 36 residents (25.2%) have suffered from the disease due to SARS-CoV-2. Most of them only developed mild symptoms (86.1%), with 3 requiring hospitalization (8.3%). The origin of infection was unknown in all cases and the need for confinement was principally due to either attending an asymptomatic patient in 9 cases (6.3%) or to being in close contact with an asymptomatic person off hospital grounds in 22 (15.4%). 60.1% of the residents surveyed reported having lost more than 6 months of their training period, and in 18.8% of cases, it was as high as 10 and 12 months. There has been a reduction of more than 75% of what was planned in surgical training (p < 0.05) of tympanoplasty, mastoidectomy, stapedectomy, cochlear implants, endoscopic sinonasal and anterior skull base surgery, septoplasty and turbinoplasty.ConclusionsThe decline in ENT activity and residents having to assist in other COVID-19 units during the most critical moments of the pandemic, has caused the main reduction in their training capacity. Virtual activities have been widely accepted, but they have not completely replaced all residents’ training needs. Specialized ENT training should be extended from 6 months to 1 year to ensure adequate training, especially for recovering the surgical Otology and Rhinology hands-on training lost during the pandemic.

BackgroundThe COVID-19 pandemic has strained intensive care unit (ICU) resources. Tracheotomy is the most frequent surgery performed on ICU patients and can affect the duration of ICU care. We studied the association between when tracheotomy occurs and weaning from mechanical ventilation, mortality, and intraoperative and postoperative complications.MethodsMulticentre prospective cohort including all COVID-19 patients admitted to ICUs in 36 hospitals in Spain who received invasive mechanical ventilation and tracheotomy between 11 March and 20 July 2020. We used a target emulation trial framework to study the causal effects of early (7 to 10 days post-intubation) versus late (>10 days) tracheotomy on time from tracheotomy to weaning, postoperative mortality, and tracheotomy complications. Cause-specific Cox models were used for the first two outcomes and Poisson regression for the third, all adjusted for potential confounders.FindingsWe included 696 patients, of whom 142 (20·4%) received early tracheotomy. Using late tracheotomy as the reference group, multivariable cause-specific analysis showed that early tracheotomy was associated with faster post-tracheotomy weaning (fully adjusted hazard ratio (HR) [95% confidence interval (CI)]: 1·31 [1·02 to 1·81]) without differences in mortality (fully adjusted HR [95% CI]: 0·91 [0·56 to 1·47]) or intraoperative or postoperative complications (adjusted rate ratio [95% CI]: 0·21 [0·03 to 1·57] and 1·49 [0·99 to 2·24], respectively).InterpretationEarly tracheotomy reduced post-tracheotomy weaning time, resulting in fewer mechanical ventilation days and shorter ICU stays, without changing complication or mortality rates. These results support early tracheotomy for COVID-19 patients when clinically indicated.FundingSupported by the NIHR, FAME, and MRC.Research in contextEvidence before this studyThe optimal timing of tracheotomy for critically ill COVID-19 patients remains controversial. Existing guidelines and recommendations are based on limited experiences with SARS-CoV-1 and expert opinions derived from situations that differ from a pandemic outbreak. Most of the available guidance recommends late tracheotomy (>14 days), mainly due to the potential risk of infection for the surgical team and the high patient mortality rate observed early in the first wave of the COVID-19 pandemic.Recent publications have shown that surgical teams can safely perform tracheotomies for COVID-19 patients if they use adequate personal protective equipment. Early tracheotomy seems to reduce the length of invasive mechanical ventilation without increasing complications, which may release crucial intensive care unit (ICU) beds sooner.The current recommendations do not suggest an optimal time for tracheotomy for COVID-19 patients, and no study has provided conclusions based on objective clinical parameters.Added value of this studyThis is the first study aiming to establish the optimal timing for tracheotomy for critically ill COVID-19 patients requiring invasive mechanical ventilation (IMV). The study prospectively recruited a large multicentre cohort of 696 patients under IMV due to COVID-19 and collected data about the severity of respiratory failure, clinical and ventilatory parameters, and whether patients need to be laid flat during their ICU stay (proned). The analysis focused on the duration of IMV, mortality, and complication rates. We used a prospective cohort study design to compare the ‘exposures’ of early (performed at day 7 to 10 after starting IMV) versus late (performed after day 10) tracheotomy and set the treatment decision time on the 7th day after orotracheal intubation.Implications of all the available evidenceThe evidence suggests that tracheotomy within 10 days of starting COVID-19 patients on mechanical ventilation allows these patients to be removed from ventilation and discharged from ICU quicker than later tracheotomy, without added complications or increased mortality. This evidence may help to release ventilators and ICU beds more quickly during the pandemic.

Purpose To determine the occurrence of olfactory and gustatory disruptions in COVID-19 patients, their association with demographic and clinical features and prognosis. Material and methods This observational cohort study involved consecutively diagnosed COVID-19 patients tested between March the 3rd 2020 and March the 24th 2020, in a geographically defined cohort area. All COVID-19 patients were evaluated in a University Hospital. The primary outcome of interest is the prevalence of smell and taste alterations, factors associated and recovery rate. Univariate and multivariate analysis by logistic regression was performed to detect factors associated to these symptoms. Results 151 patients were included and 99 (65.3%) reported olfactory or gustatory symptoms. Olfactory dysfunction was reported by 75 patients (49.7%). Isolated anosmia was found in 2 patients (1.3%). Gustatory dysfunction was reported by 91 patients (60.3%). Factors associated with higher prevalence of smell dysfunction included age, sex, and comorbidities. The time to smell disruption development was significantly shorter in mild to moderate patients than in severe patients (p = 0.043). In 85.3% of patients with smell disruption, the symptom had been resolved in the first 2 months. 14.7% of patients remained symptomatic after 3 months of follow-up. Conclusions Olfactory and gustatory dysfunction was common in COVID-19 patients. Smell disruption has high recovery rate and was associated with age, sex, and clinical severity. It may be beneficial to investigate the appearance of taste and/or smell disruptions in individual patients, with respect to diagnosis and prognosis., Highlights • Prevalence of smell and taste alterations was 65,3%. • Smell alteration was associated with age, sex and comorbidities. Only sex was found to be associated with taste alteration. • The time elapsed from disease onset to anosmia or hyposmia development was associated with clinical severity. • Recovery rate after a 3 month follow-up was 85.3%.

The recent COVID-19 (coronavirus) pandemic is causing an increase in the number of patients who, due to their pulmonary ventilatory status, may require orotracheal intubation. COVID-19 infection has demonstrated a high rate of transmissibility, especially via the respiratory tract and by droplet spread. The Spanish Society of Otolaryngology and Head and Neck Surgery, based on the article by Wei et al. of 2003 regarding tracheotomies performed due to severe acute respiratory syndrome (SARS), has made a series of recommendations for the safe performance of tracheotomies.

Objective: To determine the occurrence of olfactory and gustatory disruptions in COVID-19 patients, their association with demographic and clinical features and prognosis. Design: This observational cohort study involved consecutively diagnosed COVID-19 patients tested between March the 3rd 2020 and March the 24th 2020. Setting: A geographically defined cohort area. All COVID-19 patients were evaluated in a University Hospital. Participants: From the first 184 consecutive patients, 32 were considered ineligible and one refused to participate. Main Outcomes and Measures: The primary outcome of interest is the prevalence of smell and taste alterations, factors associated and recovery rate. Univariate and multivariate analysis by logistic regression was performed to detect factors associated to these symptoms. Results: 151 patients were included and 99 (65.3%) reported olfactory or gustatory symptoms. Olfactory dysfunction was reported by 75 patients (49.7%). Isolated anosmia was found in 2 patients (1.3%). Gustatory dysfunction was reported by 91 patients (60.3%). Factors associated with higher prevalence of smell dysfunction included age, sex, and comorbidities. The time to smell disruption development was significantly shorter in mild to moderate patients than in severe patients (p = 0.043). In 85.3% of patients with smell disruption, the symptom had been resolved in the first 2 months Conclusions and Relevance: Olfactory and gustatory dysfunction was common in COVID-19 patients. Smell disruption has high recovery rate and was associated with age, sex, and clinical severity. It may be beneficial to investigate the appearance of taste and/or smell disruptions in individual patients, with respect to diagnosis and prognosis.

Resumen La aparicion de una nueva enfermedad por coronavirus denominada COVID-19 a finales de 2019 y su expansion pandemica en el mundo ha cambiado la practica habitual de la especialidad de Otorrinolaringologia (ORL). Tras una fase de crecimiento exponencial de los contagios, se ha logrado entrar en una fase de control de la expansion de la enfermedad en la que persiste la posibilidad de contagio, pero la aparicion de nuevos casos se considera asumible por el sistema sanitario. El objetivo del presente documento es revisar la evidencia disponible y proponer estrategias y recomendaciones para la practica medico-quirurgica de la otorrinolaringologia y cirugia de cabeza y cuello, que permitan establecer la actividad habitual, adecuando los estandares de seguridad y eficacia a la situacion actual. Se requiere, por lo tanto, identificar y clasificar a los pacientes en funcion de criterios de estado infeccioso-inmunologico, y establecer las recomendaciones de proteccion en consultas, hospitalizacion y quirofano, que eviten la transmision de la enfermedad a otros usuarios y al personal sanitario, en el contexto especifico del desarrollo de nuestra especialidad. El presente documento es fruto de la colaboracion de las comisiones cientificas y del comite COVID-19 de la SEORLCCC.

Introduction Thyroid and parathyroid surgery (TPTS) is associated with risk of injury to the recurrent laryngeal nerve, superior laryngeal nerve and voice changes. Intraoperative neuromonitoring (IONM), intermittent or continuous, evaluates the functional state of the laryngeal nerves and is being increasingly used. This means that points of consensus on the most controversial aspects are necessary. Objective To develop a support document for guidance on the use of IONM in TPTS. Method Work group consensus through systematic review and the Delphi method. Results Seven sections were identified on which points of consensus were identified: indications, equipment, technique (programming and registration parameters), behaviour on loss of signal, laryngoscopy, voice and legal implications. Conclusions IONM helps in the location and identification of the recurrent laryngeal nerve, helps during its dissection, reports on its functional status at the end of surgery and enables decision-making in the event of loss of signal in the first operated side in a scheduled bilateral thyroidectomy or previous contralateral paralysis. The accuracy of IONM depends on variables such as accomplished technique, technology and training in the correct execution of the technique and interpretation of the signal. This document is a starting point for future agreements on TPTS in each of the sections of consensus.

Resumen Introduccion La cirugia de tiroides y paratiroides (CTPT) se asocia a riesgo de lesion del nervio laringeo recurrente, nervio laringeo superior y cambios en la voz. La neuromonitorizacion intraoperatoria (NMIO), intermitente o continua, en CTPT evalua el estado funcional de los nervios laringeos y se utiliza progresivamente con mas frecuencia. Esto obliga a adoptar puntos de acuerdo en los aspectos mas controvertidos. Objetivo Elaborar un documento de ayuda para orientar en la utilizacion de la NMIO en CTPT. Metodo Consenso en grupo de trabajo mediante revision sistematica y metodo Delphi. Resultados Se identificaron 7 secciones sobre las que se establecieron puntos de acuerdo: indicaciones, equipo, tecnica (parametros de programacion y registro), conducta en perdida de senal, laringoscopia, voz e implicaciones legales. Conclusiones La NMIO ayuda en la localizacion e identificacion del nervio laringeo recurrente, ayuda durante su diseccion, informa sobre su estado funcional al finalizar la cirugia y permite tomar decisiones en caso de perdida de senal en el primer lado operado en una tiroidectomia bilateral programada o si habia paralisis contralateral previa. La precision de la NMIO depende de variables como la tecnica realizada, la tecnologia utilizada y la formacion para la correcta ejecucion de la tecnica e interpretacion de la senal. El documento presentado es un punto de inicio para futuros acuerdos en CTPT en cada una de las secciones de consenso.

Hypoparathyroidism is the most common complication after total or completion thyroidectomy. It is defined as the presence of hypocalcemia accompanied by low or inappropriately normal parathyroid hormone (PTH) levels. Acute hypocalcemia is a potential lethal complication. Hypocalcemia treatment is based on endovenous or oral calcium supplements as well as oral calcitriol, depending on the severity of the symptoms. The risk of clinical hypocalcemia after bilateral thyroidectomy is considered very low if postoperative intact PTH decrease less than 80% with respect to preoperative levels. These patients could be discharged home without treatment, although this threshold may vary between institutions, and we recommend close surveillance in cases with increased risk (Graves disease, large goiters, reinterventions or evidence of parathyroid gland removal). Long-term treatment objectives are to control the symptoms and to keep serum calcium levels at the lower limit of the normal range, while preserving the calcium phosphate product and avoiding hypercalciuria.

Total laryngectomy remains essential treatment for locally advanced laryngeal carcinoma, related to better survival rates. However, it involves changes for the patient, such as the inability to communicate verbally, breathing or aesthetic changes, which affect their quality of life and require comprehensive rehabilitation. This paper was written by the total laryngectomy rehabilitation workgroup of the National Head and Neck and Skull Base working committee of the Spanish Society of Otolaryngology and Head and Neck Surgery. The purpose of the article is to combine materials, surgical procedures and means towards the comprehensive rehabilitation of total laryngectomy patients, so that they can achieve a good quality of life. This paper is aimed at all health care professionals caring for total laryngectomy patients. It is also aimed at the patients themselves, as well as ENT surgeons. We have considered staffing and material needs, all procedures before, during and after surgery and after hospital discharge. There are also detailed recommendations about types of rehabilitation and follow-up, and the need for recording these events. The comprehensive rehabilitation total laryngectomy patients is very important if we want to improve their quality of life. The recommendations we mention aim to help the healthcare professionals involved in the treatment of total laryngectomy patients to help them achieve a good quality of life, as similar as possible to the life they led before surgery.

Submandibular gland excision is traditionally performed using a transcervical approach. However, innovative surgical trials have recently been conducted to investigate techniques that can prevent or reduce visible scarring and nerve injury. The aim of the present study was to evaluate the feasibility of a new approach to submandibular gland excision that is based on the use of a minimally invasive video-assisted technique and an ultrasound scalpel in an endoscopic neck surgery program with a low annual flow of procedures. We retrospectively studied 15 patients with submandibular gland disease who underwent minimally invasive video-assisted submandibular sialadenectomy performed by two surgeons at two institutions. Eight patients had proximally located salivary calculi, three had chronic sialadenitis, and four had benign neoplasms. All dissections were carried out by a single-port gasless approach, using the Miccoli technique, involving endoscope magnification and an ultrasonic scalpel. All 15 submandibular gland resections were performed successfully, with no conversions to conventional open resection. The operative time ranged from 45 to 125 min (median 84 min). A total of 67 % of patients were discharged the day after surgery, and the maximum length of stay was 3 days. One patient experienced postoperative bleeding, and one experienced postoperative infection. There was no neural injury. The incision scar healed well in all cases, and all patients reported excellent cosmetic results. Endoscopic submandibular gland resection using a minimally invasive video-assisted technique, endoscopic magnification, and ultrasonic scalpel was feasible and resulted in excellent surgical outcomes.