Guidelines for head and neck cancer care during COVID-19 pandemic

Neck breathers (including laryngectomees) infected with COVID-19 carry a high risk of transmitting the virus to other individuals by aerosolizing tracheal secretions to their environment.  Infection control strategies specific to patients with laryngectomy should be adhered whenever they are cared for.

Personal protective equipment (PPE) should be adequately utilized, and only necessary medical providers should be in the treatment or patient’s room.  Patients should always be presumed positive with COVID-19, until proven otherwise. It is recommended that whenever they care for a laryngectomee medical providers wear a N95 respirator and face shield or a powered air‐purifying respirator (PAPR), a disposable surgical cap, gown, gloves, and shoe covers when evaluating a laryngectomee with unknown, suspected, or positive COVID‐19 status.  Standard PPE, as defined by the OccupationalHealth and Safety Administration (OSHA), can be used for COVID‐19‐negative patients. 

It is recommended to defer nasopharyngoscopy and tracheoscopy if possible as these are high risk aerosol generating procedures.  When performing flexible tracheoscopy, attempts should be made to minimize mucosal stimulation and resultant coughing.

A special article just published by DrGivi and colleagues in JAMA Otolaryngology-Head & Neck Surgery, presented guidelines for head and neck physical examination and surgical and non-surgical procedures during the coronavirus (COVID-19) pandemic.

Because head and neck examinations are considered high risk in patients with suspected or confirmed COVID-19, the authors developed recommendations for health care workers based on review of the literature and communication with physicians with firsthand knowledge of safety procedures during the COVID-19 pandemic.

The guidelines state that:

• Non urgent appointments should be postponed to limit infection of patients or health care workers. This may include postponing appointments for patients with benign disease and for those undergoing routine surveillance after treatment for head and neck cancer.
• Patients should be queried by telephone about new or concerning signs or symptoms that may indicate recurrence and/or pending issues, as well as symptoms suggestive of COVID-19.
• In-person clinic visits should be offered to those at risk for significant negative outcomes without evaluation.
• Maintaining relationships with patients and support assessments that can be made without in-person examinations. The use of telephone, video, or telemedicine visits should be considered.
• In-person examinations should be limited to patients who need a thorough head and neck examination ( e.g. postoperative visits, tracheoesophageal prosthesis complications, symptoms concerning for cancer recurrence, etc.).
  Detailed guidelines are provided for physical examinations and associated procedures.

It is expected that following carefully planned routines and procedures, will enable providing adequate care and help protect the safety and health of health providers and patients.

It is helpful to have a plan in place in case one becomes sick. Identifying a caregiver and staying in touch with family, friends, neighbors, and healthcare professionals during the pandemic through email or phone, especially if some lives alone is important. If one is aware of an exposure or are experiencing symptoms such as a sore throat, dry cough, fever, and/or shortness of breath, seek medical help as soon as possible. Trying to contact one’s care team over the phone before coming into a medical center can facilitate their care.

To read the Guidelines click this link. https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2764032


Hennessy et al. present their special considerations and best practice recommendations in the management of total laryngectomy patients. They also presented their recommendations for laryngectomy patients and how to minimizing community exposures. 

Endoscopic examination by an otolaryngologist