Collateral damage of the COVID-19 pandemic: an alarming decline in critical procedures in otorhinolaryngology in a German university hospital

Seasonality Disrupted: Post-Pandemic Trends in Otorhinolaryngological Infections

Background: The COVID-19 pandemic has notably affected the epidemiology of various infectious diseases. The imposed public health measures and disruptions in vaccination programs have potentially altered the patterns of these diseases post pandemic. Objective: To investigate the change in epidemiology of otorhinolaryngological infectious diseases in adult and pediatric patients after the COVID-19 pandemic and the relaxation of public health measures. Methods: A retrospective cohort study was conducted at a large tertiary university otolaryngology department in the south of Germany, examining admissions with specific ICD-10 diagnoses from 2019 to 2023. Data were seasonally categorized and statistically analyzed. Results: A total of 1728 inpatient cases were analyzed. There was a significant increase in otorhinolaryngological infections in the post-pandemic winter of 2022, particularly of peritonsillar abscesses, acute tonsillitis and acute mastoiditis. No significant post-pandemic spike in mononucleosis was observed. The duration of hospitalization was shorter in 2022, and the median age of patients did not change significantly pre- versus post-pandemic. Conclusions: The study indicates a significant post-pandemic rise in otorhinolaryngological infections. Remarkably, the typical "dip" in infections during the summer months was not observed in the post pandemic years, possibly reflecting the impact of the termination of non-pharmaceutical interventions. Mononucleosis was the only infection not following this pattern.

The effect of the COVID-19 pandemic on the diagnosis and progression of oral cancer

The COVID-19 pandemic placed a significant burden on healthcare resources, limiting care to emergent and essential services only. The objective of this study was to describe the effect of the COVID-19 pandemic on the diagnosis and progression of oral cancer lesions in Montreal, Canada. A retrospective analysis of health records was performed. Patients presenting for a new oncology consultation for an oral lesion suspicious for cancer between March 2018 and March 2022, within the Department of Oral and Maxillofacial Surgery of the McGill University Health Center, were included. Data was collected on sociodemographic characteristics, oral cancer risk behaviors of study participants, oral cancer delays, tumor characteristics, and clinical management. A total of 190 patients were included, 91 patients from the pre-pandemic period and 99 from the pandemic period. The demographic characteristics of the patients in the two periods were comparable. There was no significant difference in the patient, professional, or treatment delay between the two periods. There was a non-significant increase in pathologic tumor size during the pandemic, but the pathologic staging and postoperative outcomes were comparable to those of the pre-pandemic cohort. The results indicate that emergent care pathways for oral cancer treatment were efficiently maintained despite the pandemic shutdown of services.

The Impact of COVID-19 Restrictions on Hospital Admissions of Common Head and Neck Infections

INTRODUCTION

Following the emergence of COVID-19, multiple preventative measures were implemented to limit the spread of the disease. This study aims to elucidate the impact of COVID-19 restrictions on hospital admissions of otolaryngology-related infections.

MATERIALS AND METHODS

A retrospective chart review was conducted to capture all admissions for otolaryngology-related infections in the 2 years pre- and post-COVID-19 at the Health Sciences Centre in Winnipeg, Manitoba. These infections included croup, tracheitis, neck abscess, peritonsillar abscess, otitis media, mastoiditis, sinus infection, orbital infection, pharyngotonsillitis, retro/parapharyngeal abscess, and acute epiglottitis. Demographic information and admission details were collected and analyzed to compare pre- and post-COVID-19 admissions. Further analysis was conducted to compare hospital admissions of patients from rural/remote regions.

RESULTS

Between March 2018 and March 2022, 253 pediatric patients and 197 adults were admitted for otolaryngology-related infections. Total pediatric admissions decreased post-COVID-19 (154 pre-COVID-19, 99 post-COVID-19; p < 0.001) whereas adult admissions remained stable (107 pre-COVID-19, 90 post-COVID-19; p = 0.25). No significant difference in mean patient age, admission duration, surgical rates or in the proportion of admissions from patients from rural/remote regions was observed in the pediatric or adult cohort when comparing pre-COVID-19 data to post-COVID-19 data. Diagnosis-specific changes in admissions were observed in pediatric croup (40 pre-COVID-19, 15 post-COVID-19; p < 0.001) and in adult orbital infections (30 pre-COVID-19, six post-COVID-19; p < 0.001).

CONCLUSION

Following the implementation of COVID-19 restrictions, there was a decrease in admissions due to pediatric croup and adult orbital infections with an overall decrease in pediatric Otolaryngology-infection related admissions.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:3542-3547, 2024.

Impact of the COVID-19 pandemic on oncological care in Germany: rapid review

OBJECTIVES

The COVID-19 pandemic affected medical care for chronic diseases. This study aimed to systematically assess the pandemic impact on oncological care in Germany using a rapid review.

METHODS

MEDLINE, Embase, study and preprint registries and study bibliographies were searched for studies published between 2020 and 2 November 2022. Inclusion was based on the PCC framework: population (cancer), concept (oncological care) and context (COVID-19 pandemic in Germany). Studies were selected after title/abstract and full-text screening by two authors. Extracted data were synthesized using descriptive statistics or narratively. Risk of bias was assessed and summarized using descriptive statistics.

RESULTS

Overall, 77 records (59 peer-reviewed studies and 18 reports) with administrative, cancer registry and survey data were included. Disruptions in oncological care were reported and varied according to pandemic-related factors (e.g., pandemic stage) and other (non-pandemic) factors (e.g., care details). During higher restriction periods fewer consultations and non-urgent surgeries, and delayed diagnosis and screening were consistently reported. Heterogeneous results were reported for treatment types other than surgery (e.g., psychosocial care) and aftercare, while ongoing care remained mostly unchanged. The risk of bias was on average moderate.

CONCLUSIONS

Disruptions in oncological care were reported during the COVID-19 pandemic in Germany. Such disruptions probably depended on factors that were insufficiently controlled for in statistical analyses and evidence quality was on average only moderate. Research focus on patient outcomes (e.g., longer term consequences of disruptions) and pandemic management by healthcare systems is potentially relevant for future pandemics or health emergencies.

[COVID-19: Collateral damage in head and neck oncology and preventive measures for future pandemics]

The start of the COVID-19 pandemic led to enormous challenges for global healthcare, as capacities and resources had to be made available quickly for the treatment of COVID-19 patients. As a result, restrictions had to be accepted, especially in the care of oncological patients. The collateral damage of these limitations inevitably also affects patients with head and neck cancer. This review article summarizes the development of tumor incidences during the pandemic, internationally developed guidelines for the care of patients with head and neck cancer and studies on the delay in oncological therapies and mortality. In addition, the effects on the mental health of the patients, the psychosocial consequences and ethical issues are examined. In perspective, preventive measures for such negative collateral effects in future pandemics are discussed using the example of a concept for application software (app)-based digital care for patients with head and neck cancer.

[Establishing an ORL virtual outpatient Dept. during the COVID-19 pandemic]

INTRODUCTION

The COVID-19 pandemic changed medical education: teaching has been mostly converted to online mode. Our aim is to offer a complete high-quality curriculum despite the fact of worldwide cutbacks in education.

METHODS

The department of otorhinolaryngology introduced case-based learning (CBL). CBL is a learning and teaching approach that prepares students for clinical practice through the use of authentic clinical cases and places them in the role of decision maker. CBL combines theory and practice to prepare students as good as possible without intern shadowing. The students were asked to evaluate CBL as a digital format and as a teaching tool for future clinical work and preparation for the ORL exam.

RESULTS

The majority of students (>90%) rated the CBL as a successful digital format. Most students also strongly agreed or agreed that CBL is a good preparation for their future clinical work (>90%) and the ORL exam (>80%). 100% of students CBL confirmed, that they learned something new.

CONCLUSION

Following successful introduction of CBL we will implement a new teaching format. The "ORL virtual outpatient Dept." will include information from virtual, anonymized case studies. We choose diagnosis included in the "ORL virtual outpatient Dept." according to the most common ORL disorders encountered by primary care physicians. The "ORL virtual outpatient Dept." can only bridge the absence of practical training, and, in the future, serve as an additional preparation.

The Impact of COVID-19 on Cancer

Since late December 2019, the 2019 coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its rapid international spread have posed a global health threat. The World Health Organization has declared the outbreak of COVID-19 as "public health emergency of international concern". COVID-19 not only brings tremendous pressure to the medical system but also brings new challenges to the global economy. The occurrence and development of cancer has always been an area of active research, and COVID-19 also has a long-lasting impact on the diagnosis, treatment, and research of cancer. In the context, we review the adverse effects of COVID-19 on the screening, diagnosis, treatment and prognosis of cancer patients and the countermeasures in this situation, and provide solutions for improving the quality of life of cancer patients in the normalized prevention and control of COVID-19.