Tracheoesophageal voice prosthesis management in laryngectomy patients during the COVID-19 pandemic

David P Goldstein,Lisa Durkin,Jonathan Irish,Elana Aziza,Patrick Gullane,John Waldron,Douglas B Chepeha,John R De Almeida,Gilbert Ralph,Ashok R Jethwa,Dale Brown

doi:10.1186/s40463-020-00456-z

Abstract

With the COVID-19 pandemic, there has been significant changes and challenges in the management of oncology patients. One of the major strategies to reduce transmission of the virus between patients and healthcare workers is deferral of follow-up visits. However, deferral may not be possible in total laryngectomy patients. Urgent procedures may be necessary to prevent complications related to ill-fitting tracheoesophageal puncture (TEP) voice prostheses, such as aspiration or loss of voicing. In this paper, we describe the Princess Margaret Cancer Center’s approach to managing this unique patient population.

Highlights

With the outbreak of the Coronavirus (COVID-19) pandemic a state of emergency was declared in Ontario on March 17, 2020 with directives from the Ministry of Health and Long-term Care to restrict all but essential ambulatory care services [1]
Since coronavirus is transmitted through respiratory droplets or aerosolization of virus from the upper aerodigestive tract (UADT), aerosol generating procedures (AGPs), such as those frequently performed in Otolaryngology-Head and Neck Surgery, can put health
Many patients using tracheoesophageal puncture (TEP) voice prostheses may be able to tolerate small amounts of aspiration on a temporary basis without developing pneumonia, while a minority can experience serious negative health consequences from aspiration such as hospitalization for pneumonia or respiratory compromise [8]. Another complication of TEP voice prosthesis use is dislodgement which can result in aspiration of the voice prosthesis, aspiration of solids

Summary

Introduction

With the outbreak of the Coronavirus (COVID-19) pandemic a state of emergency was declared in Ontario on March 17, 2020 with directives from the Ministry of Health and Long-term Care to restrict all but essential ambulatory care services [1]. In addition to the problem or concern with the TEP, other factors such as patient’s age, past medical history (e.g. comorbidities including other respiratory conditions, immunosuppression, previous history of aspiration pneumonia and severity), current health condition with particular attention to patient report of stable or deteriorating condition and signs of aspiration pneumonia (fever or discoloration of tracheal secretions) are taken into account to determine whether an in-person appointment is required These factors help determine the risk of a major complication from aspiration and the risk of morbidity or mortality should the patient be exposed to COVID-19.

Discussion

Conclusions