Conclusion
Total laryngectomy patients represent a unique challenge during the
SARS-CoV-2 pandemic given their propensity for aerosolization of
secretions, and concomitant respiratory comorbidities that put them at
risk for higher mortality from COVID-19. At this time, it is critical to
postpone all non-urgent patient interactions in the clinic setting and
to develop new outpatient clinic workflow procedures to reduce aerosol
particle transmission. In this patient cohort, when testing for
SARS-CoV-2, it is important to include testing for the presence of the
virus in tracheal aspirates as well as in the nasal passages. We
recommend that until SARS-CoV-2 testing becomes more widely available,
the same precautions used for COVID-19 positive patients should be
implemented for laryngectomy patients with the use of enhanced PPE for
all head and neck exams. Procedures such as TEP replacement,
non-critical nasal endoscopy, or nasopharyngoscopy should be delayed
when possible and patients should be counseled on appropriate
temporizing measures that can be taken. If intervention is required, all
efforts to lower clinical suspicion for COVID-19 infection should be
taken with rapid testing, if available, and appropriate quarantine prior
to any procedures. The use of HMEs and covers over the stoma can help
limit exposure and transmission risk related to this patient population.
Table 1: Patient Instructions for the Laryngectomee Prior to
Their Clinic Visit