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