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In this article, we aim to summarize the impacts of COVID-19 on the practice of otologic surgery. Cadaveric studies have indicated COVID-19 viral particles are present in the middle ear mucosa of infected hosts. Otologic procedures can generate significant amounts of droplets due to reliance on high-speed drills. Multiple guidelines have been developed to improve patient and provider safety peri-operatively. Particle dispersion can be mitigated during microscopic mastoidectomy by utilizing barrier drape techniques. The barrier drape may similarly be applied to the surgical exoscope. Endoscopic techniques have theoretical improved safety benefits by minimizing the need for drilling. The discoveries and innovations borne of the COVID-19 pandemic will lay the groundwork for the practice of otology amidst future pandemics. [ABSTRACT FROM AUTHOR]

* Objective: To describe the mucocutaneous and soft tissue infections caused by Xanthomonas maltophilia in patients with cancer. * Design: A retrospective 15-month clinical study. * Setting: Academic, referral-based cancer center. * Patients: Of 237 patients with X. maltophilia isolated from all sites during the 15-month study period, 114 patients were judged to have true X. maltophilia infections. Only patients with mucocutaneous and soft tissue infections were included in the study. * Results: 17 (15%) of the 114 patients with X. maltophilia infection had mucocutaneous and soft tissue infections: Six patients had metastatic cellulitis, 5 had primary cellulitis usually associated with catheter use, and 6 had infected mucocutaneous ulcers. The metastatic cellulitis consisted of previously undescribed multiple, hard, tender nodules with surrounding and distant cellulitis (5 patients) or ecthyma gangrenosum (1 patient). Four of these patients died of the infection. Metastatic cellulitis and mucocutaneous infections occurred in hospitalized, neutropenic patients who received broad-spectrum antibiotics ([beta]-lactams, quinolones), often with in vitro activity against the infecting organisms. Response usually correlated with recovery from myelosuppression and administration of trimethoprim-sulfamethoxazole with or without ticarcillin-clavulanate. Catheter removal contributed to response in the treatment of primary cellulitis. * Conclusions: Mucocutaneous and soft tissue infections caused by X. maltophilia are not uncommon, and X. maltophilia can cause metastatic nodular skin lesions that mimic disseminated fungal infections. It also causes serious morbidity and high mortality in patients with metastatic skin nodules and can cause superinfections in patients receiving broad-spectrum [beta]-lactam or quinolone antibiotics to which the organisms are susceptible when the infections develop. Catheter removal contributes to a favorable outcome in patients with catheter-associated cellulitis without bacteremia. Xanthomonas maltophilia infection should be added to the differential diagnosis of mucocutaneous or soft tissue infection in patients with cancer. Trimethoprim-sulfamethoxazole with or without ticarcillin-clavulanate is the current treatment of choice for culture-proven infections, but early empiric therapy may improve outcome., Infections of the skin and mucous membranes (mucocutaneous) and soft tissue infections in cancer patients may be caused by Xanthomonas (X.) maltophilia. Such infections can result in serious illness and even death, especially in patients with severe neutropenia (decrease in neutrophil leukocytes in the blood) caused by cancer chemotherapy. A study of 114 patients with X. maltophilia infection revealed that 17 of these patients had mucocutaneous and soft tissue infections. Four of five patients with hard, tender nodules died of the infection. The nodules were a previously undocumented manifestation of X. maltophilia infection. X. maltophilia may be transmitted in hospitals to susceptible patients, and may resemble a fungal infection. X. maltophilia should be suspected as the cause of any mucocutaneous or soft tissue infection in cancer patients, especially if the patient is very neutropenic, has a fever, and is receiving broad-spectrum antibiotics. Trimethoprim-sulfamethoxazole and perhaps ticarcillin-clavulanate should be used in treating X. maltophilia infections.

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