Evolving Management of COVID‐19: A Multi‐institutional Otolaryngology Perspective

Abstract

Objective To provide evolving information on active protocols regarding inpatient, outpatient, procedural, and surgical case management taking place in otolaryngology practices in response to COVID-19. Study Type Cross-sectional multi-institutional survey. Methods An online survey of 55 otolaryngology departments across North America. Results As of March 25, 2020, almost all (n = 53 of 55, 96.3%) otolaryngology departments had canceled elective cases and were performing only urgent consults. Most residents continued to participate in operative cases (n = 45 of 49, 91.8%) and take call (n = 48 of 50, 96.0%). Of the respondents, 27 of 29 (93.1%) stated that they were deferring nonemergent tracheostomy procedures for the time being. The use of personal protective equipment followed a general trend of an increasing level of protection with an increased risk of the procedure; most (n = 49 of 54, 90.7%) incorporated N95 mask usage for bedside/clinic examinations with flexible laryngoscopy. Powered air-purifying respirators and N95 masks were used mainly for procedures involving the mucosal surfaces. Discussion Due to the high viral density in the nasal cavity and nasopharynx of patients with COVID-19, basic examinations and common otolaryngology procedures place practitioners at high risk of exposure. Although there is variability in practice among otolaryngologists across North America in managing the COVID-19 outbreak, most are primarily seeing urgent ambulatory and inpatient consultations. Most are also incorporating personal protective equipment appropriate to the level of transmission across mucous membranes. Implications for Practice In these rapidly evolving times, it is helpful to find solidarity and assurance among health care providers. Current data aimed to provide (1) perceived methods regarding the safe care of otolaryngology patients and (2) updated practice patterns at a national level.

Symptomatology of COVID-19 from the otorhinolaryngology perspective: a survey of 223 SARS-CoV-2 RNA-positive patients

“…Otorhinolaryngology clinics around the world are reorganizing outpatient services to sustain patient care and to minimize the transmission of the disease [34,35]. Because many Otorhinolaryngologic examinations are aerosol producing examinations, it is important to determine which patients are at higher risk of disease transmission and take necessary precautions accordingly [36,37].…”

Otolaryngology-related Google Search trends during the COVID-19 pandemic

“…In assessing the possible factors contributing to these trends, it may be important to recognize the 34.4% reduction in RSV for "ENT" as the context for the decreases seen in the other terms. This decrease in "ENT" queries could reflect the reduction in referrals to otolaryngologists and the widespread cancellations of elective surgeries [20]. Previous studies have shown that patients utilize more internet search terms after receiving a diagnosis as compared to before it has been given [21].…”

Essential inpatient otolaryngology: what COVID-19 has revealed

“…These aforementioned risks and concerns over lack of personal protective equipment (PPE) in the United States at the time led the American Academy of Otolaryngology-Head and Neck Surgery to release a position statement early in the pandemic (March 23, 2020) recommending that otolaryngologists limit patient care to time-sensitive and emergent problems and routinely use appropriate PPE when treating patients [8]. Other groups have proposed similar guidelines regarding triage and PPE for management of otolaryngology patients, and have reported changes in outpatient and operative otolaryngologic practice due to these guidelines [9][10][11][12]. However, to the best of our knowledge, no existing literature has characterized the impact of the pandemic on inpatient otolaryngologic consultations in the United States.…”