AHNS endocrine surgery section consensus statement on nasopharyngolaryngoscopy and clinic reopening during COVID‐19: How to get back to optimal safe care

Abstract

This article provides best practice guidelines regarding nasopharyngolaryngoscopy and OHNS clinic reopening during the COVID‐19 pandemic. The aim is to provide evidence‐based recommendations defining the risks of COVID‐19 in clinic, the importance of pre‐visit screening in addition to testing, along with ways to adhere to CDC guidelines for environmental, source, and engineering controls.

Rate of COVID‐19 Infection in Patients Following Otolaryngology vs Non‐otolaryngology Outpatient Encounters

“…Multiple clinical guidelines have been put in place, including provider N95 respiratory use, increased clinic air exchange, and barrier use. 4,6 While patient-to-provider transmission risk can be reduced with personal protective equipment, there is a theoretical risk of patient-to-patient transmission in an office setting where potentially aerosolizing procedures are performed in an unmasked setting.…”

“…Otolaryngologic physical examination as well as clinic procedures such as nasal endoscopy and nasopharyngoscopy, which require instrumentation of the upper airway, pose a challenge for a universal masking protocol. Multiple clinical guidelines have been put in place, including provider N95 respiratory use, increased clinic air exchange, and barrier use 4,6 . While patient‐to‐provider transmission risk can be reduced with personal protective equipment, there is a theoretical risk of patient‐to‐patient transmission in an office setting where potentially aerosolizing procedures are performed in an unmasked setting.…”

“…3 This perceived high exposure risk led to a number of studies on viral transmission through aerosolization, clinic room ''resting,'' and increased personal protective equipment use for ORL providers. [4][5][6] However, there has been no actual data to support the claim that ORL visits and procedures are inherently higher risk than comparable elective medical care within other specialties. In the present study, we compare rates of COVID-19 positivity following in-office visits between patients receiving ORL specialty care and patients seen for a non-ORL outpatient encounter.…”

“…As a result, routine otolaryngology (ORL) visits fell dramatically during the early period of the COVID‐19 pandemic 3 . This perceived high exposure risk led to a number of studies on viral transmission through aerosolization, clinic room “resting,” and increased personal protective equipment use for ORL providers 4‐6 . However, there has been no actual data to support the claim that ORL visits and procedures are inherently higher risk than comparable elective medical care within other specialties.…”

Follow-up of a national web-based survey on the SARS-CoV-2 infectious state of otorhinolaryngologists in Germany

“…Healthcare workers (HCW)appear to be at higher risk of contracting SARS-CoV-2 [7]. Among these HCW, due to the very nature of the specialty, otorhinolaryngologists (ORLs) have a high probability of exposure to patient aerosols [2,6,8,12,13,17,24,25]. Numerous recommendations for ORLs regarding the treat-ment of COVID-19 patients [1, 9-11, 19, 21, 22, 28] and protection against SARS-CoV-2 infection were published [4,5,14,18,20,27,31,32].…”