Utility of Telemedicine for Diagnosis and Management of Laryngology‐Related Complaints during COVID‐19

Abstract

Objectives/Hypothesis To investigate the concordance in diagnosis and management between initial telemedicine visits and subsequent in‐person visits with laryngoscopy for laryngology‐related complaints during COVID‐19. Study Design Retrospective cohort study. Methods Patients who presented to a tertiary care center with laryngology‐related complaints (voice, swallowing, airway, general throat complaints and others) and completed initial telemedicine visits and subsequent in‐person visits with laryngoscopy between March and October 2020 were included (n = 250). Preliminary diagnoses and managements provided during initial telemedicine visits were compared with the diagnoses and managements during subsequent in‐person visits with laryngoscopy. Multivariable logistic regression analysis was performed to compare concordance rates in diagnosis and management by chief complaint categories after adjusting for relevant demographic and clinical factors. Results Overall concordance rates in diagnosis and management between the initial telemedicine visit and subsequent laryngoscopy exam were 86.1% and 93.7%, respectively. Mean (standard deviation) days until laryngoscopy from the initial visit were 21.2 (23.0). Concordance rates were not associated with patient's age, gender, preferred language, provider, telemedicine visit duration, or days until laryngoscopy. Management concordance rate was relatively lower among patients with general throat complaints in comparison with voice‐related complaints (odds ratio: 0.27; 95% confidence interval: 0.08–0.90). Management changes after laryngoscopy included need for further imaging, procedures, voice therapy, and referral to other specialists. Conclusion Concordance rates in diagnosis and management remained high between the initial telemedicine visit and subsequent in‐person visit with laryngoscopy for new patients presenting with laryngology‐related complaints during the COVID‐19 pandemic. While laryngoscopy is still essential to confirm diagnosis and provide appropriate management, telemedicine may be a feasible alternative to provide suitable empiric therapy until laryngoscopy can be safely performed. Level of Evidence Level IV Laryngoscope , 2021

Clinical signs, telemedicine and online consultations in head and neck diseases during the SARS CoV-2 pandemic: an Italian experience

“…Other authors have reported high diagnostic reliability in patients with various ENT conditions, including otologic conditions, rhinosinusitis, peritonsillar abscess, and nasal fracture 14 . The diagnostic accuracy and effectiveness of empiric therapy provided during TM visits are of particular interest in determining the feasibility of its use in the effective management of patients 14 . A limitation to this type of approach is the need for an adequately trained health care technician to perform diagnostic and minor therapeutic procedures 13 , 15 .…”

“…Other alternatives described are voice recordings and speech analysis systems for speech pathology, although access to these investigations is still limited 9 , 18 . However, some authors have pointed out that the exclusive use of radiologic investigations for diagnosis is a deviation from the standard of care and may have medicolegal implications 14 . Kwok et al showed that in resource-limited settings and particularly in crisis situations such as the COVID-19 pandemic, simple initial telephone consultation has high concordance with the final treatment plan despite some limitations in diagnostic concordance due to the inability to perform physical examination 17 .…”

“…Similarly, Choi et al examined the concordance in diagnosis and management between the initial TM visit and subsequent laryngoscopic examination in an outpatient tertiary care centre; the overall concordance rates were high: 86.0 and 93.6% for diagnosis and management, respectively. They emphasised that although TM should not replace in-person physical examination and laryngoscopy for laryngology-related disorders, it can be effectively used to provide a preliminary diagnosis, appropriate management plan and triage during the current pandemic 14 .…”

“…Concerning management concordance rates for complaints related to swallowing and general throat complaints (i.e., pharyngodynia, discomfort, or throat knot feeling), TM with video can provide useful preliminary information such as overall swallowing function and change in voice quality/aspiration symptoms after swallowing 14 .…”

“…In these cases, TM can be used for appropriate triage during the pandemic, recognising urgent issues that need rapid follow-up (i.e., symptomatic airway obstruction, aspiration, severe dysphagia, suspicion of malignancy, etc.). Of course, it is important to note that the small percentage of cases with misdiagnosis or mismanagement may result in critical morbidity in these patients 14 .…”