COVID-19 and otorhinolaryngology: Returning to practice

Abstract

This article aims to focus on key points and provide an overview of the current knowledge of the Coronavirus Disease (COVID-19); the increased susceptibility of otorhinolaryngologists to the virus; its effects and impact on the ENT practice; disruption of specialist clinic services; as well as associated risks in ENT surgical procedures. Mitigation strategies that can be employed to efficiently return to practice and ensuring the highest level of safety to both the patient and the otorhinolaryngologist is emphasised whilst simultaneously adapting to the new normal. Attention was given to understanding of the virus, its effect on the ENT discipline and practice, counter measures to mitigate and minimise risk to allow for continuation of ENT services once restrictions and lockdowns are progressively lifted. Otorhinolaryngological manifestations are common symptoms of COVID-19. Evidence suggests that the highest rates of nosocomial spread were seen amongst otorhinolaryngologists. The COVID-19 pandemic unexpectedly halted a majority of the otorhinolaryngology activities, which impacted service provision in the ENT practice. As the pandemic evolves, and with its duration unpredictable, this may necessitate a fundamental shift in the way otorhinolaryngology is practiced as there may be further global viral pandemics in future and the ENT fraternity has to now adapt to the new normal. Continued vigilance is imperative and strategies optimally implemented to ensure safe return to both ENT specialist clinic services and surgeries is vital. There are currently no uniform best-practice recommendations for otorhinolaryngology in the COVID-19 setting, although key strategies to prevent the virus spread have become evident to be able to effectively ‘flatten the curve’ of COVID-19 infections over time.

Variation in aerosol generation by surgical modality during oropharyngeal and laryngeal surgery

“…Otorhinolaryngology is seen as a high‐risk field as most procedures are aerosol generating. 14 Mitigating strategies should be put in place to prevent the hazards of surgical plume. Smoke evacuation strategies need to be put in place.…”

Chronic Rhinosinusitis and COVID-19

“…11,48,49 In addition, ENT specialists are involved in aerosolgenerating procedures. 11,50,51 Although ENT nasal endoscopy is not considered an aerosol-generated procedure, it can induce sneezing, coughing, and gagging, resulting in aerosolization. 52,53 Education about how to conduct ENT consultation safely might help to reduce the nosocomial transmission of SARS-CoV-2 and other viral respiratory infections.…”