COVID‐19 and the Otolaryngologist: Preliminary Evidence‐Based Review

Abstract

The SARS-CoV-2 virus, which causes coronavirus disease 2019 (COVID-19), has rapidly swept across the world since its identification in December 2019. Otolaryngologists are at unique risk due to the close contact with mucus membranes of the upper respiratory tract and have been among the most affected healthcare workers in Wuhan, China. We present information on COVID-19 management relevant to otolaryngologists on the frontlines of this pandemic and provide preliminary guidance based on practices implemented in China and other countries and practical strategies deployed at Stanford University.

Features of anosmia in COVID-19

“…Anosmia was never the first or second symptom to develop, but it was the third symptom in 38% (22/52) of cases. Anosmia developed 4.4 (±1.9 [1][2][3][4][5][6][7][8]) days after infection onset.…”

“…Until recently, ENT symptoms had not been reported with COVID-19, except for nasal congestion and rhinorrhea [2][3][4][5][6][7][8]. However, 54 (47%) of our 114 COVID-19 patients reported anosmia.…”

“…For instance, a recent review on COVID-19 by ENT specialists on March 26 emphasized that ENT symptoms were uncommon with COVID-19 as nasal congestion and rhinorrhea were observed in less than 5% of cases. However, they noticed that there were few reports of anosmia and dysgeusia with no real description of symptoms [8]. Recently, in April, descriptions of cases of anosmia in a multicentric cohort have been associated with COVID-19 [9][10][11].…”

COVID-19 and hearing difficulties

“…COVID-19 is proving to be challenging for our public health system; all elective surgeries have been cancelled, as well as outpatients' consultations. Patients affected by Thanks to the efforts of the Otolaryngology (ORL) societies worldwide, the high risks of Otolaryngologists during this pandemic have been recognized 5 . An additional attention to our specialty is also due to the recent awareness of olfactory and gustatory dysfunctions as presenting symptoms of COVID-19 6 .…”

Pediatric laryngoscopy and bronchoscopy during the COVID-19 pandemic: A four-center collaborative protocol to improve safety with perioperative management strategies and creation of a surgical tent with disposable drapes

“…Other groups have provided extremely helpful broad insights on how to manage various necessary high-risk otolaryngologic procedures during the current pandemic, including rigid microlaryngoscopy and bronchoscopy (MLB). [13,14] In this article, we offer further detailed perioperative management strategies and present a novel specific protocol designed to improve safety by decreasing intraoperative aerosolized viral product during pediatric MLB by utilizing disposable drapes to create a contained tent immediately around the patient. While this protocol was developed to be used during the COVID 19 pandemic, the concepts are likely translatable to any future pandemic where aerosol generating procedures increase risk of pathogenic exposure.…”