CSO (Canadian Society of Otolaryngology – Head & Neck Surgery) position paper on return to Otolaryngology – Head & Neck Surgery Clinic Practice during the COVID-19 pandemic in Canada

Abstract

The novel Coronavirus (COVID-19) has created a worldwide deadly pandemic that has become a major public health challenge. All semi-urgent and elective medical care has come to a halt to conserve capacity to care for patients during this pandemic. As the numbers of COVID-19 cases decrease across Canada, our healthcare system also began to reopen various facilities and medical offices. The aim for this document is to compile the current evidence and provide expert consensus on the safe return to clinic practice in Otolaryngology – Head & Neck Surgery. These recommendations will also summarize general precaution principles and practical tips for office across Canada to optimize patient and provider safety. Risk assessment and patient selection are crucial to minimizing exposure to COVID-19. Controversial topics such as COVID-19 mode of transmission, duration of exposure, personal protective equipment, and aerosol-generating procedures will be analyzed and discussed. Practical solutions of pre-visit office preparation, front office and examination room set-up, and check out procedures are explored. Specific considerations for audiology, pediatric population, and high risk AGMPs are also addressed. Given that the literature surrounding COVID-19 is rapidly evolving, these guidelines will serve to start our specialty back into practice over the next weeks to months and they may change as we learn more about this disease.

Impact of COVID-19 on Surgical Interventions and Medical Practices in Pediatric Otolaryngology: A Narrative Review

“…COVID-19 and pediatric otolaryngology: The major transmission routes of COVID-19 are respiratory aerosols, droplets, or direct contact [ 17 ]; sneezing, coughing, talking, and even breathing can generate aerosols and droplets. However, there is debate about whether aerosol spread is an important form of disease transmission [ 18 ].…”

“…Likewise, there is no evidence that coughing or sneezing caused by nasopharyngeal sample collection increases the transmission risk of COVID-19. This procedure is also similar to flexible NPL and has the risk of causing coughing or sneezing; however, NPL is arguably less traumatic than a nasopharyngeal swab because it is performed under direct visualization [ 17 ].…”

“…In contrast, a recent cadaveric study demonstrated the absence of aerosol generation during nasal aspiration using 10F Frazier suction. Moreover, other studies have shown that suction has the potential to decrease aerosol diffusion during AGMPs [ 17 ].…”

Otolaryngology in the face of A pandemic

“… 1 , 2 , 51 For those patients who were able to be seen, rigorous screening measures were implemented, including questionnaires regarding symptoms, temperature checks, and masking requirements. 2 , 52 Furthermore, in an effort to facilitate social distancing, patients were not permitted to bring any supporting family or friends to clinic visits which was mentally and emotionally taxing for patients. 51 …”

“…Several of these challenges included (1) rearranging waiting room space and check-in/check-out procedures in order to limit the number of patients in the waiting rooms, (2) staggering appointments to enhance social distancing protocols, and (3) using physical barriers at check-in desks to limit the exchange of respiratory droplets. 2 , 51 , 52 Unnecessary objects, such as informational pamphlets and 3-D anatomical models, were removed from examination rooms to allow for efficient disinfection of rooms between patients. 51 , 52 Additionally, due to the frequency of aerosol-generating procedures performed in otolaryngology, protocols were implemented to allow for adequate air exchange to occur in the rooms which helped with decontamination.…”