Role of the otolaryngologist in nasopharyngeal swab training: A case report and review of the literature

Abstract

Nasopharyngeal swabs are commonly done in the medical field for a multitude of reasons, and they recently have been an essential component of widespread testing to control the spread of COVID-19. Although rare, improper technique when performing nasopharyngeal swabs has the potential to lead to injury or misleading test results. We present a case of uncontrolled epistaxis requiring hospitalization following a routine nasopharyngeal swab in a healthy patient. Both the complexity and variability of the anatomy of the nasopharynx can contribute to poor swabbing technique. Otolaryngologists should be encouraged to educate and support other healthcare workers to improve the yield and reduce the risk of harm due to nasopharyngeal swabs. Increased comfort levels with performing nasopharyngeal swabs will also improve the sensitivity of screening tests for common respiratory viruses such as influenza, Epstein-Barr virus (EBV), or bacteria such as Staphylococcus aureus .

Valid and Reliable Assessment of Upper Respiratory Tract Specimen Collection Skills during the COVID-19 Pandemic

“…The good effect of a short simulation-based URTS training is also comparable to other studies with similar findings [21,22]. This indicates that URTS is a well-defined procedure where non-healthcare educated workers can perform URT samples comparably to experts if they receive focused and standardized training [23].…”

Persistent Idiopathic Facial Pain After a Coronavirus Disease 2019 Diagnostic Nasopharyngeal Swab

“…Poor familiarity with common nasopharyngeal structural variations, such as septal deviations, could lead to unexpected complications. 1,9) Complications requiring surgical management, such as epistaxis, septal abscess formation, and CSF leakage, have been reported after COVID-19 nasopharyngeal swabbing. 4,5) Nasopharyngeal swab induced pain and discomfort in the tested area also have been previously reported.…”

“…Recently, nasopharyngeal swabbing has gained public attention due to the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. 1) A broad array of sampling techniques have been introduced to confirm the presence of SARS-CoV-2, such as testing bronchoalveolar lavage fluids, sputum, nasopharyngeal swabs, and saliva. 1) The U.S. Centers for Disease Control and Prevention has recommended nasopharyngeal swabs as a cost-effective and sensitive test.…”

“…1) A broad array of sampling techniques have been introduced to confirm the presence of SARS-CoV-2, such as testing bronchoalveolar lavage fluids, sputum, nasopharyngeal swabs, and saliva. 1) The U.S. Centers for Disease Control and Prevention has recommended nasopharyngeal swabs as a cost-effective and sensitive test. 2) These swabs enable direct sampling of the posterior nasopharyngeal wall, which usually contains a large amount of the SARS-CoV-2 virus.…”

“…2) These swabs enable direct sampling of the posterior nasopharyngeal wall, which usually contains a large amount of the SARS-CoV-2 virus. 1,3) However, as more healthcare workers from diverse healthcare roles collect nasopharyngeal swabs, the question has been raised about the correctness and safety of performing these swabs. Although the prevalence is very rare, complications after COVID-19 nasopharyngeal swabbing have been reported; for example, one patient had uncontrollable nasal bleeding after a nasopharyngeal swab, which was managed by surgical intervention, 4) and another patient, with a pre-existing skull base defect, had cerebrospinal fluid (CSF) leakage, which also required surgical intervention.…”