Telemedicine in Otolaryngology in the COVID-19 Era: A Year Out

Abstract

One year ago, shortly after the onset of the coronavirus disease 2019 (COVID-19) pandemic, we published our initial experience with telemedicine. We showed that during the early pandemic, there was a dramatic shift to telemedicine and that 70% of our patients would decline telemedicine in favor of an in-person visit. As clinical limitations and stay-at-home orders relaxed, we sought to define how we have used telemedicine since. After the initial month of the pandemic, our utilization of telemedicine fell to an average of only 5% of visits over the past year. Nearly 80% of all telemedicine visits were routine follow-up visits, with its usage being unaffected by local policy and pandemic surges. The usefulness and applications of telemedicine have been well described; however, after our initial reliance on telemedicine, its use has been minimal. Moving forward, attention will need to focus on innovation and expanding comprehensive virtual examinations for otolaryngology to fully embrace this technology.

Challenges of Telemedicine during the COVID-19 pandemic: a systematic review

“…As reported in 18 studies, physical examination and diagnosis-related concerns were among the major challenges in telemedicine visits [ 18 – 23 , 26 – 29 , 33 – 37 , 39 , 41 , 42 ]. Physical examination is arduous to be performed remotely [ 19 , 20 , 22 , 29 , 34 – 37 , 39 , 42 ] because some of its essential elements such as monitoring the vital signs (e.g., measuring the blood pressure) could not be achieved virtually and if to be done are inaccurate [ 18 , 19 , 26 ]. Some medical procedures and diagnostic tests are also impossible at distance [ 42 , 43 ]: telemedicine visits were deemed to be inadequate especially for surgical specialties [ 33 ].…”

“…Some medical procedures and diagnostic tests are also impossible at distance [ 42 , 43 ]: telemedicine visits were deemed to be inadequate especially for surgical specialties [ 33 ]. Flexible laryngoscopy, otoscopic evaluation, and ophthalmoscope-based virtual visits are inappropriate [ 27 , 29 , 36 ]. A qualitative paper noted the lack of consensus on one standard procedure for virtual spine examination [ 37 ].…”

“…Besides, no technology exists that allows palpation at a distance [ 42 ]. Patients considered that physical examination and ancillary diagnostic tests are most precise, accurate, and thorough when done in-person [ 27 , 33 ] and thus were more likely to reject telemedicine visits [ 29 ]. This matches the findings of Eichberg et al [ 21 ] who showed that 18.5% of unsuccessful visits were because patients require further assessment and the findings of Murphy et al [ 41 ] who noted that wrong referrals and poor diagnosis and management were more likely to result from a telemedicine visit.…”

“…Challenges faced by special populations using telemedicine during the COVID-19 pandemic were discussed in twelve studies [ 18 , 19 , 22 – 25 , 29 – 31 , 35 , 39 , 42 ]. Age, technological challenges, and reluctance to utilizing telemedicine services are closely correlated [ 29 ].…”

“…Challenges faced by special populations using telemedicine during the COVID-19 pandemic were discussed in twelve studies [ 18 , 19 , 22 – 25 , 29 – 31 , 35 , 39 , 42 ]. Age, technological challenges, and reluctance to utilizing telemedicine services are closely correlated [ 29 ]. The mean age of patients who denied telemedicine consultations due to technical difficulties was around 80 years [ 29 , 42 ]: they find it difficult to acquire the digital literacy needed and they have insufficient access to technological advances (e.g., laptop, smartphone, …) [ 22 , 25 ].…”