Changes in Clinical Practice amongst Nepalese Otolaryngologists during COVID-19 Pandemic

Background COVID-19 pandemic changed clinical practices more so for otolaryngologists due to inevitable risk of exposure. Objective To assess the changes in the clinical practice among Nepalese otolaryngologists during this pandemic. Method It was an observational study conducted as an online survey in the first two weeks of December 2020. A questionnaire pertaining to changes in clinical practice was mailed to 190 registered otolaryngologists working in various provinces of Nepal. Data were entered in Microsoft Excel 2007 and analysed in percentages. Result Out of the 77 (40.5%) who responded, nearly 50% resumed clinical practice after a month of national lockdown restarting everyday consultation by 64.9% mostly in hospital setting (81.8%) after screening patients via fever clinic by 87%. Modifications in clinical examinations was mostly done for neck (85.7%), oral cavity (44.2%) and nose (29.8%) examination with least with for ear examination (3.9%) Regular endoscopic evaluation was avoided by 19.4%. Only around 57% used adequate personal protective equipment. There was 93.5% reduction in elective operations. Mandatory COVID test was done by 89.6% mostly with reverse transcriptase polymerase chain reaction (95.9%) prior to semi-urgent case. Conclusion Changes in clinical practice were adapted to mitigate viral transmission. The changes were evident in the outpatient department where most patients were screened for fever and modifications made in the clinical examinations. Personal protective equipments were worn when available. Operative lists were limited to semi-urgent and urgent cases with covid testing customarily done for semi-urgent cases. Copyright © 2022, Kathmandu University. All rights reserved.

The Pediatric Tracheostomy Practice During COVID-19 Pandemic at a PICU

Introduction: To evaluate pediatric tracheostomies performed at a tertiary care pediatric intensive care unit (PICU) before and after the Coronavirus disease-2019 (COVID-19) pandemic. Methods: A total of 57 pediatric tracheostomy patients performed at a tertiary care PICU were included. Prognostic scores including pediatric risk of mortality 2, pediatric index of mortality 2 and pediatric logistic organ dysfunction scores, the family education process and time to home discharge were evaluated according to time of tracheostomy (pre-pandemic vs. after pandemic) and responsible surgeon (pediatric surgeon vs. otolaryngologist). MedCalc® Statistical Software version 19.7.2 (MedCalc Software Ltd, Ostend, Belgium;https: //www.medcalc.org;2021) was used for statistical analysis. Results: A non-significant tendency for higher rate of pediatric surgery-based tracheostomies was noted after the pandemic (76.0 vs. 24.0%, p=0.134). No significant difference was noted between tracheostomies performed before vs. after the COVID-19 pandemic and those performed by otolaryngologists vs. pediatric surgeons in terms of prognostic scores and time to home discharge. Conclusion: Our findings emphasize the maintenance of high quality patient care for pediatric tracheostomy patients in accordance with standardized tracheostomy protocols and policies during the pandemic period with no significant difference between tracheostomies performed before and after the COVID-19 pandemic and those performed by pediatric surgeons vs. otolaryngologists in terms of prognostic scores and time to home discharge. © 2022, Galenos Publishing House. All rights reserved.

Infection control, hand hygiene practice and PPE use among phoniatricians and ENT specialists during the COVID-19 pandemic, a UEP survey

Background: Caring for our patients while taking care of our own safety as well as theirs is a major concern during the current pandemic. Therefore, many societies developed guidance documents to educate clinicians about the required precautions. This study aims to assess personal protective equipment (PPE) usage, hand hygiene practice and infection control training among phoniatricians and otolaryngologists during the pandemic. An online survey was administered during the first wave of the COVID-19 pandemic in June 2020. Data collected included PPE availability, infection control training, adopted infection control precautions, hand hygiene practice, and use of different PPE elements as well as adherence to its use during potential aerosol generating procedures. Results: Based on their country of residences, eligible 154 participants were grouped into 4 groups and their responses were compared. Conclusion: Following the suggested recommendations, while adequate for some precautions, was still not satisfactory. Certain defects that are specific to particular groups had also been identified. © 2022, The Author(s).

The UK national registry of ENT surgeons with coronavirus disease 2019: one year on.

OBJECTIVES: To report the one-year findings of the UK national registry of ENT surgeons with suspected or confirmed coronavirus disease 2019, and the results of a survey on the coronavirus disease 2019 experience of UK ENT trainees. METHOD: An online registry was created in April 2020. A separate survey was circulated electronically to all members of the Association of Otolaryngologists in Training. RESULTS: The registry recorded 98 clinicians with confirmed or suspected coronavirus disease 2019. The majority of infections were reported in the first wave of spring 2020. Two ENT surgeons were hospitalised and one died. The majority suspected workplace exposure, with a significant proportion attributing this to a lack of personal protective equipment at a time before formal guidance had been introduced. Of the ENT trainees surveyed, almost one-third believed that they had contracted coronavirus disease 2019. CONCLUSION: This highlights the importance of ongoing risk-reduction measures, including optimal personal protective equipment and vaccination.

Quality of life and perceived financial implications among otorhinolaryngologists during the COVID-19 pandemic across India.

OBJECTIVE: The changing trends in medical practice, uncertainties and monetary apprehensions due to the COVID-19 pandemic may influence the sense of well-being among otorhinolaryngologists. The present study was conducted to evaluate quality of life (QOL) and perceived financial implications in otorhinolaryngologists during the COVID-19 pandemic across India. METHODS: A cross-sectional study was carried out among otorhinolaryngology specialists across India using WHOQOL-BREF and Consumer Financial Protection Bureau (CFPB) Financial Well-Being Scale questionnaires on Google Forms, which was kept open for the latter half of July 2020. RESULTS: A total of 358 responses were obtained; the response rate was 26.64%. Twenty-four percent of respondents worked exclusively in academic settings; 40.22% of specialists had over 10 years of work experience. Average monthly income in 2019 was between 1-3 lakhs Indian Rupees (INR) in 43.85%, while in 2020, 62.57% of the specialists had an average monthly income of below one lakh INR; this difference was statistically significant (p < 0.001). Mean WHOQOL-BREF scores for physical, psychological, social and environmental domains were 68.8 ± 1, 62.3 ± 0.75, 68.9 ± 1.17 and 65.8 ± 1.01, respectively; mean CFPB financial well-being scale score was 55.5 ± 0.66. QOL and financial well-being were better in otolaryngologists older than 60 years, male specialists and private consultants. CONCLUSIONS: There has been a tremendous impact on quality of life and financial well-being among otorhinolaryngologists in India during the COVID-19 pandemic. The study outcome may help otolaryngologists comprehend and perceive the extent to which it has affected their professional and personal lives, and explore ways to face and overcome the situation.

COVID-19 in otolaryngologists: a cross-sectional multicenter study.

INTRODUCTION: The nose and throat are areas of high viral load, which could place otolaryngologists at an even higher risk for COVID-19 than other health-care workers. OBJECTIVE: To investigate the prevalence of antibodies against SARS-CoV-2 in otorhinolaryngologists in southern Brazil, its relationship to demographic data, professional practice and reported symptoms of COVID-19, and compare it with official data on other health-care workers of the state and the general population in the same period. METHODS: In this cross-sectional multicenter study, otolaryngologists actively practicing officially registered in Rio Grande do Sul were screened for IgM and IgG antibodies against SARS-CoV-2 from August 1 to September 15, 2020. A questionnaire was also applied. RESULTS: We screened 358 (80.1%) of 447 actively practicing otolaryngologists (195 [54.5%] male; mean [SD] age, 47.77 [13.57] years; range, 26-84 years). Twenty-three were positive for IgM and/or IgG (6.4%). This result was significantly associated with reports of infected household contacts (19/315 negatives and 8/23 positives; p < 0.001). From 23 seropositive participants, 14 were asymptomatic (60.9%; p < 0.001). There were no significant associations between seroconversion and age, sex, number of patient appointments and surgical procedures, workplace (hospital or private practice), patients with or without respiratory symptoms, or level of personal protective equipment used. The rate of COVID-19 in all health-care workers in the state was 7.69% at the end of the same period. Data from state government seroprevalence was 5.26 (risk ratio [RR]; 95% CI 3.27-8.45) and 4.66 (RR; 95% CI 2.93-7.43) times higher in otolaryngologists than in the general population in August and September, respectively. CONCLUSION: Otolaryngologists had a higher seroconversion rate than the general population. Using personal protective equipment, the level of occupational exposure did not result in higher rates of infection than other health-care workers, but the presence of infected household contacts was associated with higher rates of seroconversion.

Adjustment of Health-Care Service Delivery Among Phoniatricians and ENT Specialists During the COVID-19 Pandemic, A UEP Survey.

BACKGROUND: Applying measures that prioritize staff safety, while protecting patient safety and care, represents a challenge during the current pandemic. Many documents of recommendations toward safe practice have been developed for this purpose. OBJECTIVE: To assess adjustments that have been undertaken by phoniatricians and otolaryngologists in the delivery of health-care services during the pandemic in order to reduce staff exposure to COVID-19 and improve safety. STUDY DESIGN: Cross-sectional. METHODS: An online self-administered survey was used during the first wave of the COVID-19 pandemic in June 2020 to collect data related to demographics of participants, their sources of information, administrative alterations, and changes they adopted when meeting patients for a consultation/procedure/surgery. RESULTS: The eligible 154 responses were grouped into 4 groups based on country of residence. Alterations to service delivery amongst the different groups were compared. CONCLUSIONS: The majority of participants were following the suggested recommendations to service delivery adjustments, with some inconsistencies in practice across countries.

Prospective Analysis of the Chronology of Smell and Taste Dysfunction in COVID-19 Positive ENT Doctors.

Olfactory and gustatory dysfunction has been reported as an early presentation in COVID-19. We intent to analyze the chronological outline of these chemosensory disturbances in term of onset, progression and resolution in ENT doctors with COVID-19. In six symptomatic otolaryngologists who tested positive for SARS-CoV-2, detailed symptomatology of olfactory and gustatory dysfunction was collected prospectively on regular basis till a period of at least three months. Due to their awareness, sensitivity and reliability, even mild and transient relevant symptomatology could be recorded accurately. Olfactory and gustatory dysfunction was universally present in all the six otolaryngologists. The onset of the symptoms was in first week and resolved completely within 4 weeks in four of them. In two doctors the recovery of olfactory dysfunction to near normal level was delayed and prolonged over 2 and 3 months. The pattern of involvement of basic tastes like sweet, salt, sour and bitter as well as food temperature and texture etc. pointed towards involvement of the gustatory mucosa with non-uniform involvement of the papilla and taste receptors. One of the doctors also experienced reappearance of parosmia and phantosmia in the 3rd month following complete disease resolution. Due to their expertise in the field of Otolaryngology, the recruited doctors represented the precise pattern of progression and resolution of olfactory and gustatory dysfunction in COVID-19. Larger studies are needed to validate our reported universal presence of these symptoms with complete recovery rate following disease resolution.

Utilization of telemedicine in rhinologic practice during COVID-19 pandemic.

BACKGROUND: The only two preventive interventions available for COVID-19 have been social distancing and quarantine. These preventive measures challenge health care providers by causing cancelations of elective in-person outpatient clinic visits in many hospitals, particularly in otolaryngology clinics. OBJECTIVES: To assess the applicability and feasibility of telemedicine in rhinology cases with a study of outcomes to guide rhinologists on indications of in-office visits. Assessment of patient satisfaction with telemedicine in the rhinology clinic was also investigated. METHODS: A retrospective review of electronic charts of all adult patients (>18 years) who were scheduled in the rhinology clinics of King Abdulaziz University Hospital, Riyadh, Saudi Arabia, and received a phone call as a part of telemedicine care from April through June 2020. Demographics (including age and gender), diagnosis, plan of treatment, and status of the visit (either new or follow-up) were collected. In addition, we used a special questionnaire to measure the satisfaction rate among patients who received telemedicine services. RESULTS: A total of 339 patients were included. The mean age was 41 years with 60.2% males. Only 5 cases (1.48%) were asked to attend to the clinic. The vast majority of cases were given a follow-up (n = 311, 91.7%). The most common diagnosis among the follow-up cases was chronic rhinosinusitis with nasal polyposis (n = 130, 38.3%). The satisfaction telephone survey had a total of 41 respondents out of 80 cases selected randomly. Most respondents (83.3%) were satisfied with telemedicine services. CONCLUSION: We conclude that telemedicine proved its effectiveness in the efficient management and screening of rhinology cases during public health emergencies while providing sufficient protection for patients and medical practitioners. Telemedicine as a modality of care during the pandemic faced minor or no opposition given patients' understanding of the importance of social distancing.

COVID-19 Rehab Fright Management.

Being diagnosed as positive for SARS-2 CoV RNA on PCR generates anxiety and stress as well as depression due to the prospects of being isolated. With genetically varied forms of virus on the rise the widely adopted manner to protect oneself is social distancing. This is frightening for rehabilitation professionals who at times are exposed at close quarters to the patients as rehabilitation is essential. Data in this backdrop is lacking, as this is a recent and ongoing pandemic. As such the current study was conducted with an attempt to review and highlight the causes of fright among rehabilitation professionals and possible management options in the wake of current pandemic of COVID-19 in the perspective of Pakistan. For this purpose literature was searched from major electronic databases including PubMed, Google, Google Scholar and Web-of-science, with keywords "Covid-19, mental health, telehealth, telemedicine, tele-rehabilitation and combination of words". Eighty English, full text articles were studied out of which 36 were used for the literature review. With this literature review we conclude that COVID-19 has resulted in fear of contracting and transmitting this disease among health professionals and can be reduced and managed by provision of tele-rehabilitation and telehealth facilities. Patients emerging from prolonged mechanical ventilations require extensive rehabilitation to restore routine body functions. The role of the otolaryngologist and speech language pathologist (SLP) is formal and direct to ensure appropriate and timely long term intervention and rehabilitation to ensure that these individuals re-enter mainstream activities.

Reducing potential aerosol generation in flexible nasolaryngoscopy: a novel method.

BACKGROUND: Fibre-optic nasoendoscopy and fibre-optic laryngoscopy are high-risk procedures in the coronavirus disease 2019 era, as they are potential aerosol-generating procedures. Barrier protection remains key to preventing transmission. METHODS: A device was developed that patients can wear to reduce potential aerosol contamination of the surroundings. CONCLUSION: This device is simple, reproducible, easy to use, economical and well-tolerated. Full personal protection equipment should additionally be worn by the operator.

The UK national registry of ENT surgeons with coronavirus disease 2019.

BACKGROUND: ENT surgeons are likely to be at high risk of coronavirus disease 2019 exposure. METHODS: A national registry of UK ENT surgeons with suspected or confirmed coronavirus disease 2019 was created with the support of ENT UK. Voluntary entry was made by either the affected individual or a colleague, using a web-based platform. RESULTS: A four-month data collection period is reported, comprising 73 individuals. Coronavirus disease 2019 was test-confirmed in 35 respondents (47.9 per cent). There was a need for hospitalisation in two cases (2.7 per cent) and tragically one individual died. Symptom onset peaked in March. The majority suspected their exposure to have been in the workplace, with a significant proportion attributing their disease to a lack of personal protective equipment at a time before formal guidance had been introduced. CONCLUSION: The registry suggests that a significant number of ENT clinicians in the UK have contracted coronavirus disease 2019, and supports the need for tailored personal protective equipment guidance and service planning.

Viral Infections of the Upper Airway in the Setting of COVID-19: A Primer for Rhinologists.

BACKGROUND: Viral respiratory tract infections are associated with a significant burden of disease and represent one of the leading causes of mortality worldwide. The current Coronavirus Disease 2019 (COVID-19) pandemic highlights the devastating toll that respiratory viruses have on humanity and the desperate need to understand the biological characteristics that define them in order to develop efficacious treatments and vaccines. To date, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has infected nearly 600 times more people and resulted in 200 times more deaths relative to Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) combined. OBJECTIVE: Through this review, we aim to summarize the key characteristics of respiratory viruses that hold global significance, with a focus on SARS-CoV-2. Our goal is to disseminate our current knowledge of these infectious agents to otolaryngologists, in particular rhinologists, practicing in the COVID-19 era. METHODS: The general and clinical characteristics of selected respiratory viruses along with available viral treatments and vaccines are reviewed. RESULTS: There has been significant progress in our understanding of the epidemiology and pathogenesis of various respiratory viruses. However, despite the advancement in knowledge, efficacious vaccines and antiviral treatments remain elusive for most respiratory viruses. The dire need for these scientific discoveries is highlighted by the recent COVID-19 pandemic, which has prompted investigators worldwide to conduct clinical trials at an accelerated timeline in an effort to reduce the morbidity and mortality associated with SARS-CoV-2 infection. Rhinologists will continue to remain on the front-lines of pandemics associated with respiratory viruses. CONCLUSION: In light of these unprecedented times, the need to understand the nuances of these viral respiratory pathogens, especially SARS-CoV-2, cannot be overemphasized. This knowledge base is of particular importance to otolaryngologists, whose expertise in the upper airway coincides with the anatomic tropism of these infectious agents.

Mental health among otolaryngology resident and attending physicians during the COVID-19 pandemic: National study.

BACKGROUND: Otolaryngologists are among the highest risk for COVID-19 exposure. METHODS: This is a cross-sectional, survey-based, national study evaluating academic otolaryngologists. Burnout, anxiety, distress, and depression were assessed by the single-item Mini-Z Burnout Assessment, 7-item Generalized Anxiety Disorder Scale, 15-item Impact of Event Scale, and 2-item Patient Health Questionnaire, respectively. RESULTS: A total of 349 physicians completed the survey. Of them, 165 (47.3%) were residents and 212 (60.7%) were males. Anxiety, distress, burnout, and depression were reported in 167 (47.9%), 210 (60.2%), 76 (21.8%), and 37 (10.6%) physicians, respectively. Attendings had decreased burnout relative to residents (odds ratio [OR] 0.28, confidence interval [CI] [0.11-0.68]; P = .005). Females had increased burnout (OR 1.93, CI [1.12.-3.32]; P = .018), anxiety (OR 2.53, CI [1.59-4.02]; P < .005), and distress (OR 2.68, CI [1.64-4.37]; P < .005). Physicians in states with greater than 20 000 positive cases had increased distress (OR 2.01, CI [1.22-3.31]; P = .006). CONCLUSION: During the COVID-19 pandemic, the prevalence of burnout, anxiety, and distress is high among academic otolaryngologists.