Otolaryngology consultations for COVID-19: Determining occupational exposure and inpatient interventions

ABSTRACT

Introduction: The novel coronavirus SARS-CoV-2 has ravaged the United States and transformed the way medical care is delivered. As specialists in upper airway anatomy, otolaryngology (ENT) services may be called upon to manage various head-and-neck complaints for patients with COVID-19. While ear, nose, and throat (ENT) consults may benefit critically ill patients, they also expose physicians to the transmission of COVID-19. We sought to identify the reasons for ENT intervention and examine trends in testing through the pandemic. Method: Records for all ENT consults from May 1 to September 29, 2020, were retrospectively reviewed. Demographic information, admission diagnoses, length of stay, COVID status, and ENT interventions were recorded. Univariate analysis was performed. Results: Of 1343 distinct consults, 965 (72%) were tested for COVID-19, with 62 (4.6%) positive. In May 200 (70%) of 287 consults were tested with 2 (0.7%) positive, while in September, 251 (78.5%) of 320 consults were tested with 22 (6.9%) positive. The most common ENT consultation for COVID-positive patients was nasal and oropharyngeal bleeding (n = 19, 30.6%), followed by facial trauma (n = 15, 24.2%). Other reasons included respiratory distress, tracheostomy, and foreign body (retained COVID swab). Of 96 interventions for patients with COVID-19, 49 (51%) were for management of bleeding, 24 (25%) were for upper airway evaluation (UAE), and 8 (8.3%) were for tracheostomy or trach management. Conclusion: Although patients with COVID-19 necessitated various otolaryngologic interventions, management of bleeding was the most common complaint, which may be associated with therapeutic anticoagulation as well as coagulopathy from the disease process. Bleeding control was followed by UAE and trach management, 2 aerosol-generating procedures that may increase the risk of COVID transmission. The proportion of consults tested and confirmed positive for COVID- 19 at our institution increased from May to September, possibly assisting otolaryngologists to take appropriate preventive precautions.