Separating the Physician and Patient: A Paradigm Shift for Routine Otolaryngology Examinations in COVID-19-Like Aerosol-Contaminated Environments.

OBJECTIVE: To evaluate the attitudes of physicians and patients toward physical examination in physically separated environments using a laryngoscopic examination model. MATERIALS AND METHODS: Six experienced laryngologists performed laryngoscopic examinations in 30 patients in a closed-chamber examination unit. The physicians and patients were asked to compare all domains with their previous standard laryngoscopic examination experience using a 10-point visual analog scale (0, poor performance; 10, good performance), including effectiveness of communication, difficulty of examination, perception of safety against airborne transmission of COVID-19, applicability of the unit for future examinations, perception of protective environment, and overall comfort. RESULTS: All laryngoscopic examinations were performed successfully. Effectiveness of communication, difficulty of examination, perception of protective environment, and overall comfort did not differ between physicians and patients (P > .05 for all comparisons). However, both physicians and patients found the examination to be difficult. While physicians evaluated the system as safe against airborne transmission of COVID-19, patients were not confident that the system was safe (8.70 ± 1.93 vs 2.87 ± 2.37, respectively, P = .001). Physicians also gave a higher score to future applicability of the unit for examinations than patients (8.90 ± 1.42 vs 7.10 ± 2.62, respectively, P = .001). CONCLUSION: Physically separating the physician and patient is a feasible method of physical examination in aerosol-contaminated environments.

Prediction of outcome of radiofrequency ablation of the inferior turbinates.

BACKGROUND: Radiofrequency ablation (RFA) of the turbinates is used commonly for nasal obstruction; however, there is no consensus on patient selection for this surgery. METHODS: In a prospective clinical study, 53 adult subjects with bilateral turbinate hypertrophy were evaluated subjectively and objectively with anterior rhinomanometry at baseline and at 1, 3, and 6 months post-RFA of turbinates. RESULTS: RFA of the turbinates resulted in a significant decrease in predecongestant and postdecongestant visual analogue scale (VAS) scores and resistance measurements at postoperative months 1, 3, and 6 (p < 0.001 for all). Preoperative baseline subjective response to the decongestant showed a positive correlation with postoperative first month subjective and objective outcome (p < 0.05). Preoperative baseline objective response to the decongestant showed a highly significant correlation with postoperative 1-month, 3-month, and 6-month objective outcomes of surgery (p < 0.05 for all). CONCLUSION: Objective measures do not correlate with long-term subjective satisfaction even when the nose is objectively patent in subjects who underwent inferior turbinate RFA. The patients' long-term subjective benefit from RFA surgery cannot be estimated after a rhinomanometry with topical decongestion is performed. Performing a rhinomanometry with topical decongestion may help only to estimate the patients' objective benefit from RFA surgery.

Management of a pterygopalatine fossa hydatid cyst.

Hydatid cyst disease is a rare parasitic infestation caused by larvae of Echinococcus granulosus. Although larval stage of this parasite can thrive in any part of the body, especially lungs and liver; head and neck involvement is rare. Pterygopalatine fossa involvement is reported in two cases in the literature. In this report we represent a case with solitary, secondary pterygopalatine fossa hydatid cyst extending in to the maxillary sinus, orbita, sphenoid sinus and skull base.