Nasal Endoscopy and Flexible FIberoptic Laryngoscopy
If the course of the COVID-19 pandemic is akin to the SARS outbreak, the
impact on clinical activity at an academic otolaryngology department is
expected to be substantial; over a 9-week period at the Prince of Wales
Hospital in Hong Kong, the weekly outpatient clinic visits declined by
59%, the number of operations performed dropped by 79%, the average
hospital capacity rate reduced by 79%, and the daily admission rate
diminished by 84%.35 Furthermore, as viral density
has been shown to be the highest in the nasal cavity and nasopharynx,
elective diagnostics such as flexible laryngoscopy and nasal endoscopy
should not be routinely performed in the office or inpatient setting. If
endoscopic evaluation is required in the urgent or emergent setting,
this should be only be performed using appropriate PPE and disposable
nasal pledgets for decongestion and local anesthesia. A clinical study
of 1,491 otolaryngology service consultations at Duke University from
2017 revealed 995 (66.7%) of all consultations resulted in a bedside
procedure and 243 (16.3%) consultations required operative
intervention. Consultations regarding airway evaluation (362
[47.3%] vs 143 [19.7%]) and rhinologic evaluation (79
[10.3%] vs 18 [2.5%]) were more frequent from inpatient teams
than from the emergency department. Of these evaluations, flexible
fiberoptic laryngoscopy (554 [55.7%]) and rigid nasal endoscopy
(109 [11.0%]) were two of the most commonly performed bedside
procedures. In the operating room, direct laryngoscopy (47
[11.3%]), bronchoscopy (47 [11.3%]), and tracheotomy (41
[9.9%]) were three of the most commonly performed
operations.36 Continued demand for these critical
services during the COVID-19 pandemic must be carefully evaluated by
otolaryngologists on a case by case basis in light of CMS and AAO-HNS
recommendations against elective endoscopy to mitigate risk of
infectious spread and ensure patients who require such evaluations are
carefully assessed using the proper precautions and appropriate PPE.