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.