Out of the confusion of the COVID-19 pandemic have come sweeping responses, re-imagined approaches to care, and research advances, with questions still to be answered and the lasting effects still to be seen. Representatives from the COSM subspecialty societies reviewed these changes during a Triological Society session at the Combined Otolaryngology Spring Meetings in April.
Explore This IssueJuly 2021
In New York, by early May of 2020, about 40% of city residents already knew someone who had contracted COVID-19, and about 20% knew someone who had died from the disease. Personal protective equipment and staffing were facing critical shortages.
“We really were in a crisis mode and trying to understand from the otolaryngology perspective how we could best handle this,” said Scott Rickert, MD, associate professor of otolaryngology–head and neck surgery at New York University Grossman School of Medicine in New York City. He discussed the response to the pandemic from the perspective of the American Broncho-Esophagological Association and American Society of Pediatric Otolaryngology.
Since then, the “slow build” back to a new normal has been marked by support from medical societies, creating processes for patient and clinician safety and overcoming challenges in delayed care due to COVID-19 concerns, he said. Guidelines, resources, and seminars from societies have been helpful, and changes in filtration, scheduling, operating room procedures, and testing and screening have all been part of the response.
Advantages in the Field
Advantages—potentially long-lasting ones—have spun out of the response, Dr. Rickert said. They include better use of technology with telemedicine and collaborating in patient care, a heightened “culture of safety,” outreach to rebuild practices, and learning virtually across institutions. “I think there were a lot of advantages despite all the PTSD we may feel from the COVID year we’ve had,” he said.
Others had similar accounts of advancements that have sprung out of the pandemic. Theda Kontis, MD, a facial plastic surgeon in Baltimore who presented the perspective of the American Academy of Facial Plastic and Reconstructive Surgery, said that patient volume actually increased during the pandemic as people decided they needed a change in their appearance because of Zoom meetings and had more disposable income because of canceled vacations and other changes in spending.
“What we like is that more virtual visits have made us very efficient with our use of time,” Dr. Kontis said. The need for patients to feel safe meant no double booking and no patients in the waiting room, making for a smoother patient experience.
She added that masking for physicians—or for herself, at least—is probably here to stay. “I haven’t been sick for a year,” she said. “So, I think once the pandemic is over, I’m going to be wearing masks when I see my patients.”
Ozlem Tulunay Ugur, MD, professor of otolaryngology–head and neck surgery at the University of Arkansas for Medical Sciences in Little Rock, discussing the American Society of Geriatric Otolaryngology perspective, said the pandemic has highlighted some gaps in care for the elderly. “We need to improve access to in-home and office-based rehabilitation programs,” she said.
Clinicians also need to continue to attend to the needs of the elderly as the pandemic begins to wind down. “We have to start focusing now on the mental and emotional well-being of the elderly as we understand COVID-19 more and start seeing long-term outcomes from these patients,” said Dr. Tulunay Ugur. Establishing and maintaining connections will be a major challenge. “Social distancing should not be social isolation,” she said.
Benjamin Bleier, MD, associate professor of otolaryngology–head and neck surgery at Harvard Medical School in Boston, who gave the American Rhinologic Society point of view, noted how recent research has shown that nasal endoscopies and debridements produce as many, if not more, particles as intubation, which has been considered the “standard” aerosol-generating procedure against which other procedures are measured. Most aerosol-generation studies have vastly undercounted the particles produced, as indicated by studies using more sensitive measures.
A lot of groundwork has been established to help us get through the next pandemic— but hopefully that won’t happen in our lifetime. —Cherie-Ann Nathan, MD
“I think we still have a lot to understand about this,” said Dr. Bleier. “But on the flip side, we haven’t seen a lot of epidemiologic evidence of super-spreader events in the rhinology clinic.”
In fact, these aerosols may simply be ubiquitous, he said, with clinicians and patients living in each other’s aerosol clouds. “We’re going to have to continue to mitigate them,” Dr. Bleier said. “But I think now what we need is the epidemiologic evidence and correlates to our aerosol studies to really inform the future.”
Cherie-Ann Nathan, MD, chair of otolaryngology–head and neck surgery at Louisiana State University Health Shreveport, provided the American Head and Neck Society perspective, saying that the pandemic has left the field with many lessons. A COVID-19 online bulletin board proved to be very helpful early in the pandemic for sharing news, information, and best practices. It was started in the third week of March 2020 to be a repository for information, and within the first four days, 17 documents had been vetted and posted, providing guidance on how to navigate the stresses of the pandemic.
Another important lesson, she said, was learning how to deliver bad news such as a diagnosis of distant metastases to a young patient who, due to the pandemic, had no relatives present during the consultation. Early on, this news was given to the patient when they were alone. “Never again will I do that—I think we ought to hold off on bad news and do it on a telemed visit when relatives are present,” Dr. Nathan said.
Webinars to address gaps in education and a partnership with the Head and Neck Cancer Alliance to help advocate for survivors were also critical parts to the response. “A lot of groundwork has been established to help us get through the next pandemic— but hopefully that won’t happen in our lifetime,” said Dr. Nathan.
Maggie Kuhn, MD, MAS, associate professor of otolaryngology at the University of California, Davis, presenting the American Laryngological Association perspective, said that knowledge about the impact of COVID-19 on laryngologic care has gradually deepened thanks to new research from the field. For instance, it’s now thought that flexible laryngoscopy is likely not an aerosol-generating procedure, masks may not decrease the acoustics in a voice assessment, most parts of voice therapy are at a medium-high risk, and airway surgery can be performed safely with precautions.
Lasting effects on clinical visits and on the practice of otolaryngology in general, she said, will probably include ongoing use of personal protective equipment during office encounters and laryngology fellowship training. “The closing of geographical distances with internet-based platforms has really changed the way we train our fellows in laryngology,” Dr. Kuhn said. “I suspect that this platform will remain and be a benefit to the future laryngological leaders of our society.”
Thomas R. Collins is a freelance medical writer based in Florida.