While sinus infections and upper respiratory tract infections may also cause temporary olfactory dysfunction, the prevalence with which it occurs in COVID-19 patients seems to be much higher. —Ahmad R. Sedaghat, MD, PhD
Explore This IssueDecember 2020
The reason for hearing loss is unknown, Dr. Schalch Lepe said, but it’s likely related to general inflammation of the central nervous system, because some of these cases have had associated findings of encephalitis and meningitis. A possible confounding factor is that some patients might be treated with multiple intravenous medications, some of which could be toxic to the inner ear. Currently, there is no evidence-based treatment for hearing loss caused by COVID-19.
It’s important to employ safety protocols before a patient even arrives at a practice. “All patients should be screened when making an appointment, and any patients with symptoms consistent with COVID-19 should be seen by a physician via telehealth before being seen in person,” Dr. Jones said. All patients should come to an appointment alone; if the patient is elderly or a child, they should have only one caregiver present.
To limit exposure to an infectious patient, Stella Lee, MD, associate professor of otolaryngology–head and neck surgery at the University of Pittsburgh Medical Center, said hospitals and clinics should continue current protocols: Have checkpoints where anyone who enters has their temperature taken and is asked about COVID-19 symptoms or recent contact with someone who tested positive.
Waiting room volume should continue to be kept to a minimum. Leave extra time for new patients, and insist that they complete registration materials online prior to arrival. If a patient reports an acute olfactory disturbance—a characteristic sign of COVID-19 that can occur independently or with other symptoms—consider recommending that the patient be tested for COVID-19 and self-isolate.
As has been well publicized, otolaryngologists should wear PPE, including an N95 mask, glasses or goggles, and a face shield and gloves when interacting with every patient. Maintaining proper hand hygiene and physical distancing are fundamental.
Dr. Lee uses pledgets instead of aerosolized sprays to administer topical decongestants and a local anesthetic prior to nasal endoscopy. She asks patients to keep their mask over their mouth during a procedure and have tissues in hand in case they have to sneeze.
Staff should be trained in proper disinfection and cleaning of all rooms and scopes between patients, Dr. Jones said. If possible, install disinfecting systems that sanitize the office. Consider placing fans in exam and waiting rooms to increase air circulation.
Other options include using HEPA filters in exam rooms to help increase air changes per hour to improve ventilation and clearance of viral particles or using air purifiers that can decontaminate aerosols generated during otolaryngic exams.
It’s also worth stating that practices should stay vigilant with precautions. “Unfortunately, the pandemic hasn’t gone away,” said Dr. Patel. “Although fatigue can set in when wearing masks and face shields, and practicing within these new restrictions can feel tedious, it’s important to ensure that practices aren’t the source of infection.”