Performing otolaryngological outpatient consultation during the Covid-19 pandemic

The Covid-19 pandemic has had a profound impact on the Otolaryngology outpatient clinical practice, which is at high risk of respiratory viral transmission due to the close contact between the examiner and the patient's airway secretions [1]. Moreover, most otolaryngological procedures, including oropharyngoscopy, generate droplets or aerosols from high viral shedding areas [1]. Thus, only non-deferrable consultations were performed in the outbreak's acute phase. Along with the re-opening of elective clinical services and the impending second wave of the outbreak, a reorganization is necessary to minimize the risk of nosocomial transmission [1].

This video (Video 1) shows how to safely conduct an outpatient Otorhinolaryngological consultation, focusing on complete ear, nose and throat examination, according to evidences from the published literature and Otolaryngological societies guidelines [2,3].

After telephonic screening, patients reporting Covid-19 symptoms or closecontact with a Covid-19 case within the last 14 days are referred to telehealth services [1-3]. To avoid crowding, the patient is admitted alone, after body temperature control, except for underage or disabled people [1]. The waiting room assessment must guarantee a social distance of 6 ft [1-3]. The consultation room is reorganized into two separate areas (Fig. 1): 1) a clean desk area, where an assistant wearing a surgical mask and gloves, handles the patient's documentation and writes the medical report, keeping proper distance from the patient, and 2) a separate consultation area, where the examiner, equipped with proper personal protective equipment (Fig. 2) [3,4], carries out the medical interview and physical examination. Endoscopic-assisted ear, nose and throat inspection using a dedicated monitor allows the examiner to maintain an adequate distance from the patient throughout the procedure while providing an optimal view (Figs. 3-6) [3]. Recent evidence shows that nasal endoscopy does not increase droplet production compared to traditional otolaryngological examination [5]. When necessary, nasal topic decongestion and anesthesia must be performed using cottonoids rather than sprays [3]. The patient keeps the nose and mouth covered throughout the consultation, lowering the surgical mask on the mouth for nasal endoscopy and removing it only for oropharyngoscopy. After the consultation, the doffing procedure must be carried out carefully to avoid contamination [4]. All the equipment and surfaces must undergo high-level disinfection with 70% alcohol or 0.1% bleach solutions [3]. Proper room ventilation must precede the next consultation [3].

The hints provided in this video are useful to ensure both patient and examiner safety during Otolaryngological outpatient consultations and to reduce SARS-CoV-2 transmission.