Tele-medical ENT consults paper published in JAMA-Oto

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Our latest paper on tele-medical peritonsillar abscess consults was published in JAMA-Otolaryngology. You may read the article here.

At first glance, it might seem like we could use telemedicine to treat nearly anything that is based mostly on visual information, like skin rashes, or peritonsillar abscesses in the mouth. While I generally agree, it is important as clinicians for us to actually test these assumptions with an experiment. In this paper, we tested our colleagues who were board certified Otolaryngologists to see if they could accurately diagnose tonsil abscesses using only visual information. This initial study supports that assumption, but as always, much much more data is always needed.

Here is a quicker summary of the article from Physician’s Weekly.

Overall, it has been interesting during the pandemic to see the uptick in use of telemedicine. Hopefully, this continues to make it easier for patients to get easy access to specialty care.







Loss of smell and COVID-19

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I wanted to post this infographic our practice made to help visually summarize the phenomenon of loss of smell that has been associated with COVID-19.

  • There is rapidly accumulating anecdotal evidence that anosmia (loss of smell) with resultant dysgeusia, (loss of taste) are frequently reported symptoms associated with the COVID-19 pandemic. 
  • Additionally, the limited evidence warns of these patients having no other warning symptoms for COVID-19. These patients are concerning since they may be otherwise asymptomatic spreaders. 
  • Our recommendation: There is no current official recommendation, however, my colleagues and I 1have been engaged in continuous discussions with the Academy as well as Otolaryngologists around the country. While we might previously have recommended oral steroids for an acute loss of taste or smell, due to the reports of steroids exacerbating the pulmonary effects of COVID-19 our opinion at this time would be avoiding oral steroids for ansomia or dysgeusia and considering or ruling out COVID-19 in any patient presenting with these symptoms.  
  • Be aware that COVID-19 has also been associated with sinusitis, rhinorrhea, and nasal congestion, however these are less common (<10% in available literature)

To better understand the role that anosmia is playing in this infection, the AAO-HNS has set up a de-identified reporting tool for patients with these symptoms. I would encourage any clinicians that treats or sees patients with loss of smell and COVID-19 to consider adding them to the registry to help further study this phenomenon. The link can be found below:

The initial data from this tool has been reported here . Out of 273 entries to the database, 73% of subjects were noted to have loss of smell prior to COVID-19 diagnosis and it was the initial symptom of COVID-19 in 26.6% of patients. There was some improvement noted in 27% of patients with an average improvement time of 7.2 days and 85% of the patients who improved, did so within 10 days. This is still anecdotal data and it is too early to make any serious conclusions, but in these rapidly changing times, this is the best we currently have.