Abstract

  Purpose of this article is to give a gross idea that how COVID pandemic has affected the Otorhinolaryngology OPD in last few months and how we have adopted new practices in ENT OPD. This study consists of general presentation of patients coming to investigator in ENT OPD, detection rate of RAT and RTPCR tests and general measures that were taken during COVID era and how we have modified our OPD setup accordingly. Also, we have described about the general measures that were taken during this study period which was from May 2020 to February 2021 in Dr.Vaishampayan Memorial Government Medical College and Ashwini Rural Medical College, Hospital and Research Center, Solapur.

Keywords: COVID-19; URTI;Detection Rate; Anosmia

Introduction

  The Coronavirus (SARS-CoV-2) has spread rapidly all across the world since December 2019 after its outbreak from Wuhan city in China[1]. World Health Organization (WHO) finally declared Coronavirus outbreak as a pandemic disease on 11 March 2020. Earlier the spread of disease was supposed to be zoonotic but now it has been proved that the virus spreads by aerosol infection by human-to-human contact[2].

  This SARS-CoV-2 mainly affects the respiratory system. The patients come in ENT OPD with chief complaints of common cold, cough, fever, headache, breathlessness, myalgia which goes in favor of COVID during this pandemic era[3]. Otorhinolaryngologist deal with the examination of oral cavity, nasal cavity and airway examination in their OPD, so they are at a much higher risk of getting infected with this SARS-CoV-2 infection as its main modality of spread is through droplet from one infected individual to other[4].

Materials and Methods

  We screened out all cases coming to investigator with URTI and related complaints in ENT OPD during a 10 months’ time period that is from May 2020 to February 2021 (Table 1). This study was conducted jointly by Dr V.M.Govt Medical College and Ashwini Rural Medical College,Hospital and Research Center, Solapur.

  There was 70% of URTI symptom cases were reported consistently in all the months.

Results

  400 patients had COVID related symptoms which included cough, URTI, fever, sneezing, rhinorrhea, myalgia, headache, sore throat, congested nose, runny nose, loss of taste, loss of smell, difficulty in breathing, chest infections. All these symptoms were present in various permutation and combinations (Table 2).

  This study includes 400 patients coming to ENT OPD who are symptomatic and are subjected to either RAT/RT-PCR testing or both. Many patients with URTI infection denied the testing because of the fear of COVID and quarantine process which was compulsorily executed during this time period. The patients who denied/ran off from the institution are not included in this study. Also, patients who had other ENT complaints than above are not included in the study. Initially, few patients who came with RAT positive were also subjected to RT-PCR study for the confirmation of the disease. It was observed that, out of 250 RAT test, 170 cases (68%) found to be positive. Further, out of 321 RT-PCT tests, 287 cases (89.4%) confirm of COVID-19 positive (Table 3).

  Once the number of cases of COVID started decreasing patients in whom surgical intervention was needed and indicated were subjected to various surgical procedures (Table 4).

  Elective surgeries were carried out from December 2020 onwards and out of 46 patients who were subjected to elective surgeries in 3-month time duration 12 patients came with postop complications. We subjected these 12 patients to RT-PCR testing. Out of these 12 patients in whom RT-PCR was done 8 patients came positive. Out of 8 patients who had post-surgical complications 6 of them had comorbidity. Complications which were encountered post-surgery were facial paresis, mucormycosis, high grade fever, ARDS, tetany and diarrhea. So, we can conclude that even post-surgery patient can come COVID positive and the incidence of such post-surgical positive cases is more in co-morbid patients.

Discussion

PPE and self-care: It was our duty to examine patients but before that we had to take care of ourselves. As an otorhinolaryngologist that was difficult task as we were exposed to aerosols all the time while examining the patient. Modifications that were done in our OPD were:

1. Use of headlight to examine
2. Use of PPE, googles, shields, disposable gloves and N95 mask [5]
3. Use of endoscopes only when emergency and needed
4. Only surgical emergencies were taken care of with PPE.

Swab collection: Proper training of residents regarding swab collection from oropharynx and nasopharynx was done by faculty and through webinars given by AIIMS/such renowned institutes[6]. Doning doffing was a challenge initially and was taught in proper way[7].

Psychological impact: In OPD we faced problems of convincing patients while subjecting them to RAT/RT-PCT test as many of them were very reluctant to it. Most of them also had fear, feeling of loneliness, anxiety, depression, frustration and boredom to sit at home during the quarantine period[8]. Counselling such kind of patients was a real task.

All cleaning sterilization methods: All possible cleaning methods were used. Hand washing steps of WHO were followed in OPD after examining each and every patient[9]. Surface sterilization were done with 1% sodium hypochlorite solution[10]. Social distancing of patients was followed and wearing mask was compulsory in waiting area.

Summary

  Majority patients coming with URTI infections (74.5%) were COVID positive and were confirmed with the help of RAT and or RT-PCR testing. Loss of taste (1%) and anosmia (2%) were the least noted symptoms who came to ENT OPD in this duration and these patients turned out to be COVID positive when tested. Positive case detection rate by RT-PCR testing (89.4%) was higher than RAT testing (68%). So as the time proceeded, we insisted patients to undergo RT-PCR testing and RAT was used for emergency situations thereafter. Out of 8 patients who had post-surgical complications were again subjected for RT-PCR testing and 6 of them had comorbidity. So, we can say comorbid patients are at a higher risk of having COVID infection [11]. Out of 8 patients who had anosmia, 6 were having mild to moderated degree anosmia and got recovered after 3-4 weeks post treatment. 2 patients had total anosmia and are on follow-up. Patients who had loss of taste got recovered completely in 4-6 weeks recovery period. So, the loss of taste and smell is the major indicator for COVID and this loss is most of the times temporary which gets reversible[12,13]. We came across only 12 such patients till date.

Conflict of Interest

  The authors declare that there are no conflicts of interest regarding the publication of this article.

References

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Citation

Citation: Kshitija R Pathak., et al. “Otorhinolaryngology Department during COVID-19 Scenario". Acta Scientific Otolaryngology 3.6 (2021):02-05.

Copyright

Copyright: © 2021 Kshitija R Pathak., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.