COVID-19 (coronavirus disease) - ENT, Hearing & Balance



Coronavirus disease (COVID-19) is caused by a new strain of Coronavirus (SARS-CoV-2) discovered in 2019 and not previously identified in humans. Common symptoms include fever, cough and shortness of breath. On 11 March 2020 the World Health Organization (WHO) declared the current COVID-19 outbreak a pandemic. 

For authoritative information about the science underpinning the epidemic see: https://coronavirusexplained.ukri.org/en.

Here we have gathered important resources, guidance and advice statements from international organizations and societies related to COVID-19, and the management of patients with ENT, hearing and balance problems by ENT and Audiology professionals. We are working on updating the information below as soon as new guidelines become available.  

Guidelines are underpinned by Evidence. In the current pandemic, high-quality evidence is sparse but that which is available is collected below. Information is also provided on new, emerging evidence from trials in progress and newly completed studies.

Guidelines

Many organizations, including professional bodies, are producing guidelines based on the best available evidence, however limited that may be. Here we provide a curated list of guidance relevant to ENT, hearing and balance problems in a variety of languages. We will expand and update this list as further guidance and evidence become available. If you are aware of other resources that should be included, please let us know.

General guidelines

RCS - Guidance for surgeons working during the COVID-19 pandemic (20/03/2020)

Personal protection equipment (PPE)

RCS - COVID-19: Good Practice for Surgeons and Surgical Teams (03/04/2020)

Public Health England - Guidance COVID-19 personal protective equipement (PPE) (02/04/2020)

Including advice on:

- Aerosal Generating procedures

- Operating theartres and operative procedures

- Collection of nasopharyngeal swab(s)

National Health Service (NHS) - Government Advice on PPE, Infection Control, Aerosol Generation from NHS (27/03/2020)

Centers for Disease Control and Prevention (CDC) - CDC recommendations on how to extend the life of N95 masks (27/03/2020)

ENT UK - PPE for the Covid-19 Pandemic Survey (26/03/2020)

ENT Canada - Guidance for Health Care Workers Performing Aerosol Generating Medical Procedures during COVID-19 Pandemic (26/03/2020)

ENT UK - FFP3 respirator usage: current ENT UK recommendations (25/03/2020)

ENT UK - Guidance PPE for patients with emergency oropharyngeal and nasopharyngeal conditions whose COVID status is unknown (25/03/2020)

ENT Canada - Personal Protective Measures in the Princess Margaret Head and Neck Cancer Clinic (24/03/2020)

Western Australia ENT - Recommendations for PPE for Aerosol Generating Procedures during COVID-19 pandemic (24/03/2020)

Boston Children's Hospital - N95 mask alternative (20/03/2020) (video)

British Association of Oral & Maxillofacial Surgeons (BAOMS) - Guidance for Personal Protective Equipement for OMFS Procedures during Covid19 Crisis (20/03/2020)

The Netherlands National Institute for Public Health and the Environment - N95 mask reprocessing (18/03/2020)

Decontamination of equipment

ENT UK - PPE for nasal endoscope decontamination during the COVID-19 pandemic (27/03/2020)

Specific guidelines

Conditions

Ear

ORL - Prioritizing otologic surgery during the COVID-19 Pandemic (14/04/2020)

BSHAA - Coronavirus - advice for practitioners (01/04/2020)

Audiology

ASHA - A COVID-19 Update from ASHA's Chief Staff Officer for Speech-Language Pathology (20/04/2020)

BAA, BSA, BSHAA, AIHHP - COVID-19 Audiology services during the pandemic: Joint guidance from the UK's professional bodies (09/04/2020)

BTA - Tinnitus Services and COVID-19

Please see materials provided by colleagues at the British Academy of Audiology (24/03/2020) and American Academy of Audiology

EHIMA - Coronavirus-pandemic: Message by the EIHMA President to professionals and users of hearing intruments (24/03/2020)

NHS England - COVID-19 prioritisation within community health services (20/03/2020)

Nose

ERS - Risk for Otorhinolaryngologists

Alteration in sense of smell/taste

American Academy of Otolaryngology - Head & Neck Surgery (AAO-HNS) - Anosmia, Hyposmia, and Dysgeusia Symptoms of Coronavirus Disease (22/03/2020)

ENT UK - Loss of sense of smell as a marker of COVID-19 infection (21/03/2020)

International Federation of Oto-Rhino-Laryngological Societies (IFOS) - Alerte anosmie COVID-19 (20/03/2020) (French)

Epistaxis

ENT UK - COVID-19 Epistaxis Management (25/03/2020)

Throat

Tonsilitis and quinsy

ENT UK - COVID-19 Adult Tonsillitis & Quinsy Guidelines (27/03/2020)

Head and neck

IFOS - Cancerérologie ORL et COVID-19: état des lieux (25/03/2020) (French)

ENT UK - Initial guidance for head and neck cancer management during Covid-19 (24/03/2020)

BAHNO - Proposed guidance for laryngectomy surgery during the COVID-19 pandemic (24/03/2020)

British Association of Endocrine & Thyroid Surgeons (BAETS) - BAETS statement on COVID-19 and Thyroid Cancer Services (24/03/2020)

ENT UK - Remote triaging of urgent suspected head and neck cancer referrals during Covid-19 pandemic (23/03/2020)

Kaiser Permanente Northern California - NCAL HN Oncological Surgery in COVID Era (22/03/2020)

BLA - Covid-19 Important Guidance (20/03/2020

ENT UK - Initial guidance for head and neck cancer management during Covid19 pandemic (18/03/2020) - MEMBERS ONLY

University of Toronto - Pandemic Planning Clinical Guidelines for Patients with Cancer (10/03/2020)

Global Surgery - CovidSurg - Cancer

Procedures

Aerosol-generating procedures (AGP) in general

ENT UK - Aerosol-generating procedures in ENT (23/03/2020)

Stanford University - COVID-91 Statement (20/03/2020)

Stanford University - Precautions for Endoscopic Transnasal Skull Base Surgery During the COVID-19 Pandemic

Tracheostomy

AAOHNS - Position Statement: Tracheostomy Recommendations During the COVID-19 Pandemic (27/03/2020)

IFOS - Alert COVID-19 endoscopie et fibroscopic ORL, chirurgie endonasal, tracheotomie et soins de tracheotomie (21/03/2020) (French)

ENT UK - COVID-19 Tracheostomy Guidance (23/03/2020)

ENT Canada - Recommendations from the CSO-HNS Taskforce on Performance of Tracheostomy During the COVID-19 Pandemic (23/03/2020)

NTSP - NTSP considerationg for tracheostomy in the Covid-19 outbreak (20/03/2020)

ENT UK - Tracheostomy guidance during the COVID-19 Pandemic (19/03/2020)

Wei WI et al. Safe tracheostomy for patients with severe acute respiratory syndrome*. Laryngoscope 2003:113;1777-9

Nasendoscopy and laryngoscopy

ENT UK - COVID-19 Adult Nasoendoscopy (FNE) and Possible Upper Aerodigestive Tract Fish Bone Investigation (01/04/2020)

Frauenfelder C, Butler C, Hartley B, Cochrane L, Jephson C, Nash R, Hewitt R, Albert D, Wyatt M, Hall A. Practical insights for paediatric otolaryngology surgical cases and

performing microlaryngobronchoscopy during the COVID-19 pandemic, International Journal of Pediatric Otorhinolaryngology. (in press)

ENT UK - Nasal endoscopy and laryngoscopy examination of ENT patients (23/03/2020)

IFOS - Alert COVID-19 endoscopie et fibroscopic ORL, chirurgie endonasal, tracheotomie et soins de tracheotomie (21/03/2020) (French)

Otological procedures

ENT UK - Guidance for undertaking otological procedures during COVID-19 pandemic (25/03/2020)

Standford University - COVID-19 and Ear Surgery

Audiological diagnostic and therapeutic procedures

Please see materials provided by colleagues at the British Academy of Audiology.

Patient subgroups - paediatrics

ENT UK - Experience of a Paediatric Otolaryngologist: navigating the current challenges (26/03/2020)

BAPO - BAPO statement on SARS Cov2 and Paediatric Otolaryngology Provision (26/03/2020)

Frauenfelder C, Butler C, Hartley B, Cochrane L, Jephson C, Nash R, Hewitt R, Albert D, Wyatt M, Hall A. Practical insights for paediatric otolaryngology surgical cases and

performing microlaryngobronchoscopy during the COVID-19 pandemic, International Journal of Pediatric Otorhinolaryngology. (in press)

This list has been compiled from a number of sources. These are detailed here.

Evidence

New evidence

New evidence from a variety of study types is likely to be published in the coming days and weeks.  Cochrane has launched a COVID-19 Register. Cochrane's COVID-19 Study Register is a freely-available, continually-updated, annotated reference collection of human studies on COVID-19, including interventional, observational, diagnostic, prognosticm, epidemiolgical, and economic designs.

We have created an Excel sheet that contains information about:

  • published reports on ear, nose and throat outcomes in patients with confirmed COVID-19;
  • published reports relating to PPE in ear, nose and throat and related clinical settings;
  • published reports relating to managing ear, nose and throat conditions during the COVID-19 pandemic.

Curated from Cochrane's COVID-19 Register and other sources. 

Download Excel sheet of papers with ear, nose and throat outcomes in COVID-19 infection

Trials in progress

For a register of COVID-19 related trials that are in progess and may – or may not – have yet published results (links are included when results are available) please see Covid-19 TrialsTracker.

Data from trials

Cochrane's partner Vivli is collecting and sharing data from COVID-19 related clinical trials (published data and individual patient data from published and unpublished trials); see here.

Existing evidence

There are many reliable sources of evidence that have been appraised and synthesised. These include the following:

Cochrane general COVID-19 resources and news

Cochrane has an extensive collection of resources related to COVID-19 and these are available here.

Cochrane COVID-19 Special Collections

Cochrane Special Collections, of relevance to the care of ENT, hearing and balance patients, are available as follows:

Cochrane COVID-19 Rapid Reviews

Cochrane is engaging with a range of stakeholders to build a bank of important questions emerging from the COVID-19 pandemic, including the World Health Organization (WHO), the Australian National Health and Medical Research Council (NHMRC), the UK National Institute for Health Research (NIHR) and the Brazilian Ministry of Health. The first 60 questions underwent a very early prioritisation process to allow work to begin immediately on urgent reviews. The remaining questions will undergo a rapid prioritisation process with stakeholders. The list of suggested topics can be found here. Some of these are underway, others will be prioritized for later completion.