The coronavirus disease 2019 (Covid-19) pandemic has sent shock waves throughout the National Health Service and healthcare systems across the world. Although we are still within the midst of the pandemic, and indeed several areas of the UK remain under lockdown restrictions, we are all gradually finding ways to resume ENT services. However, we must remain vigilant and maintain preparations for a possible second wave. The contents of this current issue of The Journal of Laryngology & Otology provide much needed guidance and clarification for our specialty at this time. We are grateful to Cambridge University Press who have kindly agreed to make all coronavirus disease related articles Open Access until the end of August 2020, to ensure the widest distribution of the latest research.
As part of a pan-European collaborative effort, the Union of the European Phoniatricians have produced a position statement which includes guidance, as well as an exit strategy, for resuming laryngological services during the Covid-19 pandemic.Reference Geneid, Nawka, Schindler, Oguz, Chrobok and Calcinoni1 This guidance is especially pertinent and timely, as many laryngology procedures fall under the umbrella of aerosol-generating procedures (i.e. procedures that have the potential to generate aerosol).
In this issue of The Journal, Stephenson et al. publish the results of the UK national registry of UK ENT surgeons with suspected or confirmed Covid-19, created with the support of ENT UK.Reference Stephenson, Sowerby, Hopkins and Kumar2 Coronavirus disease 2019 was confirmed in 47.9 per cent of respondents, with symptom onset peaking in March 2020. The study concludes that personal protective equipment (PPE) and tailored clinical guidance are critical for the protection of the UK ENT workforce.
As represented by several articles in this month's issue, Covid-19 has, in many cases, resulted in the restructuring of ENT services, including ENT out-patient departments,Reference Halliwell-Ewen, Atkin, Huins and Dalton3 head and neck cancer services,Reference Warner, Scholfield, Adams, Richards, Ali and Ahmed4,Reference Taylor, Omakobia, Sood and Glore5 tracheostomy provision and care,Reference Glibbery, Karamali, Walker, Fitzgerald, Connor, Fish and Irune6 surgical techniques,Reference Clamp and Broomfield7 novel methods for performing flexible nasolaryngoscopy,Reference Curran, Calder, Yaneza and Iyer8 and PPE use.Reference Patel, Hardman, Yang, Robson, Putnam and George9
Continuing with the anosmia in Covid-19 theme, Avci et al., in their study of 1534 coronavirus disease patients, report that 44.2 per cent of patients presented with anosmia and 43.9 per cent had dysgeusia.Reference Avci, Karabulut, Farasoglu, Boldaz and Evman10 They also found that the presence of anosmia was higher in the out-patient compared with the in-patient setting. The authors hypothesise that in-patients may have fewer smell loss complaints because of decreased awareness of olfactory dysfunction associated with the presence of severe symptoms. Reassuringly, a study by Vaira et al. in this month's issue revealed that, in the majority of cases, chemosensory function completely returned within 30 days.Reference Vaira, Hopkins, Petrocelli, Lechien, Chiesa-Estomba and Salzano11 However, 7.2 per cent of patients still experienced severe dysfunction at 60 days post-onset. The authors of the study recommend instituting specific therapies for moderate to severe olfactory disturbance if still present 20 days after symptom onset.
Finally, a small study by Hussain et al. identified a significant association between epistaxis and Covid-19 infection.Reference Hussain, Mair and Rea12 The authors hypothesise that the increased risk of epistaxis may result from the inflammatory impact of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) on nasal mucosa. Further clinical studies are warranted to demonstrate this association. However, caution and adequate PPE are recommended when dealing with epistaxis patients given the potentially increased risk of SARS-CoV-2 infection.
