One of the consequences of the coronavirus pandemic has been a dramatic rise in the use of telemedicine. This is particularly the case with ENT consultations. ENT doctors have been found to be particularly vulnerable to Covid 19 infections - in Wuhan two out of the five doctors who died were ENT doctors, in the UK one ENT consultant (out of about 700 in total) died in the early stages of the UK pandemic, and another was ventilated. This is thought to be due to the high concentration of coronavirus inhaled during the types of examinations we perform. Patients are also put at risk because an ENT surgeon may not realise he or she has a coronavirus infection. As a consequence of this our national body, ENT UK, has advised that all non-urgent in-person consultations are temporarily suspended in the UK .
As you may be wondering what can be done within a video or telephone consultation, I thought it would be helpful to write a short article about my recent experiences of it. So far, I have found it be a very useful form of consultation, with several advantages:
Time saved on travel, which is also good for the environment.
The absence of geographical restrictions. As long as you have a good internet connection, you can have an appointment with a consultant of your choosing, regardless of where you live.
Whilst ENT is a surgical specialty, it is a little known fact that, on average, over 90% of the patients we see do not require surgery. Most ENT conditions are treated with medicines or other forms of therapy, such as physiotherapy, speech therapy, hearing therapy or vestibular therapy.
Examples of common ENT conditions that can often be treated by video consultation include:
Chronic sinusitis - symptoms of this condition can include: a blocked, congested nose (like having a permanent cold); pressure or discomfort in the face; a poor sense of smell; or discharge out of the front, or down the back of the nose. In many cases, the best medical treatment is as effective as sinus surgery (and the benefits usually continue after you stop taking medication).
Nasal blockage - there are many causes of a blocked nose, ranging from problems with swelling of the lining of the nose, (sometimes caused by allergies); to structural problems, such as a deviated septum (a bend in the middle partition of the nose). Medicines are frequently effective at improving such problems.
Glue ear - in most cases, glue ear (mucous on the inside of the eardrum) can be effectively managed with observation and simple measures such as the use of an Otovent balloon.
Dizziness - the diagnosis of the cause of dizziness relies heavily on the history given by the patient. Much of the neurological examination can take place by video consultation, and tests/scans can be arranged as required. In the majority of cases, the treatment of dizziness consists of lifestyle changes, vestibular therapies and medication. Surgery is rarely required.
Nosebleeds - many nosebleeds can be managed with simple advice and antibiotic creams in the nose. These have been found to be as effective as cauterising the nose with silver nitrate (a common outpatient procedure).
Voice problems - whilst it won’t be possible to examine your voice box (larynx) via a video consultation, the history of the problem can often give helpful pointers as to possible causes; and the voice itself can be assessed. Speech therapy can be performed by video consultation, and medicines prescribed where appropriate.
Silent (Laryngopharyngeal) reflux and globus sensation (the feeling of a lump in the throat) are usually managed with a combination of advice, lifestyle adjustments and medical treatments. Surgery is rarely required.
The principal disadvantage of remote consultations is the limitations with regards to examination. However, it is often possible to get an excellent view of the face, skin problems, the mouth, and the front part of the nose with the use of mobile phone cameras. Various neurological examinations can also be performed. Scans (such as ultrasound scans, MRI or CT scans) can be arranged and provide very useful information, and these images can be subsequently reviewed with the patient during a follow-up consultation. Although in most cases, an in-person review will be required at some stage, telemedicine consultations can markedly reduce the need to travel for appointments.
Like most consultants, I did not previously undertake many video consultations. However, my recent positive experience has encouraged me to continue to expand these services after the coronavirus pandemic has ended.
Please do get in touch if you have any questions or thoughts. If you’re interested in a video or consultation, they can be booked here.