Clinical applicability of the study
This audit demonstrated room for improvement. First, emergency cases
admission dropped by 31.56 %. It can be assumed that accidents were
less frequent with the general confinement of the population. However,
not all ENT emergencies are traumatic and patients may not have dared to
come. If the follow-up of cancer patients has been carried out, it is
also possible that new cancers detection has been delayed. Reassuring
communication is therefore necessary to allow patients to receive care
even if they do not have a pathology linked to Covid-19.
The second room for improvement is patient selection. In our study, more
than a quarter admissions did not need any treatment. The major factors
of a better case selection were referral by a doctor and a recent ENT
history. Epistaxis were clearly responsible for ENT emergency need. The
incidence of epistaxis could have been increased by the generalization
of nasopharyngeal PCR testing. However, epistaxis was the most frequent
ENT emergency referral long before SARS-CoV2
testing. 5,9
Our study was not designed to study mortality rate and due to the small
number, no definitive conclusion can be drawn. However, our data might
suggest an increase in the all-cause death rate. Possible explanations
might be the patient’s fear of presenting to the hospital, work overload
in primary care and overwhelmed teams in ICU.
The widespread impact and duration of this pandemic makes it unique from
any crisis encountered to date by our specialty. While best-practice
recommendations for ENT surgery amid Covid-19 are being
implemented10, special attention should be paid to
non-Covid patients. Otolaryngology service has to be up and running,
albeit adapting, in close partnership with primary care.
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TABLESTable 1 : Outpatient activity.Table 2 : Surgical activity.
Table 3 : Odds ratios for having a specific ENT management(minor
ENT procedure, inpatient treatment, surgical procedure).
Table 4 : Comparison to last year activity.