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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  9. Atta L, Delrez S, Asimakopoulos A, Bendavid G, Delhez A, Goffinet M, Rogister F, Lefebvre PP, Poirrier AL. A prospective audit of acute ENT activity in a university teaching hospital. B-ENT 2019;15:71-76.
  10. Bann DV, Patel VA, Saadi R, et al. Impact of coronavirus (COVID-19) on otolaryngologic surgery: Brief commentary. Head Neck. 2020;10.1002/hed.26162. doi:10.1002/hed.26162 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.