Telemedicine in otolaryngology

ENT Telephone Clinics During the Coronavirus Pandemic: An Analysis of 400 Telephone Consultations at a District General Hospital

BACKGROUND

The COVID-19 pandemic led to the introduction of telephone consultations in order to provide specialist health care remotely. This study analyses the outcomes of ear, nose, and throat (ENT) telephone consultations.

METHODS

Retrospective analysis was undertaken of 400 ENT telephone consultations.

RESULTS

All 2-week-wait neck or face lump patients underwent imaging and 78% were successfully discharged. 80% of vertigo patients and 100% of 2-week-wait throat symptom patients were offered face-to-face consultations. All primary hyperparathyroidism patients were managed remotely, being discharged, or with telephone follow-up. The majority of routine referrals were managed without the need for face-to-face consultation.

CONCLUSION

Vertigo patients and 2-week-wait throat symptom patients should be offered a face-to-face consultation in the first instance. For patients with neck or face lumps, initial referral for imaging may improve patient flow and facilitate safe discharge. It is appropriate to continue with telephone consultations for all other patient groups.

The role of telephone clinics in ENT

OBJECTIVE

This quality improvement project assessed the outcomes of telephone consultations for ENT patients in order to identify areas where telephone consultations may be useful in the long term.

METHOD

New ENT patient appointments in May 2019 and May 2020 were reviewed. Total outcomes as well as subspecialty-specific and presentation-specific outcomes were compared for telephone versus face-to-face consultations.

RESULTS

There were 638 consultations in total (465 in 2019 and 173 in 2020). Following telephone consultations, more patients were followed up and fewer patients were listed for surgery or discharged. Overall outcomes for subspecialties followed the general trend, albeit with a few variations.

CONCLUSION

Lack of clinical examination in telephone consultations likely affects confidence in making a diagnosis and therefore discharging or listing patients for surgery. Nevertheless, looking at specialty-specific and presentation-specific data, there may be a role for telephone consultations in selected patients.

Factors Shifting Preference Toward Telemedicine in the Delivery of Skin Cancer Reconstruction Care

OBJECTIVES

Identify which delivery modality for skin reconstruction care, face-to-face (FTF) in-person versus two telemedicine modalities, store-and-forward (S&F) and live video chat (LVC), is patient preferred and how cost, access, wait time, and demographics influence this preference.

STUDY DESIGN

Cross-sectional survey.

METHODS

A 16-question survey querying demographics and five scenario-specific preferences questions for the delivery of skin cancer reconstruction care was created and distributed via Amazon Mechanical Turk (MTurk), a crowdsourcing online marketplace, and in-person to Mohs micrographic surgery patients.

RESULTS

1394 MTurk and 55 in-person responses were included. While 82.1% of online respondents prefer FTF clinic visits, this decreases to 58.3% with an in-person visit cost (p < 0.01) and furthermore to a minority 43.5% with both an in-person visit cost and wait time (p < 0.01) despite 77.8% believing that usefulness to the surgeon would improve FTF. Both the MTurk and in-person cohorts demonstrated similar response patterns despite considerable demographic differences. Multivariable analyses revealed that telemedicine was preferred by MTurk respondents with Medicaid (adjusted OR [95% CI]: 1.97 [1.18-3.31]) or Medicare (1.69 [1.10-2.59]) versus private insurance, and prior skin cancer (2.01 [1.18-3.42]) and less preferred by those earning $140,000+ per year (0.49 [0.29-0.82]) compared to those earning <$20,000 per year.

CONCLUSIONS

FTF visits are preferred for skin cancer reconstruction care; this shifts toward virtual care with a cost and wait time in spite of the perceived quality of care. Individuals with socioeconomic barriers to access prefer telemedicine. MTurk can be a valuable tool for behavioral research in FPRS.

LEVEL OF EVIDENCE

NA Laryngoscope, 133:294-301, 2023.

Telehealth solutions for assessing auditory outcomes related to noise and ototoxic exposures in clinic and research

Nearly 1.5 billion people globally have some decline in hearing ability throughout their lifetime. Many causes for hearing loss are preventable, such as that from exposure to noise and chemicals. According to the World Health Organization, nearly 50% of individuals 12-25 years old are at risk of hearing loss due to recreational noise exposure. In the occupational setting, an estimated 16% of disabling hearing loss is related to occupational noise exposure, highest in developing countries. Ototoxicity is another cause of acquired hearing loss. Audiologic assessment is essential for monitoring hearing health and for the diagnosis and management of hearing loss and related disorders (e.g., tinnitus). However, 44% of the world's population is considered rural and, consequently, lacks access to quality hearing healthcare. Therefore, serving individuals living in rural and under-resourced areas requires creative solutions. Conducting hearing assessments via telehealth is one such solution. Telehealth can be used in a variety of contexts, including noise and ototoxic exposure monitoring, field testing in rural and low-resource settings, and evaluating auditory outcomes in large-scale clinical trials. This overview summarizes current telehealth applications and practices for the audiometric assessment, identification, and monitoring of hearing loss.

Patient satisfaction with telemedicine in rhinology during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has forced the rapid integration of telemedicine services across several specialties, especially in Otolaryngology where risk of transmission is very high. Studies before and during the COVID-19 pandemic have shown that Otolaryngology is generally amenable to telemedicine. However, few studies have assessed patient satisfaction with telemedicine during the COVID-19 pandemic, and fewer have focused on patient satisfaction with telehealth in Rhinology.

OBJECTIVES

To determine if patients believe the benefits of virtual live synchronous telemedicine visits out-weigh the drawbacks when compared to in-person clinical visits.

METHODS

Single center retrospective case series and survey study of patients presenting to a tertiary care Rhinology practice between 3/15/2020 and 6/1/2020. All patients had previous in-person encounters with Rhinology (n = 45).

RESULTS

Twenty-nine participants (64.4%) had audio-video visits while 16 (35.6%) had audio visits. 36 (80%) patients stated that their needs were met during their telemedicine visit while 32 (71.1%) patients felt that nothing was missed or not addressed during the virtual visit. The most commonly cited advantage to telemedicine visits was convenience (22.2%) and provider availability (20.0%). While most participants did not disclose a disadvantage to a virtual visit besides the lack of a physical exam (68.9%), the most commonly cited disadvantage to a virtual visit was technological difficulties (17.8%).

CONCLUSIONS

Virtual telemedicine visits were shown to effectively meet the needs of established patients and address concerns in a convenient time efficient manner. However, patients indicated that limited technology and a less personalized feel hindered the telemedicine experience in Rhinology.

Telemedicine in Otolaryngology in the COVID-19 Era: Initial Lessons Learned

Objectives/Hypothesis

The COVID‐19 pandemic has led to unprecedented global changes in the delivery of healthcare over a short period of time. With the implementation of shelter‐in‐place orders, otolaryngology clinic visits at our institution were transitioned to telemedicine. This change enabled the rapid characterization of the patients who accepted and declined telemedicine.

Study Design

Cross‐sectional analysis.

Methods

A review was conducted of 525 otolaryngology patients at a tertiary‐care referral center with scheduled visits requiring rescheduling to a future date or a telemedicine visit. Visit, demographic information, and reason for deferring telemedicine were collected for analysis.

Results

Seventy‐two percent of patients declined a telemedicine visit, with the most common reason being the lack of a physical exam (97%). There was an even distribution of demographics between those who accepted and declined visits. There was an association between declining telemedicine with older age (P = .0004) and otology visits (P = .0003), whereas facial plastics patients were more likely to accept (P < .0001). Patients scheduled earlier during the pandemic were more likely to accept a visit with a median of 28 days from onset of shelter‐in‐place orders versus 35 for those who declined (P < .0001).

Conclusions

We describe our initial experience with a transition to telemedicine, where the majority of patients would decline a virtual visit due to the lack of a physical exam. Although the future remains uncertain, telemedicine will continue to play a vital role in healthcare delivery. We believe that understanding our patient base gives critical insights that will help guide and improve virtual care to meet patients' needs.

Level of Evidence

4 Laryngoscope, 130:2568–2573, 2020

Telemedicine for head and neck ambulatory visits during COVID-19: Evaluating usability and patient satisfaction

BACKGROUND

In light of the COVID-19 pandemic, there has been a rapid increase in telemedicine visits. Otolaryngology patient satisfaction with these visits has not yet been extensively studied using a validated survey.

METHODS

All patients who had telemedicine visits with three head and neck surgeons, by phone or video-based platform, between March 25, 2020 and April 24, 2020. Retrospective chart reviews were conducted to determine demographic, disease, and treatment information. Patients who had a video visit were contacted by telephone and, if they could be reached and consented, were administered the telehealth usability questionnaire (TUQ).

RESULTS

Hundred surveys were completed. The average score across all questions was 6.01 on a scale from 1 to 7, where 7 indicated the highest level of patient agreement. The highest scores were for questions related to satisfaction with telehealth (6.29), while the lowest were related to reliability (4.86).

CONCLUSIONS

Patients are generally highly satisfied with telemedicine.

Using Technology in Global Otolaryngology

Technology is integral to the diverse diagnostics and interventions of Otolaryngology. Historically, major advances in this field derive from advances of associated technologies. Challenges of visualization and surgical access are increasingly overcome by integrating endoscopic, electronic, and robotic instruments. Otolaryngology is often limited to urban areas and large academic centers, making it difficult to allocate care and resources to many underserved populations. The widespread use of technology has important implications in regards to global access to this field as telemedicine is most effectively applied to specialties that are heavily reliant on data and visuals that may be electronically disseminated.

Diagnosis of Middle Ear Disease using Tympanograms and Digital Imaging

OBJECTIVE: The study investigates the ability of physicians with different levels of training to accurately identify middle ear (ME) pathology using tympanograms and tympanic membrane (TM) digital photographs.

STUDY DESIGN AND SETTING: Groups of medical students, internal medicine residents, and attending and resident otolaryngologists were presented with a set of 50 matched tympanograms and photographs of TMs. The physicians were asked to differentiate between a normal and an abnormal-appearing TM. The sensitivity and specificity of diagnosis of ME pathology by physicians were compared with the gold standard, examining the ME cavity for pathology during myringotomy.

RESULTS: The sensitivity did not vary among physicians with different levels of training; however, specificity improved with an increase in physician experience.

CONCLUSIONS AND SIGNIFICANCE: This study establishes a baseline for accuracy of diagnosis of ME pathology using tympanograms and photographs of TMs as compared with binocular otomicroscopy and the gold standard, myringotomy. EBM rating: B-2.

Web-based analysis of nasal sound spectra

The spectral analysis of the nasal sound is an indicator of the nasal airflow pattern. We investigated a new technique for nasal sound analysis via Internet. This study includes 27 patients and 22 healthy people. Patients were treated by septoplasty operation for septal deviation. Postoperation 10(th) day, this technique was applied to follow nasal airflow course. The patients recorded the nasal sound by microphone into the computer as a .wav file and sent us via internet, all those records were evaluated by us. The results were sent back to themselves. The 11 patients who had nasal obstruction symptoms (group A) were called to the hospital to check. In the nasal sound analyses e-mails of those patients, the sound intensity was at high frequencies (2-4 kHz, 4-6 kHz) above 30 dB, but low (500-1000 Hz) and medium frequencies (1-2 kHz), are below then 10 dB. In the patients without nasal obstruction symptom (group B), the sound intensity was at high frequencies below 10 dB, but low and medium frequencies are above 20 dB. There was a statistically significant difference in sound intensity between group A and group B. In the endoscopical examination of those obstructions, which decreases the nasal airway, crusting formation in the nasal cavity was found. Web-based nasal sound analysis is an important method to follow the postoperative course and the nasal airflow evaluation. The new method will save time and money, avoiding a return visit to the hospital unnecessarily.

Knowledge and utilization of Information Technology among health care professionals and students in Ile-Ife, Nigeria: a case study of a university teaching hospital

BACKGROUND

The computer revolution and Information Technology (IT) have transformed modern health care systems in the areas of communication, teaching, storage and retrieval of medical information. These developments have positively impacted patient management and the training and retraining of healthcare providers. Little information is available on the level of training and utilization of IT among health care professionals in developing countries.

OBJECTIVES

To assess the knowledge and utilization pattern of information technology among health care professionals and medical students in a university teaching hospital in Nigeria.

METHODS

Self-structured pretested questionnaires that probe into the knowledge, attitudes and utilization of computers and IT were administered to a randomly selected group of 180 health care professionals and medical students. Descriptive statistics on their knowledge, attitude and utilization patterns were calculated.

RESULTS

A total of 148 participants (82%) responded, which included 60 medical students, 41 medical doctors and 47 health records staff. Their ages ranged between 22 and 54 years. Eighty respondents (54%) reportedly had received some form of computer training while the remaining 68 (46%) had no training. Only 39 respondents (26%) owned a computer while the remaining 109 (74%) had no computer. In spite of this a total of 28 respondents (18.9%) demonstrated a good knowledge of computers while 87 (58.8%) had average knowledge. Only 33 (22.3%) showed poor knowledge. Fifty-nine respondents (39.9%) demonstrated a good attitude and good utilization habits, while in 50 respondents (33.8%) attitude and utilization habits were average and in 39 (26.4%) they were poor. While 25% of students and 27% of doctors had good computer knowledge (P=.006), only 4.3% of the records officers demonstrated a good knowledge. Forty percent of the medical students, 54% of the doctors and 27.7% of the health records officers showed good utilization habits and attitudes (P=.01)

CONCLUSION

Only 26% of the respondents possess a computer, and only a small percentage of the respondents demonstrated good knowledge of computers and IT, hence the suboptimal utilization pattern. The fact that the health records officers by virtue of their profession had better training opportunities did not translate into better knowledge and utilization habits, hence the need for a more structured training, one which would form part of the curriculum. This would likely have more impact on the target population than ad hoc arrangements.