PESHAWAR: As the elective services, OPDs and clinic remain closed to ensure social distancing due to Covid-19 pandemic, a consultant has made recommendations for the management of all emergencies of ear, nose and throat (ENT) to avoid complications to patients and safeguard healthcare providers from the virus.

Prof Gharib Nawaz, a consultant at Hayatabad Medical Complex Presently, said that presently only life-threatening emergencies were managed due to Covid-19 pandemic. He said that those recommendations would provide roadmap to do all ENT emergencies without fear.

“Those emergencies, which pose threat to life like airway obstruction, or those that may damage an organ like a simple button battery cell if left alone, can damage ear permanently,” Prof Gharib Nawaz, head of ENT-A ward at HMC, told Dawn.

He said that such procedures were dangerous as those might add to the problems of an already compromised respiratory system and being aerosol generating could cause spread of infection more extensively.

According to Prof Gharib Nawaz, every patient has to be taken as Covid-19 positive during pandemic

“The Covid-19 is spread by droplets. The droplets are heavy, more than five micron and cannot travel in air for more than few feet while aerosol is less than five micron and can cover longer distances in air, facilitating spread,” he said.

Prof Gharib Nawaz said that the lockdown might prolong due to the ongoing infection, but doctors should take care of the patients requiring treatment for their critical conditions.

In general situation, of the total patients coming to hospitals and clinic every day, 30 to 40 per cent are the ones with ENT problems but most of them can wait, however, the emergencies require urgent management and cannot be delayed.

“Covid-19 is an acute complex multi-system disease. It has brought about a paradigm shift in the management of almost all other diseases. During the pandemic, every patient has to be taken as Covid-19 positive while managing ENT emergencies. Manage the patients as conservatively as possible, avoid intervention unless necessary,” said Prof Gharib Nawaz.

The patients with common problems, like tonsillitis, can be treated conservatively because risk of surgery is more dangerous as far as the pandemic continues.

“There is a point. Covid-19 has adversely affected other patients in two ways. Due to Covid-19, the other patients don’t get proper attention and secondly management of other patients has become difficult and tedious,” he said.

Majority of ENT emergency procedures are aerosol-generating, causing the disease to be airborne and carry high risk of transmitting the virus infection and should be avoided unless there is risk of life or losing an organ and shall be done with highest level of care using complete personal protective equipment (PPE).

Minimum possible human resource shall be used, keeping a designated group on duty for a week and at the end of the week if test facility is available swabs may be taken, if negative, they shall join their families. If the test facility is not available, every group shall be given a week long break for a self-quarantine in their houses.

“If possible, negative pressure should be used in operating room. If not available, the procedure should be done in strictly closed door and turn off laminar flow (if present). If available, use only in-line suction circuits. Use of power instrument should be avoided as much as possible. Use of systemic steroid is not favoured by many experts during the pandemic,” said Prof Gharib Nawaz.

Published in Dawn, May 11th, 2020