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Impact of Covid-19 on Ear, Nose and Throat referrals

I've seen quite an impact from Covid-19, the lockdown and other restrictions. They are triggered by two elements: mask wearing and Zoom conversations.

Issue with mask wearing and ENT complications

Mask wearing is the biggest one. Firstly those with a blocked nose find wearing a mask much more difficult than those with a normally breathing nose. They feel that the presence of the mask restricts an already compromised flow meaning breathing becomes difficult, particularly in warm weather. I have treated rhinitis, nasal polyps and deviated nasal septums in order to correct this.

The other element of mask wearing that causes problems is the fact that patients can smell their own breath, as exhaled air flows around under the mask and can be re-breathed. Those with chronic tonsil infection or stones suddenly become aware of this. I have performed tonsillectomy under local anaesthetic to eradicate this problem.

Swab tests and ENT

Some patients find having the nose swab test very uncomfortable, as the swab has to go right to the back of the nose to get a proper sample. The person doing the test just pushes the swab deep into the nose without looking, and if there is an obstruction this can be extremely painful and cause nose bleeds. It means some people become fearful of having the test done, and often refuse. I've also had to cauterise noses to stop the bleeding becoming recurrent.

Loss of sense of smell and taste has been a big predictor of Covid19 infection. We first realised the association in early April 2020. My studies show that this was a symptom in over 90% of those testing positive for Covid19 antibodies. Most patients found that their sense of smell and taste returned a few weeks after infection. However some have had no improvement at all, and some have disordered sense of smell and taste, for example coffee smelling like bleach. This appears to be quite long lasting. ENT examination is required to rule out infection or rhinitis as a cause. I treat patients with any loss or disordered sense of smell and taste with high dose steroids for 5 days.

And finally....

Finally, Zoom type consultations are a problem because those working from home are not quite as conscious of their appearance when getting ready for work. Suddenly they see their slightly unkempt faces, often without make up, in the Zoom window next to the main window, and become acutely aware of the ageing process on their facial skin, prompting a call to me for Botox!


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