Dr Malik highlights ENT manifestations in COVID-19 patients

-By Dr Sonia Sameen

Rawalpindi: Dr Malik Jawad Faisal, Associate Professor, ENT Department, PIMS and FMDC, Finance Secretary, PMA Islamabad, former General Secretary, Pakistan Society of Otorhinolaryngology, and a founding member of the Pakistan Rhinoplasty Association, recently conducted a webinar session with Medical News Pakistan in which he discussed the ENT manifestations of COVID-19.

ENT specialists are the most prone to the virus since the coronavirus is an aerosol generated virus. One of the best things that ENT specialists can do to protect themselves at this time is to place a transparent glass or plastic sheet on their table to serve as a protective shield. Try to use a bigger table to ensure a greater distance between the patient and the physician, said Dr Malik.

As ENT specialists, it is particularly problematic for us to wear face shields because it impairs us from wearing our headlight – an essential inspection tool. Instead of manipulating the tongue depressor yourself, ask your patient to hold it and then examine from a distance, he noted. Another factor that is crucial here is a detailed medical history. Minimize contact as much as possible. Use a headlight to examine from a distance. If it is not possible, wear a face shield and use a torch and disposable arthroscope tips to examine patients, said Dr Malik.

ENT doctors should also make it a habit to wash their nostrils and gargle when washing their hands after every patient consultation, he advised.

Viral transmission is primarily due to nasal inhalation of aerosol droplets making the nasal cavity the first entry point. The reason why social distancing was recommended to tackle the spread of this virus because the coronavirus is a heavy virus that travels for a maximum distance of 1 meter, and then it finds its way to the ground, he told.

Allergic patients are more prone to the virus as their nasal and throat mucosa are already inflamed and damaged. Since the initial barrier to the infection is already damaged, it leaves the upper respiratory tract is more prone to faster dissemination and further damage by the virus. Many asymptomatic people managed to contract the virus and combat it as well due to their nasal and throat secretions. Allergic patients are already immunocompromised, and their symptoms might be masked, so they are at very high risk.

In response to a question concerning any permanent damage related to COVID-19, Dr Malik said that permanent damage, if any, is only in the lungs in the form of fibrosis, which leads to reduced lung capacity. Permanent damage in the upper respiratory tract is rare; however, loss of smell and taste may continue for up to six months.

When it comes to the initial symptoms of COVID-19, loss of taste and smell was reported in more than 70% of the presenting patients. The three most commonly encountered symptoms aside from fever included coughing and loss of breath, loss of taste and smell, and diarrheal symptoms.

In response to a question regarding presenting symptoms, Dr Malik informed that unlike the regular flu that starts with high-grade fever, COVID stays within 99 to 100 degrees for a week or so, and then it increases. A characteristic ground glass appearance is chest X-rays is essential for COVID diagnosis along with PCR, he added.

For doctors, since they are in close contact with patients, I recommend that they use the N95 mask without a filter or respirator. A simple surgical mask is sufficient for others who are not at a high risk of acquiring the infection.

Reinfection is possible with the coronavirus. Viruses can change their gene sequence and thus reinfect an individual in the form of a different variant. For this reason, people should continue to practice care even after recovering, he noted.

Dr Malik ended his session, saying that I would advise people to maintain social distancing and wear a mask responsibly. Avoid self-medication as it only puts your own life at risk. Consult a professional if you have any concerns.