The clinical consequences of the COVID-19 lockdown: A report from an Italian referral ENT department

Abstract

Objectives: To evaluate the clinical effects of health care reorganization because of COVID-19, in a non-red zone Italian referral department of Otorhinolaryngology.

Materials and methods: We retrospectively reviewed the statistics of admissions to the Emergency Department (ED) of the Careggi University Hospital, Florence, from January 1, 2020, to May 17, 2020. Data regarding elective and urgent head and neck disorders were reviewed and the most challenging cases were discussed.

Results: During the lockdown period, outpatient otolaryngological consultations and elective procedures decreased by 78% and 75% respectively, while emergency/urgency surgery increased by 128%. The five most emblematic clinical cases were thoroughly analyzed.

Conclusion: Our analysis shows how the profound rearrangement of clinical and surgical activities, along with the citizens' fear to seek medical care has probably exacerbated the management of many routine head and neck conditions.

Level of evidence: 4.

Keywords: COVID‐19; SARS‐CoV‐2; emergency medicine; head and neck surgery; otorhinolaryngology.

FIGURE 1

Bar chart: On the x axis, week number from the beginning of 2020; on the y axis, overall number of admissions to our ED. Starting from the tenth week, a stratification between patients coming to the ED for COVID‐19‐associated symptoms and for other symptoms is given

FIGURE 2

Case 1: A, an intraoperative view of the transcervical drainage of the purulent fluids extensively involving all the fascial planes of the neck; B, coronal view of the CT scan shows an impressive involvement of both the neck and upper thorax. Case 2: C, an endoscopic view of the left nasal fossa with purulent material coming from the frontal infundibulum; D, axial CT scan shows the extensive involvement of the cerebral frontal lobes

FIGURE 3

Case 3: E, right paramandibular, stony‐hard, irregular‐shaped, 8 × 6 cm mass; F, coronal CT scan shows a heterogeneous, polylobed mass. Case 4: G, swelling, erythema, and ptosis of left superior eyelid with a Pott's puffy tumor; H, coronal CT scan reveals an acute frontal rhinosinusitis complicated by orbital involvement. Case 5: I, squamous cell carcinoma of the skin of the cheek; L, axial CT scan shows the cutaneous mass involving deep tissues