Experience with Telemedicine in a Tertiary Academic Otologic Clinic During the COVID-19 Pandemic

Abstract

Objective: To examine the utility of telemedicine in a tertiary otologic practice.

Study design: Retrospective case series.

Setting: Tertiary neurotology clinic.

Patients: Consecutive adult patients presenting via video visit between January 2020 and January 2021.

Interventions: Televideo modality to conduct visits with patients seeking evaluation for new concerns, second opinions, or routine follow-up for established conditions.

Main outcome measures: Success of the televideo visit defined by the televideo visit being sufficient for determining a definitive plan and not requiring deferment of recommendations for a subsequent in-person visit.

Results: A total of 102 televideo visits were performed among 100 unique patients. Of those, 92 (90.2%) visits were for second opinions or evaluation of new concerns, most commonly for vestibular schwannoma (n = 32, 31.4%), followed by sensorineural hearing loss (n = 20, 19.6%). Other visits were conducted for early postoperative follow-up and established general follow-up. In 91.2% of cases (n = 93), patients were successfully evaluated and provided recommendations from the initial video visit. All visits with patients having a diagnosis of meningioma (n = 7), and nearly all with vestibular Schwannoma (97%, n = 31) and sensorineural hearing loss (95%, n = 19) were successful. Of the 79 patients offered surgery as one potential treatment option, 31 patients underwent surgery at our institution by time of review. Patients with unsuccessful visits (n = 9, 8.8%) were advised to schedule additional in-person diagnostic imaging, vestibular testing, or cochlear implant candidacy evaluation to establish a more definitive care plan.

Conclusion: Virtual televideo visits were successful for a high percentage of selected patients seen at a tertiary neurotology practice, particularly those seeking evaluation of vestibular schwannoma or sensorineural hearing loss.

FIG. 1

Flowchart detailing overview of study including patient enrollment and visit characterization.

FIG. 2

Definition of successful virtual visits by certainty of diagnosis and certainty of plan.

FIG. 3

Heat maps depicting regional spread of visits based on patient zip code data extracted from the medical record. Left: blue dots represent patients seen during in-person visits (2019). Right: red dots represent patients seen during virtual visits (2020).

FIG. 4

Suitability of varying neurotological concerns for virtual visit. Most recommendations presented in this figure are based on study data presented herein. However, some indications (e.g., dizziness, tinnitus, otalgia) were not represented in this study, but were added to this figure to more comprehensively cover the breadth of the specialty, with these recommendations based on clinical insight. CHL indicates conductive hearing loss; CI, cochlear implant; CSF, cerebrospinal fluid; IT, intratympanic; MHL, mixed hearing loss; SNHL, sensorineural hearing loss; Tplasty, tympanoplasty.