The expanded use of telemedicine in otolaryngology during the COVID-19 pandemic has shown how beneficial the approach can be for patients and clinicians.

“The widespread success of telemedicine in otolaryngology–head and neck surgery during the pandemic highlighted its potential to enhance access, convenience, and patient satisfaction without compromising quality care,” F. Jeffrey Lorenz, MD, and colleagues wrote. “This led to its continued use even after the health crisis subsided.”

Telehealth regulations, however, are continuously evolving, Dr. Lorenz and colleagues noted.

To examine current and future policies related to the use of telemedicine in the specialty, the researchers conducted interviews with clinicians from the otolaryngology–head and neck surgery department of a large academic medical center. They also asked about suggestions for implementation and the rationale for continuing to use telemedicine in the specialty.

A viewpoint discussing their findings was published in Otolaryngology—Head and Neck Surgery. Physician’s Weekly spoke with Dr. Lorenz to learn more.

PW: What prompted this viewpoint?

Jeffrey Lorenz, MD: The Penn State Department of Otolaryngology—Head and Neck Surgery launched a telemedicine program at the onset of COVID-19. Following the pandemic’s peak, the department continued with telehealth appointments and is firmly committed to offering this service to eligible patients in the future. In contrast, some findings in the literature have indicated reduced telemedicine use after the pandemic ended. With our success, we found it essential to advocate for continued use of telemedicine and communicate how to adapt to evolving guidelines.

PW: How did telemedicine in otolaryngology change with COVID-19?

Jeffrey Lorenz, MD: Before the pandemic, telemedicine was scarcely used in otolaryngology. Our department didn’t even provide it as an option. However, during the COVID-19 public health crisis, telehealth emerged as a vital method for delivering healthcare while mitigating the spread of the virus.

To illustrate this widespread use with an example, one study showed that, during the pandemic, approximately 99% of otolaryngologists integrated telemedicine into their practice. The Penn State Department of Otolaryngology—Head and Neck Surgery transitioned from not offering any virtual visits to conducting more than 3,000 virtual consultations at the peak of the pandemic in 2020 and 2021 combined.

PW: What does telemedicine in otolaryngology look like now?

 Jeffrey Lorenz, MD: There are many similarities between telemedicine now compared with during the pandemic. Patients continue to request telemedicine visits, even though pandemic restrictions have largely subsided, and in-person options are available again. However, now that it is more of a luxury than an absolute necessity, telemedicine use evolved, and criteria were developed to determine diagnoses amenable to this service.

So far, our findings indicate that patients with conditions like sleep-disordered breathing, sleep apnea, epistaxis, nasal congestion, and various other diagnoses are good candidates for telemedicine. Additionally, the platform proves advantageous for established patients, enabling them to review study results, receive follow-ups for laceration repair, and attend postoperative visits for procedures like tonsillectomy and adenoidectomy.

PW: What are the benefits and drawbacks?

Jeffrey Lorenz, MD: Telemedicine in otolaryngology offers several distinct advantages. Patients have embraced telehealth, consistently expressing their preference for this approach. It enhances access to care, reduces the need for extensive travel, and provides a high level of convenience. Patients can effortlessly attend appointments and minimize disruptions to their daily routines. This is particularly appreciated by parents of pediatric patients.

However, there are notable drawbacks. Some visits necessitate an in-person exam. There are instances where physical presence is vital for a complete evaluation, such as otology referrals or an exam with flexible laryngoscopy. Additionally, not all insurance plans cover telehealth services, and billing for telehealth appointments no longer includes facility fees, which could pose financial challenges for healthcare facilities that rely on such fees to support their operations.

PW: What is the future of telemedicine in otolaryngology?

Jeffrey Lorenz, MD: The COVID-19 public health emergency declaration has ended, but certain telehealth guidelines remain in effect. At present, patients will retain the ability to consult with physicians and advanced practice providers through telehealth services.

The future success of telemedicine in otolaryngology from a clinical standpoint will depend on a continuous evaluation of the appropriateness of telehealth consultations for patients. This involves establishing clear guidelines and criteria for determining which cases can be effectively managed through remote interactions and which may require an in-person examination. Striking the right balance is key to ensuring that patients receive the highest quality of care while benefiting from the convenience and accessibility that telemedicine offers.

In addition to refining referral protocols, exciting technological innovations are on the horizon. One example is the emergence of smartphone otoscopes and similar diagnostic tools. Such innovations, when paired with telehealth platforms, have the potential to allow for detailed visual examinations of the ear, nose, and throat. This could allow certain appointments that were traditionally confined to in-office visits to be conducted remotely, offering a broader scope for telemedicine in otolaryngology.

Dr. Lorenz would like to thank his co-authors, Tiffany Heikel, PA-C, and David Goldenberg, MD, FACS, for their work on this research.