26/03/2020
Article today in the Australian Financial Review:
EXTREME VIRAL RISK CUTS EAR, NOSE AND THROAT SURGERY
Jill Margo - Health Editor
Mar 23, 2020 – 10.55am
Surgeons who operate on the ear, nose and throat (ENT) are taking radical and unprecedented action to protect themselves and their teams from the new coronavirus.
ENT surgeons work in the viral epicentre of the body and are at extreme high risk of infection. They are now restricting themselves to urgent operations and cutting back their clinics. Some are closing them.
Routine operations such as tonsillectomies, nasal and much sinus surgery will be suspended for at least a month.

Deaths of ENT surgeons have been reported in China, Iran, Italy and the UK, says Professor Sacks.
The unavailability of these common procedures means many people will continue to live with their symptoms until the pandemic curve flattens.
"This is unprecedented in my life," said Professor Raymond Sacks, deputy president of the Australian Society of Otolaryngology, Head and Neck Surgery.
“The toll on ENTs has been terrifying, with deaths reported in China, Iran, Italy and the UK – and one of two on life support in the UK dying over the weekend.
“In China, infection from a patient of unknown COVID-19 status spread to 14 members of an endoscopic skull-base surgical team, operating on a pituitary tumour through the nose.”
Professor Sacks, who is professor of surgery at Sydney and Macquarie universities, said the viral load was highest in the nose, the area joining the back of the nose to the throat, and the throat.
There is already high infectivity among ENTs around the work, and high fatality rate.
— Professor Raymond Sacks, Australian Society of Otolaryngology, Head and Neck Surgery
“So instrumentation and working in these areas places practitioners at a greater risk of increased viral load. There is already high infectivity among ENTs around the work, and high fatality rate.
“They get it badly and, unlike the general community, it affects all ages. One ENT resident [trainee] was only in his 30s.”
Professor Sacks is deeply concerned about himself, his colleagues, his staff and his patients.
“We should be operating with appropriate full personal protective equipment but we need to be cognisant of scarce resources, particularly at this early stage of the pandemic.”
The society has changed its guidelines, recognising that “time sensitivity” and “urgency” are determined by individual surgeons who need to be aware of potential risks to themselves and their staff.
The society suggests that routine elective clinic visits be stopped and, where possible, telephone and video consultations be used.
Members need to be extremely vigilant and consider patients vulnerable to the consequences of viral infection, such as those with a tracheostomy, respiratory compromise or immune suppression.
Not definitive
Although negative test results are not definitive, the society stresses the importance of testing patients before surgery. In the absence of confirmed negative status by two tests more than 24 hours apart, patients should be treated as positive.
From Monday, elective sinus and nasal surgeries, the removal of adenoids and tonsils, ear drum repairs and hearing rehabilitation surgery including cochlear implantation will cease.
Conditions requiring emergency/immediate or urgent (within 30 days) surgery such as tracheotomies, head and neck cancer, removal of airway foreign bodies and drainage of abscesses in the head, neck and ear will continue.
“All cases will be treated on their own merit, with individual surgeons making decisions based on the risks and benefits to both the patient and the peri-operative staff," Professor Sacks said.
