Introduction
The rapid spread of coronavirus disease 2019 (COVID-19) worldwide raised
concerns about its heavy impact on the health care delivery system and
forced significant changes in the realities of the clinical practice we
are accustomed to. With these changes comes a need for a different
approach to outpatient evaluation of common otolaryngology complaints in
patients with new symptoms.
Recently published set of guidelines for evaluation of head and neck
during the COVID-19 pandemic recommended to postpone the management of
benign disease including benign salivary or thyroid gland
disease.1 In order to limit the chance of COVID-19
infection among patients or health care workers, surveying patients via
telephone or telemedicine visit was advised, reserving in-person
evaluation for the patients at risk for significant negative outcomes.
The challenge is that these measures can only be applied in clear-cut
clinical scenarios, when the disease process is most likely benign and
the care delivery can be postponed.
In cases with a high degree of uncertainty based on available clinical
information, many physicians will have to decide how to proceed after
initial telemedicine encounter. Clinicians will have to consider how to
balance a potential delay in diagnosis, including cancer diagnosis,
against the risk of COVID-19 exposure, and may need to exercise their
best judgement knowing that for head and neck cancer the risk of
progression with cancer care delay is high.2 In this
communication, we present our approach to triaging and evaluation of
patients with complaints concerning for salivary gland disease.