Practice of Telehealth in Otolaryngology: A Scoping Review in the Era of COVID-19

Abstract

Objective

The COVID-19 pandemic has spurred widespread adoption and advancement in telehealth activities, representing a marked change in otolaryngology practice patterns. The present study undertakes a scoping review of research focused on telehealth in otolaryngology (teleotolaryngology) to identify key themes and commonly utilized outcome measures that will assist future development in this growing field.

Data Sources

PubMed, Embase, and Cochrane databases and reference review.

Review Methods

Per guidelines of the PRISMA Extension for Scoping Reviews, we performed database queries using a comprehensive search strategy developed in collaboration with research librarians at the Columbia University Irving Medical Center. We identified 596 unique references to undergo title and abstract review by 2 independent reviewers, leaving 439 studies for full-text review.

Results

We included 285 studies for extraction of notable findings, leaving 262 unique studies after accounting for content overlap. We identified core outcome measures, including patient and provider satisfaction, costs and benefits, quality of care, feasibility, and access to care. Publication volume increased markedly over time, though only 4% of studies incorporated randomized study group assignment. Using an iterative approach to thematic development, we organized article content across 5 main themes: (1) exploration of teleotolaryngology evolution, (2) role in virtual clinical encounters, (3) applications in interdisciplinary care and educational initiatives, (4) emerging and innovative technologies, and (5) barriers to implementation.

Conclusion

This scoping review of teleotolaryngology documents its evolution and identifies current use cases, limitations, and emerging applications, providing a foundation from which to build future studies, inform policy decision making, and facilitate implementation where appropriate.

Keywords

telehealth telemedicine access COVID-19 pandemic

COVID-19 has altered the practice of medicine. To preserve resources and reduce exposures, the health care system has adopted novel care delivery models while maintaining access. Impactful changes have occurred in telehealth, specifically telemedicine. Whereas “telehealth” encompasses an array of digital health care–related activities, “telemedicine” describes diagnosis and management decisions provided remotely via telecommunication.¹ Telemedicine in turn can be conducted asynchronously, with examination and evaluation/diagnosis separated temporally, or synchronously in real time.

Most notably the pandemic has catalyzed the use of telemedicine due to necessity and yet has demonstrated its viability as a method for providing outpatient care. Before COVID-19, telemedicine had <1% utilization rates among Medicaid recipients.² However, during the pandemic, state-issued mandates limited the availability of in-person clinical visits, while insurers eliminated copays and closed the reimbursement gap between telemedicine and in-person visits, both of which bolstered utilization rates of telemedicine.³ Moreover, recent trends suggest that patients and providers increasingly carry the raw tools for telehealth: upward of 82% of Americans owned smartphones as of 2015, and electronic medical records feature mobile device integration.⁴ Concerns with interstate licensure, platform confidentiality, and reimbursement highlight that medicolegal accommodations have lagged technological solutions in telemedicine.⁵ While intuitively best suited for nonprocedural specialties, telehealth and telemedicine have been broadly implemented, including within otolaryngology.

To evaluate the use of telehealth activities in otolaryngology (teleotolaryngology), we reviewed the literature comprehensively. The diversity of teleotolaryngology applications and study formats is best synthesized through a scoping review, which appraises the state of the field despite a lack of commonly used outcomes. Our objectives in this review are to broadly identify studies that detail clinical telehealth applications, to highlight key themes, and to summarize study outcomes and measures that may be utilized in future investigation. Herein, we document the progress of teleotolaryngology and identify areas for improvement, expansion, and further research.

Methods

We conducted a review of the literature in accordance with guidelines of the PRISMA Extension for Scoping Reviews (Preferred Reporting Items for Systematic Reviews and Meta-analyses).⁶ We queried the PubMed, Embase, and Cochrane databases for English-language studies published from 1996 to November 20, 2020 (the search date), using a search strategy developed in collaboration with the research librarian team at Columbia University Irving Medical Center: “(telemedicine[MeSH Terms]) AND (Otolaryngology[MeSH Terms]) or (tele* [tiab] and otolaryng* [tiab]).” A specific reference search for articles contained within relevant systematic reviews was also conducted to augment search inclusiveness, resulting in 117 additional articles, including 2 articles from 1994 that are the earliest explicit use of teleotolaryngology.^7-11 Exclusion criteria included inability to locate or access full-length text, a lack of specific reference to clinical otolaryngology practice, a primary objective or focus not related to telehealth and telemedicine, nonprimary or review-based literature, oral presentations or poster sessions, and journal correspondence or editorial pieces without extractable material.

During the data extraction phase, 2 reviewers classified full-length studies using level of evidence (LoE) ratings, with a senior author refereeing discrepancies: LoE 1, randomized study group allocation; LoE 2, prospective observational study; LoE 3, retrospective observational study; LoE 4, case series or study lacking a control group; and LoE 5, review article predominantly reflecting expert opinion.

We employed a staged approach to organize studies based on common themes and to categorize outcome measures. After an initial phase of familiarization with the existing literature via an inductive approach to identify themes presented by available data, we then relied on a latent approach to capture subtle context in the available studies in an effort to conceptually consolidate themes and outcome measures that reflect the full range of content and conclusions present in extracted studies. We thus categorized studies based on the following themes: (1) history and evolution of teleotolaryngology, (2) role in virtual clinical encounters, (3) trends in applications and utilization, (4) emerging technologies and innovations, and (5) perceived limitations and barriers to implementation. We identified 5 main outcome measures that reflect key metrics in research evaluating teleotolaryngology: patient and provider satisfaction, costs and benefits, quality of care, feasibility, and access to care. All outcomes addressed at least once in each study were stratified according to these categories and recorded. As our aim did not include a quantitative comparison of specific study outcomes or meta-analysis, we did not perform a formal risk of bias assessment, as is customary for scoping reviews of this nature.¹²

Results

A PRISMA-style flowchart outlines the screening process of reviewed studies ( Figure 1 ). We identified 596 unique references for title and abstract review by 2 independent reviewers, leaving 439 for full-text review. Of these, 154 were subsequently excluded, leaving 285 studies for data extraction. There were 23 articles with substantial overlap in content or study population that were pooled for purposes of data extraction, leaving 262 unique studies for inclusion in the results tables and descriptive analysis of relative distribution by year, LoE, and outcomes.

The majority of relevant studies were published within the past decade: 202 (77%) from 2010 onward, as compared with 46 from 2000 to 2009 and 14 from 1994 to 1999 ( Figure 2 ). Most studies (n = 109, 42%) were LoE 4. Ten articles (4%) incorporated randomized study group assignment. The most common outcome measure was feasibility, occurring in 202 articles (77%), followed by patient and provider satisfaction in 82 (31%), costs and benefits in 57 (22%), access to care in 54 (21%), and quality of care in 52 (20%).

Defining Telehealth in Otolaryngology: History and Evolution

We identified 27 studies that traced the history and evolution of telemedicine in otolaryngology (Supplemental Table S1, available online). Studies consisted predominantly of pilot studies, case series, literature reviews, and qualitative discussions; accordingly, 12 (44%) were LoE 5. Twenty studies (74%) addressed feasibility, while 9 (33%) addressed costs and benefits.

Otolaryngology clinical visits regularly incorporate procedures to accurately diagnose patients, prompting a desire for telehealth infrastructure that improves remote evaluations in underserved regions.^13-15 Early proponents envisioned expanded geographic coverage for general and emergent otolaryngologic care, earlier pathology detection, and streamlined interdisciplinary coordination.^16,17 Calls were made to dedicate resources toward defining, testing, and deploying otolaryngologic telemedicine. Early on, asynchronous telemedicine predominated. In particular, the integration of the Internet into daily practice allowed for “store and forward” consultations whereby information is collected and transmitted for remove evaluation.¹⁷ Early studies also demonstrated that coordinating care outside conventional temporal and geographic restrictions increases provider efficiency, translating to shorter wait times and reduced costs for patients; however, not every region or system requires teleconsultation services.^18,19

Clinical Encounters: Synchronous and Asynchronous Consultations in Teleotolaryngology

Seventy-nine studies examined the clinical encounter provided by a teleotolaryngology consultation (30% of total; Supplemental Table S2, available online). Of these, 67 (85%) addressed feasibility. Of the 79 studies on clinical encounters, 36 (46%) focused on methods of telediagnosis and were often noninferiority studies assessing remote physical examination modules, imaging, or remote instrumentation. Fifty-two studies (66%) were published in 2010 or later versus 22 (28%) in 2000 to 2009 and 5 (6%) in 1994 to 1999, suggesting an increased focus on teleotolaryngology approaches over time.

Synchronous video visits may provide adequate care to patients as compared with in-person visits, for example as part of safe postoperative evaluation.²⁰ Additionally, certain core physical examination maneuvers and clinical scales can be adapted for telemedicine, with evidence for noninferiority of remote use.^21,22 Furthermore, patients seem largely satisfied with video visits.²³ Nevertheless, authors note logistical caveats, such as a need for specialty-trained staff at the patient’s location to perform diagnostic endoscopies.²³

Trends in Teleotolaryngology Applications: Multidisciplinary Care, Expanded Access, and Telementoring

Trends in the use of teleotolaryngology were critically evaluated in 56 studies (21% of total; Supplemental Table S3, available online). Twenty-three studies (41%) evaluated patient or provider satisfaction via investigating patient outreach and education—for instance, creating and maintaining patient health portals may improve quality-of-life measures in cancer populations.²⁴ The adaptation of guidelines to mobile applications represents another approach to health portals.^25,26 Additionally, 21 studies (38%) investigated interdisciplinary care and teleconferencing among physicians, audiology, and/or speech-language pathology, as in virtual tumor boards.^27,28

Studies also examined the potential for telemedicine to increase access in nontraditional community settings, such as screening platforms in schools, trained community health liaisons, and engagement with rural populations.^29-31 Educational training programs have been shown to increase health literacy and self-management skills in the short and long term.^32,33 Applications in remote mentoring and skills acquisition between physicians and trainees have additionally been established.³⁴

Emerging Technologies and Innovations

We identified 38 studies addressing emerging technologies within teleotolaryngology (15% of total; Supplemental Table S4, available online). Thirty-two studies (84%) were published in the 2010 or later, suggestive of growth within this sector. Thirty-six (95%) targeted feasibility—for example, using novel technologies to exchange, process, or analyze information and advance clinical practice. Twenty-three (61%) were LoE 3 or better, highlighting the controlled and randomized studies examining cutting-edge technologies.

Electronic medical record systems are increasingly integrating mobile device capabilities with promising applications not only in the outpatient setting but also for inpatient care, such as video postoperative free flap checks.³⁵ Additionally, novel devices have been developed and tested for the diagnosis of nasal obstruction and vocal fold paralysis and for cochlear implant fitting.^36-39 Moreover, telesurgery has become a reality, and technologies for streamlined production of physical examination tools, such as 3-dimensional printing, have demonstrable cost savings.^40,41 Finally, as on-site pathology services can be expensive, virtual laboratories have been developed for evaluation of middle ear pathology, broadening the global teleotolaryngology infrastructure.⁴²

Perceived Limitations and Barriers to Implementation

Perceived barriers to teleotolaryngology were substantively addressed in 10 studies (Supplemental Table S5, available online). Reflecting the difficulty of rigorously assessing barriers, these studies were LoE 5, presenting predominantly qualitative findings and expert opinion. All studies focused primarily on logistics or cost-effectiveness. A focus on cost appeared in 6 studies—for example, as related to the implementation of infrastructure and physician reimbursement.

High implementation costs and sacrifices in accuracy and efficacy of practice are perceived by stakeholders as problematic.^43,44 Workflow and infrastructure barriers were also voiced, such as suboptimal platform usability and slower delivery of care.⁴⁵ Finally, legal issues remain a substantial impediment, especially in the United States, where medical licensure is granted on a state-by-state basis; patient confidentiality and data security also remain key concerns.^46,47

COVID-Era Telemedicine

After years of mounting interest, the COVID-19 pandemic sparked an explosion in teleotolaryngology. Fifty-two studies explicitly addressed telemedicine in the pandemic (20% of total; Supplemental Table S6, available online). Logistical factors such as HIPAA-compliant platform expansion (Health Insurance Portability and Accountability Act) and Medicare billing alterations, as well as drastically reduced in-person clinic volume and increased missed appointments, made telemedicine a solution for practice preservation.^48-51 Although a lack of physical examination may deter patients, studies report high rates of patient satisfaction and a shift in patient priorities based on Google search trends.^52-56 Providers posit that the restructuring of institutional priorities guiding the increased proportion of telemedicine to in-person clinical visits must account for nuances in subspecialty practice, and they call for vigilance in ensuring equitable telemedicine implementation across populations, including resource-limited communities and developing countries.^51,57-59 Finally, virtual telementoring initiatives have fostered continuity in resident and medical student training.^60-63

Discussion

The COVID-19 pandemic demands creativity and flexibility by otolaryngologists to ensure continuity of safe care for patients. Surgical subspecialties have reviewed telemedicine use cases, emphasizing the importance for platforms to field common clinical presentations.⁶⁴ This paradigm shift calls for standardized evidence-based telemedicine models, prompting this scoping review to frame the literature and outline avenues for policy making and future research in teleotolaryngology. Limitations include bias in categorizing studies with qualitative criteria and inability to perform quantitative outcomes comparisons or formally assess interstudy heterogeneity.

Teleotolaryngology platforms and technologies are increasingly advanced and affordable. However, only 4% of included studies achieved an LoE 1, demonstrating a scarcity of high-quality evidence. As most studies addressed feasibility, most interventions remain in experimental phases outside of routine practice. Quality of care was uncommonly addressed, suggesting that telemedicine has not been adequately compared with in-person standards of care. Given the preponderance of pilot studies reporting success in at least 1 outcome, future work must assess teleotolaryngology for publication bias.

Universal metrics will be necessary to facilitate evidence-based evaluation in the teleotolaryngology literature. A nationwide survey probing the extent of teleotolaryngology utilization, technological functionality, and providers’ perceptions of costs and benefits, building on Holderried et al, would further establish standardized measures of provider satisfaction.⁶⁵ On the patient side, we must assess whether patients understand the benefits of telemedicine, are amenable to its use, and view it as an adequate mode of evaluation. Encouragingly, Sorensen et al find that 86% of people are satisfied with telemedicine surgical consultation.⁶⁶ Feasibility of synchronous and asynchronous encounters is best evaluated by time to visit completion and specialist response rate, respectively, encapsulating clinical efficiency, remote physical examination, and audiovisual communications. In terms of quality assurance, telemedicine visits will need to integrate measures used to evaluate standard encounters, such as validated clinical scales, patient-reported quality-of-life measures, follow-up laboratory tests and imaging, postprocedural outcomes assessment, and complication rates. Finally, access to telemedicine should be measured in otolaryngology patient populations—for example, drawing from insurance claims data stratified by geographic locale and telemedicine access.⁶⁷

Diagnostic visualizations of the sinonasal cavity, larynx, aerodigestive tract, and ear are cornerstones of the otolaryngologic evaluation. Demonstrating noninferiority of remote devices facilitating tailored subspecialty examination will hasten the integration of real-time video visits into daily use. The current body of evidence examining the noninferiority of remote diagnostics is perhaps the most amenable to meta-analysis, given the common use of outcome measures such as sensitivity, specificity, and diagnostic agreement among providers and as compared with the gold standard. Future efforts should capitalize on current market interest in developing remote-enabled devices while ensuring diagnostic accuracy through validated clinical scales.

As cost is seen as a major barrier by patients and providers, more comprehensive analyses are warranted. Factors representative of cost should be formally studied across geographically, socioeconomically, and culturally diverse samples where telemedicine is in use or in demand. Such factors include cost and time required for training in telemedicine platforms, out-of-pocket expenses, patient volume and geographic range as proxies of provider impact, patient wait and travel time, and carbon emissions, among others. Importantly, while the cost-effectiveness of telemedicine seems intuitive, not all studies arrive at this conclusion.⁶⁸

Various examples of eliminating excess in-person visits exist, including postoperative chat, telephone, and video follow-up protocols; however, additional studies are needed. “Forward triage” describes the shunting of lower-risk patients from emergency departments, and perioperative triage in teleotolaryngology has remained largely unstudied.⁶⁹ Comparable strategies accounting for clinical urgency and necessity of in-person examination should be adapted in noncrisis times.

No clinical practice guidelines for use of teleotolaryngology currently exist. The literature indicates that telemedicine facilitates multidisciplinary care among otolaryngologists and ancillary specialties. Modern electronic medical record systems offer the opportunity for rapid intraprovider communication and information exchange. In our field, imaging studies often drive management, yet reliable open access image repositories remain a distant promise for automated diagnostics.⁷⁰ Developing a central imaging repository protecting patient confidentiality would eliminate the need for patients to act as couriers of physical media, reduce redundant study acquisition, and streamline efficiency of imaging review.

Increased funding at the institutional, state, and federal levels for telemedicine may defuse anxieties related to implementation costs. The use of a single definition for telemedicine and related terms by government agencies tasked with health care administration may enable this.⁷¹ Funding should be directed not only toward research efforts but also toward alleviating the burdensome overhead associated with purchase and integration of telemedicine infrastructure.

Telehealth technologies facilitate additional freedom for providers and patients: automated scheduling and appointment reminders, remote access to professional opinion, and management of clinical symptoms and insurance details in security-compliant mobile applications. As mobile endoscopy adaptors, trained telemedicine facilitators, and dedicated sites for virtual visits become cheaper and more available, these may be incorporated ad hoc to expand practice reach. In this setting, we must continue to exercise age-old skills of careful listening and observation to further our insights in a patient-focused manner.⁷² Provider advocacy on the local and state levels for adequate insurance coverage and comparable reimbursement to in-person visits may encourage legislative intervention and alleviate concern for suboptimal remuneration.⁷³

Finally, the communication of empathy through a screen is an unenviable task. The deluge of articles exploring teleotolaryngology’s role during the COVID-19 pandemic reflects the poise and adaptability of providers in the field. Telemedicine creates an inevitable human distance between providers and patients; however, we must bear in mind that it also carries the potential to diminish physical distance for those most in need. An abiding commitment to the delivery of safe, culturally inclusive, humanistic, and, most important, high-quality care for our patients will, as always, provide the guiding light.

Conclusions

Teleotolaryngology has been brought to the foreground during the COVID-19 pandemic. This scoping review provides a foundation from which to build future studies, to inform policy decision making, and to facilitate the implementation of teleotolaryngology where appropriate. Given the likelihood of its proliferation, future work in teleotolaryngology should establish standardized outcome measures and apply more rigorous, higher-powered methodologies to ensure that safe, patient-centered quality care is provided in the virtual realm.

Supplemental Material

sj-pdf-1-oto-10.1177_01945998211013751 – Supplemental material for Practice of Telehealth in Otolaryngology: A Scoping Review in the Era of COVID-19

Supplemental material, sj-pdf-1-oto-10.1177_01945998211013751 for Practice of Telehealth in Otolaryngology: A Scoping Review in the Era of COVID-19 by Joseph N. Gonzalez, Lucas G. Axiotakis, Victoria X. Yu, David A. Gudis and Jonathan B. Overdevest in Otolaryngology–Head and Neck Surgery

Supplemental Material

sj-pdf-2-oto-10.1177_01945998211013751 – Supplemental material for Practice of Telehealth in Otolaryngology: A Scoping Review in the Era of COVID-19

Supplemental material, sj-pdf-2-oto-10.1177_01945998211013751 for Practice of Telehealth in Otolaryngology: A Scoping Review in the Era of COVID-19 by Joseph N. Gonzalez, Lucas G. Axiotakis, Victoria X. Yu, David A. Gudis and Jonathan B. Overdevest in Otolaryngology–Head and Neck Surgery

Footnotes

Acknowledgements

We acknowledge the expertise in the database search provided by John Usseglio of the Augustus C. Long Health Sciences Library at Columbia University Irving Medical Center.

This article was presented at the American Rhinologic Society Virtual 66th Annual Meeting; September 10-12, 2020.

Author Contributions

Joseph N. Gonzalez, screening of article eligibility, data acquisition, data interpretation and analysis, manuscript preparation and revision; Lucas G. Axiotakis Jr, screening of article eligibility, data acquisition, data interpretation and analysis, manuscript preparation and revision; Victoria X. Yu, screening of article eligibility, data interpretation and analysis, manuscript revision; David A. Gudis, project conception and design, manuscript drafting and organization; Jonathan B. Overdevest, project conception and design, refereeing of disputes, manuscript drafting and organization.

Disclosures

Competing interests: None.

Sponsorships: None.

Funding source: None.

Supplemental Material

Additional supporting information is available in the online version of the article.

References

Kvedar

Coye

Everett

Connected health: a review of technologies and strategies to improve patient care with telemedicine and telehealth. Health Aff. 2014;33(2):194-199.

Douglas

Heggs

Wrenn

Mack

Rust

Assessing telemedicine utilization by using Medicaid claims data. Psychiatr Serv. 2017;68(2):173-178.

Portnoy

Waller

Elliott

Telemedicine in the era of COVID-19. J Allergy Clin Immunol Pract. 2020;8(5):1489-1491.

Krebs

Duncan

DT.

Health app use among US mobile phone owners: a national survey. JMIR mHealth uHealth. 2015;3(4):e101.

Becker

Dandy

Gaujean

Fusaro

Scurlock

Legal perspectives on telemedicine part 1: legal and regulatory issues. Perm J. 2019;23:18-293.

Tricco

Lillie

Zarin

, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467.

Bush

Thompson

Irungu

Ayugi

The role of telemedicine in auditory rehabilitation: a systematic review. Otol Neurotol. 2016;37(10):1466-1474.

Caffery

Farjian

Smith

AC.

Telehealth interventions for reducing waiting lists and waiting times for specialist outpatient services: a scoping review. J Telemed Telecare. 2016;22(8):504-512.

Ning

Cabrera

D’Anza

Telemedicine in otolaryngology: a systematic review of image quality, diagnostic concordance, and patient and provider satisfaction. Ann Otol Rhinol Laryngol. Published online July 13, 2020. doi:10.1177/0003489420939590

10.

Said

Ngo

Hwang

Hom

DB.

Navigating telemedicine for facial trauma during the COVID-19 pandemic. Laryngoscope Investig Otolaryngol. 2020;5(4):649-656.

11.

Singh

Kasle

Jiang

, et al. A review of telemedicine applications in otorhinolaryngology: considerations during the coronavirus disease of 2019 pandemic. Laryngoscope. Published online September 17, 2020. doi:10.1002/lary.29131

12.

Munn

Peters

MDJ

Stern

Tufanaru

McArthur

Aromataris

Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143.

13.

Lango

Handorf

Arjmand

The geographic distribution of the otolaryngology workforce in the United States. Laryngoscope. 2017;127(1):95-101.

14.

Vickery

Weterings

Cabrera-Muffly

Geographic distribution of otolaryngologists in the United States. Ear Nose Throat J. 2016;95(6):218-223.

15.

McCool

Davies

Where does telemedicine fit into otolaryngology? An assessment of telemedicine eligibility among otolaryngology diagnoses. Otolaryngol Head Neck Surg. 2018;158(4):641-644.

16.

Heneghan

Sclafani

Stern

Ginsburg

Telemedicine applications in otolaryngology. IEEE Eng Med Biol Mag. 1999;18(4):53-62.

17.

Burgess

Holtel

Syms

Birkmire-Peters

Peters

Mashima

PA.

Overview of telemedicine applications for otolaryngology. Laryngoscope. 1999;109(9):1433-1437.

18.

Anari

Arullendran

Reilly

How we do it: cost-benefit analysis of implementing a telephone review system in an ENT outpatient setting. Clin Otolaryngol. 2006;31(4):331-334.

19.

Bergmo

TS.

An economic analysis of teleconsultation in otorhinolaryngology. J Telemed Telecare. 1997;3(4):194-199.

20.

Urquhart

Antoniotti

Berg

RL.

Telemedicine—an efficient and cost-effective approach in parathyroid surgery. Laryngoscope. 2011;121(7):1422-1425.

21.

Lundberg

Biagio

Laurent

Sandström

Swanepoel

de W

. Remote evaluation of video-otoscopy recordings in an unselected pediatric population with an otitis media scale. Int J Pediatr Otorhinolaryngol. 2014;78(9):1489-1495.

22.

Moshtaghi

Sahyouni

Haidar

, et al. Smartphone-enabled otoscopy in neurotology/otology. Otolaryngol Head Neck Surg. 2017;156(3):554-558.

23.

Waibel

Cain

Hall

Keen

RS.

Multispecialty synchronous telehealth utilization and patient satisfaction within Regional Health Command Europe: a readiness and recapture system for health. Mil Med. 2017;182(7):e1693-e1697.

24.

van den Brink

Moorman

, et al. Impact on quality of life of a telemedicine system supporting head and neck cancer patients: a controlled trial during the postoperative period at home. J Am Med Informatics Assoc. 2007;14(2):198-205.

25.

Bousquet

Hellings

Agache

, et al. Allergic Rhinitis and Its Impact on Asthma (ARIA) phase 4 (2018): change management in allergic rhinitis and asthma multimorbidity using mobile technology. J Allergy Clin Immunol. 2019;143(3):864-879.

26.

van der Hout

van Uden-Kraan

Holtmaat

, et al. Role of eHealth application Oncokompas in supporting self-management of symptoms and health-related quality of life in cancer survivors: a randomised, controlled trial. Lancet Oncol. 2020;21(1):80-94.

27.

Stalfors

Lundberg

Westin

Quality assessment of a multidisciplinary tumour meeting for patients with head and neck cancer. Acta Otolaryngol. 2007;127(1):82-87.

28.

Mayadevi

Thankappan

Limbachiya

, et al. Interdisciplinary telemedicine in the management of dysphagia in head and neck. Dysphagia. 2018;33(4):474-480.

29.

Whitten

Cook

Shaw

Ermer

Goodwin

Telekid Care: bringing health care into schools. Telemed J. 1998;4(4):335-343.

30.

Bush

Hardin

Rayle

Lester

Studts

Shinn

JB.

Rural barriers to early diagnosis and treatment of infant hearing loss in Appalachia. Otol Neurotol. 2015;36(1):93-98.

31.

Ramkumar

Rajendran

Nagarajan

Balasubramaniyan

Suresh

DK.

Identification and management of middle ear disorders in a rural cleft care program: a telemedicine approach. Am J Audiol. 2018;27(3S):455-461.

32.

Corrêa de

Freire

Zabeu

, et al. Teleducation about cleft lip and palate: an interdisciplinary approach in the promotion of health. Int Arch Otorhinolaryngol. 2015;19(2):106-111.

33.

Edmonds

Ribbe

Thielman

Henry

JA.

Progressive tinnitus management level 3 skills education: a 5-year clinical retrospective. Am J Audiol. 2017;26(3):242-250.

34.

Snyderman

Gardner

Lanisnik

Ravnik

Surgical telementoring: a new model for surgical training. Laryngoscope. 2016;126(6):1334-1338.

35.

Alemi

Seth

Heaton

Wang

Knott

PD.

Comparison of video and in-person free flap assessment following head and neck free tissue transfer. Otolaryngol Head Neck Surg. 2017;156(6):1035-1040.

36.

Seren

Web-based analysis of nasal sound spectra. Telemed J E Health. 2005;11(5):578-582.

37.

Wormald

Moran

Reilly

Lacy

PD.

Performance of an automated, remote system to detect vocal fold paralysis. Ann Otol Rhinol Laryngol. 2008;117(11):834-838.

38.

Lohmann

Carlson

Sladen

DP.

Intraoperative cochlear implant device testing utilizing an automated remote system: a prospective pilot study. Otol Neurotol. 2018;39(3):313-317.

39.

Skarżyński

Świerniak

Ludwikowski

Bruski

Ł.

Between Kajetany and Odessa, Ukraine for cochlear implants. Telemed J E Health. 2019;7:e17(1-6).

40.

Thompson

Albarki

Lodhia

Fitzpatrick

A 3D printed smartphone adaptor for nasolaryngoscopy. Laryngoscope Investig Otolaryngol. 2020;5(1):31-36.

41.

Wirz

Torres

Swaney

, et al. An experimental feasibility study on robotic endonasal telesurgery. Neurosurgery. 2015;76(4):479-484.

42.

Dimitriadis

Papacharalampous

Bibas

AG.

Toward a low-cost global temporal bone telepathology network. Otolaryngol Head Neck Surg. 2013;148(5):881-883.

43.

Garritano

Goldenberg

Telemedicine in otolaryngology–head and neck surgery. Ear Nose Throat J. 2012;91(6):226-229.

44.

Saadi

Goldenberg

Using technology in global otolaryngology. Otolaryngol Clin North Am. 2018;51(3):555-561.

45.

Rubin

Sataloff

RT.

Telemedicine: part II [editorial]. Ear Nose Throat J. 2018;97(8):226-228.

46.

Goldenberg

Wenig

BL.

Telemedicine in otolaryngology. Am J Otolaryngol. 2002;23(1):35-43.

47.

Bush

Sprang

Management of hearing loss through telemedicine. JAMA Otolaryngol Head Neck Surg. 2019;145(3):204-205.

48.

Kolb

Born

Banker

Barth

Aaronson

NL.

Improving attendance and patient experiences during the expansion of a telehealth-based pediatric otolaryngology practice. Otolaryngol Neck Surg. Published online October 20, 2020. doi:10.1177/0194599820965917

49.

Hildrew

Pang

KCS

Faden

Otolaryngology in the time of COVID: an overview of common open-source telemedicine platforms. Laryngoscope Investig Otolaryngol. 2020;5(5):839-845.

50.

Pollock

Setzen

Svider

PF.

Embracing telemedicine into your otolaryngology practice amid the COVID-19 crisis: an invited commentary. Am J Otolaryngol. 2020;41(3):102490.

51.

Setzen

Svider

Setzen

Eloy

Johnson

AP.

The novel corona virus and rhinology: impact on practice patterns and future directions. Am J Otolaryngol. 2020;41(6):102569.

52.

Cho

RHW

Yeung

ZWC

OYM

, et al. Pearls of experience for safe and efficient hospital practices in otorhinolaryngology–head and neck surgery in Hong Kong during the 2019 novel coronavirus disease (COVID-19) pandemic. J Otolaryngol Head Neck Surg. 2020;49(1):30.

53.

Fieux

Duret

Bawazeer

Denoix

Zaouche

Tringali

Telemedicine for ENT: effect on quality of care during COVID-19 pandemic. Eur Ann Otorhinolaryngol Head Neck Dis. 2020;137(4):257-261.

54.

Ohlstein

Garner

Takashima

Telemedicine in otolaryngology in the COVID-19 era: initial lessons learned. Laryngoscope. 2020;130(11):2568-2573.

55.

Pier

Pasick

Benito

Alnouri

Sataloff

RT.

Otolaryngology-related Google Search trends during the COVID-19 pandemic. Am J Otolaryngol. 2020;41(6):102615.

56.

Meng

Dai

Hang

Wang

Smartphone-enabled wireless otoscope-assisted online telemedicine during the COVID-19 outbreak. Am J Otolaryngol. 2020;41(3):102476.

57.

Kidane

Kim

Sharon

JD.

Moving toward equitable telemedicine in otolaryngology–head and neck surgery. JAMA Otolaryngol Neck Surg. Published online November 25, 2020. doi:10.1001/jamaoto.2020.4329

58.

Kowalski

Imamura

Castro Junior

G de

, et al. Effect of the COVID-19 pandemic on the activity of physicians working in the areas of head and neck surgery and otorhinolaryngology. Int Arch Otorhinolaryngol. 2020;24(3):e258-e266.

59.

Ramirez

Ojeaga

Espinoza

Hensler

Honrubia

Telemedicine in minority and socioeconomically disadvantaged communities amidst COVID-19 pandemic. Otolaryngol Neck Surg. Published online July 28, 2020. doi:10.1177/0194599820947667

60.

Chao

Frost

Brody

, et al. Creation of an interactive virtual surgical rotation for undergraduate medical education during the COVID-19 pandemic. J Surg Educ. Published online July 2, 2020. doi:10.1016/j.jsurg.2020.06.039

61.

Guo

Kiong

Yao

CMKL

, et al. Impact of the COVID-19 pandemic on otolaryngology trainee education. Head Neck. 2020;42(10):2782-2790.

62.

Pellegrini

Danis

Levi

. Medical student participation in otolaryngology telemedicine clinic during COVID-19: a hidden opportunity. Otolaryngol Neck Surg. Published online November 10, 2020. doi:10.1177/0194599820970964

63.

Plocienniczak

Noordzij

Grillone

Platt

Brook

Guidelines for resident participation in otolaryngology telehealth clinics during the COVID-19 pandemic. Otolaryngol Neck Surg. 2020;163(3):498-500.

64.

Novara

Checcucci

Crestani

, et al. Telehealth in urology: a systematic review of the literature. How much can telemedicine be useful during and after the COVID-19 pandemic? Eur Urol. 2020;78(6):786-811.

65.

Holderried

Hoeper

Holderried

Blumenstock

Ernst

Tropitzsch

Attitudes toward e-health: the otolaryngologists’ point of view. Telemed J E Health. 2018;24(6):425-432.

66.

Sorensen

Bessen

Danford

Fleischer

Wong

SL.

Telemedicine for surgical consultations—pandemic response or here to stay?

Ann Surg. 2020;272(3):e174-e180.

67.

Barnett

Ray

Souza

Mehrotra

Trends in telemedicine use in a large commercially insured population, 2005-2017. JAMA. 2018;320(20):2147.

68.

de la Torre-Díez

López-Coronado

Vaca

Aguado

de Castro

Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review. Telemed J E Health. 2015;21(2):81-85.

69.

Hollander

Carr

BG.

Virtually perfect? Telemedicine for COVID-19. N Engl J Med. 2020;382(18):1679-1681.

70.

Prior

Almeida

Kathiravelu

, et al. Open access image repositories: high-quality data to enable machine learning research. Clin Radiol. 2020;75(1):7-12.

71.

Doarn

Pruitt

Jacobs

, et al. Federal efforts to define and advance telehealth—a work in progress. Telemed J E Health. 2014;20(5):409-418.

72.

McCoul

ED.

Grasping what we cannot touch: examining the telemedicine patient. JAMA Otolaryngol Head Neck Surg. Published online June 18, 2020. doi:10.1001/jamaoto.2020.1266

73.

Wilson

Rampa

Trout

Stimpson

JP.

Reimbursements for telehealth services are likely to be lower than non-telehealth services in the United States. J Telemed Telecare. 2017;23(4):497-500.

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