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\begin{document}

\title{COVID-VU - a national survey of the use of flexible endoscopy for the
upper aerodigestive tract in clinical practice amidst the COVID-19
pandemic}



\author[1]{Avgi Loizidou}%
\author[2]{Taran Tatla}%
\author[3]{Ian  Harvey}%
\author[4]{ Miriayi  Aibibula}%
\author[5]{Justin  Roe}%
\author[6]{Neeraj Sethi}%
\author[7]{Anne Schilder }%
\affil[1]{Royal National Throat Nose and Ear Hospital}%
\affil[2]{London North West Healthcare NHS Trust}%
\affil[3]{School of Public Health, San Diego State University, San Diego, CA, USA}%
\affil[4]{Clinical Marketing Team Lead, Ambu Limited}%
\affil[5]{Royal Marsden Hospital NHS Trust}%
\affil[6]{Nottingham University Hospitals NHS Trust}%
\affil[7]{evidENT, Ear Institute, University College London, UCLH Royal National Throat, Nose and Ear Hospital}%


\vspace{-1em}



  
  \date{May 25, 2024}


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\selectlanguage{english}
\begin{abstract}
Keywords Flexible nasendoscopy, COVID-19, upper aerodigestive tract,
aerosol generating procedure Objectives Flexible nasendoscopy (FNE) is
an invaluable multi-disciplinary tool for upper aerodigestive tract
(UADT) examination. During the COVID-19 pandemic concerns were raised
that FNE had the potential of generating aerosols resulting in human
cross-contamination when performed on SARS-COV2 carriers. ENT UK issued
guidelines restricting FNE to essential cases, specifying that FNE
should be performed in a well-ventilated room, preferably with a monitor
screen and wearing enhanced PPE. We surveyed ENT UK members and Royal
College of Speech and Language Therapists (RCSLT) members to determine
the impact of the COVID-19 pandemic on FNE practice of the UADT. Design
An observational internet-based survey Setting FNE practice in community
clinics, outpatient departments, inpatient wards, ICUs, emergency
departments and operating theatres. Participants UK-based ENT surgeons
and speech and language therapists using FNE in clinical practice. Main
outcome measures Frequency, indication and local guidelines of FNE of
the UADT before, during and emerging from the COVID-19 first peak.
Results 314 responses: 82\% from ENT clinicians, 17\% from SLTs and 1\%
from nurse practitioners (NP) and physician associates (PA). Overall,
there has been a large reduction in the volume and indications for FNE
during the first peak of the COVID-19 pandemic with limited recovery by
mid-August. Cancer and airway assessments were impacted less. A wide
range of FNE protocols are reported varying in choice of endoscope,
extent of PPE and sterilization methods. Recommended practice appears
influenced predominantly by local factors. The majority of services used
reusable endoscopes manually cleaned with Tristel wipes or sent for
central sterilization at non-uniform intervals, while a minority of
services exclusively used single-use video-endoscopes. When there was no
dedicated AGP rooms, centers managed with simple window opening and a
widely variable room ``down-time'' between patients. Endoscope
preference reflected user familiarity. ENT trainees expressed a
preference for single-use video capturing endoscopes for continuing
service models. Conclusion Despite guidance, local practice of FNE
remains interrupted and highly variable nationally. A collaborative
approach is required to re-introduce FNE safely across UK healthcare
setting to ensure timely diagnosis and optimal patient care.%
\end{abstract}%



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