Table I.

Summary of Telemedicine Best Practices by Sub‐Specialty.

Discipline	Scope of telemedicine use	Benefits	Limitations	Recommendations for practice	Areas for future research
H&N Oncology	Majority for postsurgical follow‐up, also preoperative planning Assessment for potential malignancy: video evaluation of oral/mucosal lesions and thyroid nodules or goiters Remote free flap assessment	Cost effective Reduced travel and wait times for pre/postoperative visits yields high patient satisfaction For free flap assessments, reduced travel time and time spent on assessment increases provider satisfaction For inpatient care, can improve communication between members of the care team	Proper evaluation of potential malignancy may require an in‐person examination; medicolegal implications Evaluations of free flap requires an in‐person assistant; Doppler ultrasound	For clinical visits, use telemedicine for postoperative follow‐up and to expedite workup of patients with high grade and/or stage malignancies Telemedicine should facilitate collaboration between staff members, and be used in conjunction with nursing for free flap assessments. Secure sharing of digital photographs between members of the care team	Development of standardized clinical practice guidelines in evaluation of malignancy Controlled studies examining the outcomes of H&N patients evaluated with telemedical methods compared to conventional in‐person examination, in terms of cost, safety, surveillance adherence, and oncologic outcomes
Otology/Neurotology	Video‐otoscopy for diagnosis or evaluation of general ear complaints, otitis media, posttympanostomy tube placement Smartphone otoscopy; used by primary care providers and parents of pediatric patients Auditory rehabilitation: cochlear implant fitting, programming, and maintenance, as well as hearing aid programming and remote gain assessments	Improved access to care in underserved or rural areas Store‐and‐forward telemedicine is as effective as in‐person evaluation for planning elective ear surgeries such as tympanoplasty and mastoidectomy	Successful implementation of video‐otoscopy requires equipment and training: common problems include failure to image the tympanic membrane, and inadequate removal of cerumen Concerns about patient safety in remote cochlear implant programming	Every effort should be made to maximize image quality in video‐otoscopy Use of reliable standardized grading scales for diagnosis based on remotely acquired images Remote users of video‐otoscopes must be trained to select the correct size speculum, remove cerumen, and identify the tympanic membrane Remote cochlear implant programming must allow for allow termination of stimulation and reversal of any changes in the case of disruption of the internet connection, and an audio‐video link between provider and patient must be maintained 15	Smartphone tele‐otoscopy Reimbursement and cost‐effectiveness Development of formal diagnostic and management algorithms and guidelines, Development of training guidelines for remote otoscopy, which may include patient positioning, visual inspection of the external ear, appropriate hand position, manipulation of direction of speculum, focus adjustment, recording capture, video‐otoscope software use, and equipment cleaning 16
Laryngology	Remote laryngoscopy and stroboscopy; examination of lesions Detection of vocal fold paralysis with remote automated analysis Vocal rehabilitation Videoconference Online portal for supported home practice	May facilitate serial imaging of laryngeal carcinoma Vocal rehabilitation: increased communication with clinician and increased compliance with therapy recommendations Avoiding endoscopic examination may reduce disease transmission in the time of COVID‐19	Devices required to obtain high‐quality imaging are expensive and difficult to obtain; must be operated by trained personnel Examining dynamic functioning of larynx requires videoconferencing with high bandwidth	Use of reliable standardized grading scales for diagnosis based on remotely acquired images Maximizing bandwidth and reliability of internet connection for videoconferencing Maintain regular follow‐up with patients for remote vocal rehabilitation	Use of telemedicine for swallowing disorders Reimbursement and cost‐effectiveness Use of machine learning to automate detection of vocal pathologies Effectiveness of CT scans as a substitute to nasal endoscopy to facilitate telehealth consultations Development of formal diagnostic and management algorithms and guidelines
Rhinology	Remote intranasal imaging or CT sinus imaging History taking; triage of patients who require nasal endoscopy Epistaxis patients	Avoiding intranasal endoscopic examination may reduce disease transmission in the time of COVID‐19	Devices required to obtain high‐quality intra‐nasal imaging are expensive and difficult to obtain Not all cases of epistaxis can be managed remotely; prone to complications	Forgoing nasal endoscopy for other imaging procedures more medicolegal to telemedicine such as CT has medicolegal implications. Clinical guidelines should carefully consider patient history and risk factors for complications.	Effectiveness of CT scans as a substitute to nasal endoscopy to facilitate telehealth consultations Development of formal diagnostic and management algorithms and guidelines
Facial Plastics and Reconstructive Surgery	Image‐based triaging and evaluation of facial trauma, lesions, or deformities Telemedical consultation for facial trauma	Image‐based diagnosis is amenable to store‐and forward technology Video or image based communication between patient and provider facilitates closer postoperative follow‐up and wound care, leading to higher patient satisfaction	Standardized facial images may be difficult to obtain	Frequent communication with patients in the postoperative period. Review of images prior to virtual visits may improve patient satisfaction	Development of standardized clinical practice guidelines in evaluation of facial trauma Controlled studies examining the outcomes of facial trauma patients evaluated with telemedical methods, compared to conventional in‐person examination
Pediatric ORL	Triaging and evaluation of common pediatric ORL problems (e.g. otitis media) Postoperative follow‐up of common pediatric ORL procedures, such as tonsillectomies and adenoidectomies	Improved access to care in underserved or rural areas Improved communication with parents Telemedicine specialty consults in the emergency setting may improve outcomes	Limited validation and outcomes research	Frequent communication with patients and parents in the pre‐ and postoperative periods	Prospective outcomes studies are required to validate concordance of diagnosis and patient safety. Limited research on reimbursement and cost‐effectiveness