Table 4. Recommendations for different procedures in the otolaryngology clinic during the COVID-19 pandemic.

Procedure	COVID-19 Testing	Management/PPE recommendations
Regular physical exam	N/A	COVID-19 known, high suspicion, or patient under investigation follow CDC guidelines. COVID-19 negative or low suspicion, regular surgical mask and gloves.
Nasal packing (Epistaxis)	Generally, no time for testing in this situation	Assume COVID-19+ status and follow CDC guidelines Procedure comments: Initially recommend conservative measures (Afrin, Afrin, pinching the nose). If these do not stop the bleeding, packing with absorbable materials (PosiSep vs Gelfoam vs Surgiflo) to avoid a second visit to manipulate the nasal cavity.
Nasal endoscopy	If emergent, no testing. If non-emergent, deferred until COVID-19 results	Assume COVID-19 status and follow CDC guidelines. Procedure comments: Do not use nasal sprays.
Otologic procedures	Generally enough time to order COVID-19 test	If COVID-19 status or testing not available, assume COVID-19 status and use full PPE as per CDC guidelines. Procedure comments: No ear suctioning if suspicion of tympanic membrane perforation in emergency setting, unless wearing full PPE.
Tracheostomy tube change	If emergent, no testing. If non-emergent, deferred until COVID-19 tests is negative	Assume COVID-19 status and use full PPE as per CDC guidelines.

Abbreviations: CDC, Centers for Disease Control and Prevention; COVID-19, coronavirus disease 2019; N/A, not applicable; PPE, personal protective equipment.