P Bertholon1, H Thai-Van2, D Bouccara3, M-J Esteve-Fraysse4, S R Wiener-Vacher5, E Ionescu6. 1. Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Nord, CHU Saint-Étienne, Avenue A Raimond, 42270 Saint Priest en Jarez, France. 2. Service d'Audiologie et d'Explorations Otoneurologiques, Hôpital Edouard Herriot, 69003 Lyon, France; Hôpital Femme Mère Enfant, 69500 Bron, France; Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; Institut de l'Audition, Centre de recherche de l'Institut Pasteur, Inserm U1120, 75012 Paris, France. Electronic address: hung.thai-van@chu-lyon.fr. 3. Service d'ORL et de Cancérologie Cervico-Faciale, AP-HP, Hôpitaux Universitaires Paris-Ouest, Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France. 4. Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Purpan, 1, place du Docteur Baylac, 31300 Toulouse, France. 5. Service d'ORL et de Chirurgie Cervico-Faciale, Centre d'exploration de l'équilibre de l'enfant (EFEE), Hôpital Universitaire Robert Debré, 48, boulevard Sérurier, 75019 Paris, France. 6. Service d'Audiologie et d'Explorations Otoneurologiques, Hôpital Edouard Herriot, 69003 Lyon, France; Hôpital Femme Mère Enfant, 69500 Bron, France; Institut de l'Audition, Centre de recherche de l'Institut Pasteur, Inserm U1120, 75012 Paris, France.
Abstract
OBJECTIVES: In the context of the SARS-CoV-2 pandemic, patients may have been dissuaded from seeking consultation, thus exposing themselves to a risk of loss of chance. This guide aims to define how teleconsultation can assist in assessing vertiginous adults or children, and to gather the information needed to provide quick medical care. METHODS: These recommendations rely on the authors' experience as well as on literature. A survey on otoneurologic approach via telemedicine has been conducted based on a literature search until March 2020. RESULTS: The first clinical assessment of the vertiginous patient via teleconsultation can only be successful if the following conditions are met: initial contact to verify the feasibility of the assessment at a distance, the presence of a caregiver in order to assist the patient, the possibility of making video recordings. Medical history via telemedicine, as in a face-to-face assessment, allows to assess the characteristics, duration, frequency, and potential triggering factors of the vertigo, in both children and adults. During teleconsultation, the following tests can be carried out: oculomotricity evaluation, assessment of balance, simple neurological tests, checking for positional vertigo/nystagmus and, eventually to perform canalith-repositioning procedures. In children, the following should be searched for: history of hearing or visual impairment, a context of fever or trauma, otorrhea, signs of meningeal irritation. CONCLUSION: The neurotologic telemedicine relies on the accuracy of the clinical assessment, which is based on history taking and a few simple tests, encouraging the development of a decision-making algorithm adapted for teleconsultation. However, the latter has its limitations during an emergency examination of a new patient presenting vertigo, and, at least in some cases, cannot replace a face-to-face consultation. Teleconsultation is often adapted for follow-up consultations of previously selected vertiginous patients during face-to-face assessment.
OBJECTIVES: In the context of the SARS-CoV-2 pandemic, patients may have been dissuaded from seeking consultation, thus exposing themselves to a risk of loss of chance. This guide aims to define how teleconsultation can assist in assessing vertiginous adults or children, and to gather the information needed to provide quick medical care. METHODS: These recommendations rely on the authors' experience as well as on literature. A survey on otoneurologic approach via telemedicine has been conducted based on a literature search until March 2020. RESULTS: The first clinical assessment of the vertiginous patient via teleconsultation can only be successful if the following conditions are met: initial contact to verify the feasibility of the assessment at a distance, the presence of a caregiver in order to assist the patient, the possibility of making video recordings. Medical history via telemedicine, as in a face-to-face assessment, allows to assess the characteristics, duration, frequency, and potential triggering factors of the vertigo, in both children and adults. During teleconsultation, the following tests can be carried out: oculomotricity evaluation, assessment of balance, simple neurological tests, checking for positional vertigo/nystagmus and, eventually to perform canalith-repositioning procedures. In children, the following should be searched for: history of hearing or visual impairment, a context of fever or trauma, otorrhea, signs of meningeal irritation. CONCLUSION: The neurotologic telemedicine relies on the accuracy of the clinical assessment, which is based on history taking and a few simple tests, encouraging the development of a decision-making algorithm adapted for teleconsultation. However, the latter has its limitations during an emergency examination of a new patient presenting vertigo, and, at least in some cases, cannot replace a face-to-face consultation. Teleconsultation is often adapted for follow-up consultations of previously selected vertiginous patients during face-to-face assessment.
Authors: H Thai-Van; D Bakhos; D Bouccara; N Loundon; M Marx; T Mom; I Mosnier; S Roman; C Villerabel; C Vincent; F Venail Journal: Eur Ann Otorhinolaryngol Head Neck Dis Date: 2020-10-21 Impact factor: 2.665