{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T16:34:55Z","timestamp":1783442095581,"version":"3.54.6"},"reference-count":36,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T00:00:00Z","timestamp":1724284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>This study was designed to examine the changes in emergency room visits in otolaryngology, head and neck surgery, during the COVID-19 pandemic. The study included 11,277 patients who presented to a tertiary care hospital (ER) and an emergency practice (EP) during on-call hours in the first half of 2018, 2019, and 2020. The epidemiologic parameters, diagnoses, and level of urgency were recorded using a four-step scale. A comparison was made between the pre-pandemic years and 2020. The findings revealed a significant decrease in the frequency of ER visits in the second quarter of 2020 compared to 2019 (ER: 30.8%, EP: 37.8%), mainly due to the fact that there were significantly fewer patients, with low levels of urgency. Certain diagnoses, such as epistaxis (\u22123.0%) and globus sensation (\u22123.2%), were made at similar frequencies to 2019, while inflammatory diseases like skin infections (\u221251.2%), tonsillitis (\u221255.6%), sinusitis (\u221259%), and otitis media (\u221270.4%) showed a significant reduction. The study concludes that patients with a low triage level were less likely to visit the ER during the early stages of the pandemic, but some diagnoses were still observed at comparable rates. This suggests a disparity in perception between patients and ER staff regarding urgency. Many of the issues discussed were also emphasized in the 2024 proposal by the German Ministry of Health to reform emergency care in Germany.<\/jats:p>","DOI":"10.3390\/diseases12080194","type":"journal-article","created":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T11:14:41Z","timestamp":1724325281000},"page":"194","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The COVID-19 Pandemic and Emergencies in Otolaryngology\u2013Head and Neck Surgery: An Analysis of Patients Presenting to Emergency Rooms in South-West Germany: A Bi-Center Study"],"prefix":"10.3390","volume":"12","author":[{"given":"Stephan","family":"Wolpert","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital T\u00fcbingen, BW, Elfriede-Aulhorn-Stra\u00dfe 5, 72076 T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora","family":"Knoblich","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital T\u00fcbingen, BW, Elfriede-Aulhorn-Stra\u00dfe 5, 72076 T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Holderried","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital T\u00fcbingen, BW, Elfriede-Aulhorn-Stra\u00dfe 5, 72076 T\u00fcbingen, Germany"},{"name":"Department of Medical Development Process and Quality Management, University Hospital T\u00fcbingen, 72076 T\u00fcbingen, Germany"},{"name":"Institute of Health Care and Public Management, University of Hohenheim, 70599 Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1972-3797","authenticated-orcid":false,"given":"Sven","family":"Becker","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital T\u00fcbingen, BW, Elfriede-Aulhorn-Stra\u00dfe 5, 72076 T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4724-2440","authenticated-orcid":false,"given":"Thore","family":"Schade-Mann","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital T\u00fcbingen, BW, Elfriede-Aulhorn-Stra\u00dfe 5, 72076 T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1067\/mem.2002.122707","article-title":"Overcrowding in emergency departments: Increased demand and decreased capacity","volume":"39","author":"Derlet","year":"2002","journal-title":"Ann. Emerg. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1136\/bmj.324.7343.958","article-title":"Emergency medicine","volume":"324","author":"Fatovich","year":"2002","journal-title":"BMJ"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1056\/NEJMoa2001017","article-title":"A Novel Coronavirus from Patients with Pneumonia in China, 2019","volume":"382","author":"Zhu","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1590\/s1677-5538.ibju.2020.s101","article-title":"The SARS-CoV-2 Coronavirus and the COVID-19 Outbreak","volume":"46","author":"Lauxmann","year":"2020","journal-title":"Int. Braz. J. Urol."},{"key":"ref_5","first-page":"694","article-title":"[Effects of the SARS-CoV-2 pandemic on the otorhinolaryngology university hospitals in the field of medical care]","volume":"99","author":"Dazert","year":"2020","journal-title":"Laryngorhinootologie"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Szczesniak, D., Gladka, A., Misiak, B., Cyran, A., and Rymaszewska, J. (2021). The SARS-CoV-2 and mental health: From biological mechanisms to social consequences. Prog. Neuropsychopharmacol. Biol. Psychiatry, 104.","DOI":"10.1016\/j.pnpbp.2020.110046"},{"key":"ref_7","unstructured":"RKI (Robert-Koch-Institut): Routinedaten aus dem Gesundheitswesen in Echtzeit (SUMO) (2020). Notaufnahme-Situationsreport (SitRep) 21.10.2020, RKI."},{"key":"ref_8","first-page":"545","article-title":"Medical Emergencies during the COVID-19 Pandemic","volume":"117","author":"Slagman","year":"2020","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s00106-021-01121-1","article-title":"Analysis of ENT emergency patients during the COVID-19 pandemic in Germany","volume":"70","author":"Bulut","year":"2022","journal-title":"Hno"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"102865","DOI":"10.1016\/j.amjoto.2020.102865","article-title":"ENT emergencies during the first wave of COVID-19 pandemic in Spain: Our experience","volume":"42","year":"2021","journal-title":"Am. J. Otolaryngol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3525","DOI":"10.1007\/s00405-020-06119-z","article-title":"Changes in the use of Otorhinolaryngology Emergency Department during the COVID-19 pandemic: Report from Lombardy, Italy","volume":"277","author":"Elli","year":"2020","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Tseng, W.M., Lin, P.H., Wu, P.C., and Kao, C.H. (2022). Examining patient flow in a tertiary hospital\u2019s emergency department at a low coronavirus prevalence region. BMC Emerg. Med., 22.","DOI":"10.1186\/s12873-022-00694-6"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/s00101-008-1477-9","article-title":"[Manchester triage system. Process optimization in the interdisciplinary emergency department]","volume":"58","author":"Schellein","year":"2009","journal-title":"Anaesthesist"},{"key":"ref_14","unstructured":"Australasian College for Emergency Medicine (2016). Guidelines on the Implementation of the Australasian Triage Scale in Emergency Departments, Australasian College for Emergency Medicine."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.otorri.2020.11.010","article-title":"Variation in volumes and characteristics of ENT emergency visits during COVID-19 pandemic. Where are the patients?","volume":"73","author":"Sapountzi","year":"2022","journal-title":"Acta Otorrinolaringol. Esp. (Engl. Ed.)"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1146\/annurev-virology-012420-022445","article-title":"Seasonality of Respiratory Viral Infections","volume":"7","author":"Moriyama","year":"2020","journal-title":"Annu. Rev. Virol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"NP95","DOI":"10.1177\/0145561320984560","article-title":"ENT Referral From Emergency Department During COVID-19: A Single-Center Experience","volume":"102","author":"Campagnoli","year":"2023","journal-title":"Ear Nose Throat J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.idh.2019.01.003","article-title":"Clinician perceptions of respiratory infection risk; a rationale for research into mask use in routine practice","volume":"24","author":"Barratt","year":"2019","journal-title":"Infect. Dis. Health"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Wang, M.X., Gwee, S.X.W., Chua, P.E.Y., and Pang, J. (2020). Effectiveness of Surgical Face Masks in Reducing Acute Respiratory Infections in Non-Healthcare Settings: A Systematic Review and Meta-Analysis. Front. Med., 7.","DOI":"10.3389\/fmed.2020.564280"},{"key":"ref_20","unstructured":"Buda, S., D\u00fcrrwald, R., Biere, B., Buchholz, U., Tolksdorf, K., Schilling, J., Goerlitz, L., Streib, V., Preu\u00df, U., and Prahm, K. (2021). Influenza-Wochenbericht KW 13\/2021, Arbeitsgemeinschaft Influenza\u2013Robert Koch-Institut."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.ijid.2020.06.062","article-title":"COVID-19 preventive measures showing an unintended decline in infectious diseases in Taiwan","volume":"98","author":"Galvin","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.12968\/hmed.2022.0349","article-title":"Immunity debt and unseasonal childhood respiratory viruses","volume":"83","author":"Munro","year":"2022","journal-title":"Br. J. Hosp. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"109518","DOI":"10.1016\/j.celrep.2021.109518","article-title":"Long-term SARS-CoV-2-specific immune and inflammatory responses in individuals recovering from COVID-19 with and without post-acute symptoms","volume":"36","author":"Peluso","year":"2021","journal-title":"Cell Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/S2215-0366(20)30491-0","article-title":"The mental health impact of the COVID-19 pandemic on people with and without depressive, anxiety, or obsessive-compulsive disorders: A longitudinal study of three Dutch case-control cohorts","volume":"8","author":"Pan","year":"2021","journal-title":"Lancet Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/s11920-020-01189-6","article-title":"Planning for Mental Health Needs during COVID-19","volume":"22","author":"Han","year":"2020","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.1136\/heartjnl-2020-317981","article-title":"COVID-19 pandemic and infarctions: Another call to reorganise our healthcare systems","volume":"106","author":"Deferrari","year":"2020","journal-title":"Heart"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2871","DOI":"10.1016\/j.jacc.2020.04.011","article-title":"Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States During COVID-19 Pandemic","volume":"75","author":"Garcia","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"554","DOI":"10.3399\/bjgp15X687193","article-title":"Globus pharyngeus: An update for general practice","volume":"65","author":"Jones","year":"2015","journal-title":"Br. J. Gen. Pract."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1053\/j.gastro.2005.08.060","article-title":"Functional esophageal disorders","volume":"130","author":"Galmiche","year":"2006","journal-title":"Gastroenterology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/hsc.12281","article-title":"Room for one more? A review of the literature on \u2018inappropriate\u2019 admissions to hospital for older people in the English NHS","volume":"25","author":"Thwaites","year":"2017","journal-title":"Health Soc. Care Community"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"u200524.w996","DOI":"10.1136\/bmjquality.u200524.w996","article-title":"Rapid access rather than open access leads to improved effectiveness of an ENT emergency clinic","volume":"2","author":"Smyth","year":"2013","journal-title":"BMJ Qual. Improv. Rep."},{"key":"ref_32","first-page":"20552076221091358","article-title":"The role of telemedicine services in changing users\u2019 intentions for presenting to the emergency departments in Saudi Arabia","volume":"8","author":"Alfaleh","year":"2022","journal-title":"Digit. Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e11233","DOI":"10.2196\/11233","article-title":"Use of Telemedicine to Screen Patients in the Emergency Department: Matched Cohort Study Evaluating Efficiency and Patient Safety of Telemedicine","volume":"7","author":"Rademacher","year":"2019","journal-title":"JMIR Med. Inform."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Montellier, M., Delpech, R., Mion, M., Bou\u00e9, F., and Metzger, M.-H. (2022). Designing and describing an electronic referral system to facilitate direct hospital admissions. BMC Primary Care, 23.","DOI":"10.1186\/s12875-022-01656-4"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"5081","DOI":"10.1007\/s00405-021-06728-2","article-title":"Delayed presentation of head and neck cancer patients during COVID-19 pandemic","volume":"278","author":"Kara","year":"2021","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1080\/14728214.2020.1852215","article-title":"Emerging immune checkpoint inhibitors for the treatment of head and neck cancers","volume":"25","author":"Green","year":"2020","journal-title":"Expert Opin. Emerg. Drugs"}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/12\/8\/194\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:41:20Z","timestamp":1760110880000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/12\/8\/194"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,22]]},"references-count":36,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["diseases12080194"],"URL":"https:\/\/doi.org\/10.3390\/diseases12080194","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,22]]}}}