Lockdown Boredom in COVID-19 Pandemic: As a Cause of Pediatric Foreign Bodies

Abstract

COVID-19 has been impacting a large number of people worldwide. In this lockdown has restricted people to stay at home which is likely to impact their physical and mental health especially children can result in a high prevalence of psychological distress. Long term home isolation has potentially increased the risk of domestic accidents in children like lodgment of foreign bodies in Ear, Nose and Throat. Otolaryngologists are at increased risk of getting the infection due to their direct exposure to the airways of the patient, while removing foreign bodies. Preoperative planning and SARS-CoV2 testing is of particular importance for the pediatric population and if testing cannot be performed, patients in all age groups should be handled as though they are positive for COVID-19, and appropriate precautions should be taken.

The World Health Organization (WHO) on March 11, 2020, has declared the novel corona virus (COVID-19) outbreak a global pandemic [1]. COVID-19 has been impacting a large number of people worldwide. As of August 4th, 2020, there are 18,576,446 cases worldwide and 1,893,078 cases in India reported according to the Center for Systems Science and Engineering (CSSE) at John Hopkins University.

India took the historic decision of a 21 day national lockdown on March 25th, which was further extended with different restrictions as per the need of the situation. This lockdown has restricted people to stay at home which is likely to impact their physical and mental health. Especially vulnerable to this are the children they can’t go out for playing and also their schools are closed.

It has been found that children staying at home due to lockdown spend more time in using phones, sitting in front of TV and internet which can lead to psycho-social problems, like lower self-esteem [2]. Excess use of internet can lead to internet addiction disorder, which can affect their mental health. Moreover, spending more time inside the house makes children vulnerable to effects of indoor pollution which can affect their brain development leading to limited development of cognitive abilities [3].

As learned from experiences with SARS, quarantine can result in a high prevalence of psychological distress, manifested most frequently by low mood and irritability [4], with emotional disturbances and exhaustion, anger, anxiety, boredom, insomnia and depressive symptoms [5,6,7,8,9].

Long term home isolation has potentially increased the risk of domestic accidents in children like lodgment of foreign bodies in Ear, Nose and Throat. Commonly found foreign bodies in children are beads, plastic toys, pebbles, buttons, colors, coins and popcorn kernels. Foreign bodies in the airway are commonly seen in the pediatric population [10, 11]. One case series over a 20-year period reported that 75% of patients with foreign bodies to the airway were younger than 9 years [11]. Unfortunately, FB injuries are a neglected epidemic and there’s a lack of sensibility in terms of recognition and acknowledgement of the FB injury risk. Particularly, foreign bodies in the nose and in the ears produce local inflammation which may result in a pressure necrosis and damage the surrounding structure [12].

Foreign bodies of the ear and nose often can be managed in the outpatient setting with simple instruments without need of any COVID testing. Topical anaesthesia can be used for uncooperative children to reduce the pain. Foreign bodies in the throat are often medical emergencies that could potentially progress to surgical emergencies. Throat foreign bodies and difficult ear and nose foreign bodies are managed surgically using short general anaesthesia, after the COVID testing of the patient.

ENT Surgeons are at increased risk of getting the infection due to their direct exposure to the airways of the patient, while removing foreign bodies from nasopharynx and oropharynx, which are the common place where this highly contagious virus reside. Several recent studies of COVID-19 in the pediatric population in China demonstrate a large portion of cases are asymptomatic or minimally symptomatic. In a study of eight infected families, nine positive children were identified, but asymptomatic infection occurred in 66.7% of pediatric cases [13]. Emerging data suggests that asymptomatic patients may carry and spread infection [14]. Around the world, including in China, Iran, and Italy, many of the physicians infected by COVID 19 are specialists exposed to the nasopharynx and oropharynx, including anesthesiologists, critical care physicians, ophthalmologists and otolaryngologists [15]. Preoperative planning and SARS-CoV2 testing is of particular importance for the pediatric population and if testing cannot be performed, patients in all age groups should be handled as though they are positive for COVID-19, and appropriate precautions should be taken [16].

Abbreviations

COVID-19:

Coronavirus disease 2019

PPE:

Personal protective equipment

SARS-CoV-2:

Severe acute respiratory syndrome coronavirus-2

References

  1. 1.

    Cucinotta D, Vanelli M (2020) WHO declares COVID-19 a pandemic. Acta Bio Med [Internet] 91(1):157–160

  2. 2.

    Grechyna D (2020) Health threats associated with children lockdown in Spain during COVID-19. SSRN. https://doi.org/10.2139/ssrn.3567670

  3. 3.

    Franklin PJ (2007) Indoor air quality and respiratory health of children. Paediatr Respir Rev 8:281–286

    Article  Google Scholar 

  4. 4.

    Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ (2020) The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 395:912–920

    CAS  Article  Google Scholar 

  5. 5.

    Yoon M-K, Kim S-Y, Ko H-S, Lee M-S (2016) System effectiveness of detection, brief intervention and refer to treatment for the people with post-traumatic emotional distress by MERS: A case report of community-based proactive intervention in South Korea. Int J Ment Health Syst 10:51

    Article  Google Scholar 

  6. 6.

    Hawryluck L, Gold WL, Robinson S, Pogorski S, Galea S, Styra R (2004) SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis 10:1206–1212

    Article  Google Scholar 

  7. 7.

    Mihashi M, Otsubo Y, Yinjuan X, Nagatomi K, Hoshiko M, Ishitake T (2009) Predictive factors of psychological disorder development during recovery following SARS outbreak. Health Psychol. Off J Div Health Psychol Am Psychol Assoc 28:91–100

  8. 8.

    Marjanovic Z, Greenglass ER, Coffey S (2007) The relevance of psychosocial variables and working conditions inpredicting nurses’ coping strategies during the SARS crisis: An online questionnaire survey. Int J Nurs Stud 44:991–998

    Article  Google Scholar 

  9. 9.

    Reynolds DL, Garay JR, Deamond SL, Moran MK, Gold W, Styra R (2007) Understanding, compliance and psychological impact of the SARS quarantine experience. Epidemiol Infect 136:997–1007

    Article  Google Scholar 

  10. 10.

    Heim SW, Maughan KL (2007) Foreign bodies in the ear, nose, and throat. Am FamPhysician 76(8):1185–1189

    Google Scholar 

  11. 11.

    Baharloo F, Veyckemans F, Francis C et al (1999) Tracheobronchial foreign bodies: presentation and management in children and adults. Chest 115(5):1357–1362

    CAS  PubMed  Google Scholar 

  12. 12.

    Kalan A, Tariq M (2000) Foreign bodies in the nasal cavities: a comprehensive review of the aetiology, diagnostic pointers, and therapeutic measures. Postgrad Med J 76(898):484–487

    CAS  Article  Google Scholar 

  13. 13.

    Su L, Ma X, Yu H, Zhang Z, Bian P (2020) The different clinical characteristics of corona virus disease cases between children and their families in China—the character of children with COVID-19. Emerg Microbes Infect 9(1):707–713

    CAS  Article  Google Scholar 

  14. 14.

    Lai CC, Liu YH, Wang C, Wang Y, Hseuh S et al (2020) Asymptomatic carrier state, acute respiratoyr disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): facts and myths. J Microbiol Immunol Infect. https://doi.org/10.1016/j.jmii.2020.02.012

  15. 15.

    Patel ZM, Fernandez-Miranda J, Hwang PH et al (2020) Precautions for endoscopic transnasal skull base surgery during the COVID-19 pandemic. Neurosurgery. https://doi.org/10.1093/neuros/nyaa145

  16. 16.

    AAO-HNS Position Statement: Otolaryngologists and the COVID-19 Pandemic. March 23, 2020, 1:37pm. https://www.entnet.org/content/aao-hns-position-statement-otolaryngologists-and-covid-19-pandemic. Accessed 30 Mar 2020

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Satinder Pal Singh M.S. ENT.

Ethics declarations

Conflict of interest

Not applicable.

Financial Disclosure

Not applicable.

Availability of Data and Materials

Not applicable.

Ethics Approval and Consent to Participate

Not applicable.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Arora, R., Singh, S.P. Lockdown Boredom in COVID-19 Pandemic: As a Cause of Pediatric Foreign Bodies. Indian J Otolaryngol Head Neck Surg (2020). https://doi.org/10.1007/s12070-020-02262-5

Download citation

Keywords

  • COVID-19 pandemic
  • Otolaryngology
  • Pediatric foreign bodies
  • Personal protective equipment