Impact of environmental pollutants on Otorhinolaryngological Emergencies in the COVID-19 Era

Abstract: Air pollution (AP) is a critical environmental factor influencing public health, with well-documented associations with upper respiratory tract (URT) diseases. This study investigates the relationship between ENT emergency department (ENT-ED) visits at Azienda Ospedale Università di Padova (AOPD) and daily concentrations of environmen- tal pollutants during the first year of the COVID-19 pandemic (March 2020–March 2021), compared to pre-pandemic data from 2017. The study focuses on patients diagnosed with URT inflammatory diseases, excluding those with COVID-19 infection, who sought care at the AOPD ENT-ED. Environmental data, including meteorological variables, air pollutants, and major aeroallergen levels, were collected from regional monitoring stations. A total of 4594 patients were admitted in 2020/2021, marking a 37% reduction from 2017, with URT inflammatory admissions decreasing by 52%. A significant decline in PM10, NO2 and Alternaria levels was observed, whereas Betullaceae and Corylaceae concentrations signifi- cantly increased. Multivariate analyses revealed strong associations between aeroallergen exposure and ENT admissions, particularly for Alternaria, which had a notable impact on total admissions (p < 0.001) and was significantly linked to cases of otitis media and tonsillitis. PM10 concentrations on specific days preceding ED visits were associated with increased incidences of pharyngitis and rhinosinusitis (p < 0.05). These findings reinforce the connection between environmental pollutants and ENT emergency visits, highlighting the adverse effects of AP and climate variables on URT diseases, even during a pandemic when enhanced airway protection measures were in place. This study underscores the necessity of stringent air quality regulations and interdisciplinary strategies to mitigate environmental health risks and inform future public health policies.