Aerosol generation during routine rhinologic surgeries and in-office procedures

Area of Science:

• Otolaryngology
• Infectious Disease Control
• Surgical Aerosol Generation

Background:

• Cadaveric studies indicated that endonasal drilling and cautery produce aerosols, raising concerns for otolaryngologists during the COVID-19 pandemic.
• Quantifying aerosol generation in live patients during routine rhinologic surgeries and in-office procedures is essential for safety protocols.

Purpose of the Study:

• To measure and quantify aerosol generation during various rhinologic surgeries and in-office procedures in live patients.
• To evaluate the effectiveness of different mask conditions in reducing aerosol concentrations during these procedures.

Main Methods:

• Aerosol concentrations (0.30–10.0 μm) were measured in real-time using an optical particle sizer.
• Mask conditions were varied during rigid nasal endoscopy (RNE) and postoperative debridement (POD).

Main Results:

• Higher aerosol concentrations were observed during RNE and POD when no mask was used compared to masked conditions.
• Masking the patient's mouth during POD significantly reduced aerosol generation (P < .001).
• Aerosol spikes occurred during functional endoscopic sinus surgeries (FESS) with a microdebrider, but not during anterior skull base surgeries (ASBS) with suction mitigation.

Conclusions:

• Utilizing a surgical mask over the patient's mouth or a slit mask for endoscopy during RNE substantially decreases aerosol generation.
• While masks reduce aerosols, their efficacy in preventing disease transmission requires further investigation.
• Suction mitigation effectively prevented aerosol spikes during powered drilling in ASBS.