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Airborne Aerosol Generation During Endonasal Procedures in the Era of COVID-19: Risks and Recommendations.
Otolaryngol Head Neck Surg. 2020 09; 163(3):465-470.OH

Abstract

OBJECTIVE

In the era of SARS-CoV-2, the risk of infectious airborne aerosol generation during otolaryngologic procedures has been an area of increasing concern. The objective of this investigation was to quantify airborne aerosol production under clinical and surgical conditions and examine efficacy of mask mitigation strategies.

STUDY DESIGN

Prospective quantification of airborne aerosol generation during surgical and clinical simulation.

SETTING

Cadaver laboratory and clinical examination room.

SUBJECTS AND METHODS

Airborne aerosol quantification with an optical particle sizer was performed in real time during cadaveric simulated endoscopic surgical conditions, including hand instrumentation, microdebrider use, high-speed drilling, and cautery. Aerosol sampling was additionally performed in simulated clinical and diagnostic settings. All clinical and surgical procedures were evaluated for propensity for significant airborne aerosol generation.

RESULTS

Hand instrumentation and microdebridement did not produce detectable airborne aerosols in the range of 1 to 10 μm. Suction drilling at 12,000 rpm, high-speed drilling (4-mm diamond or cutting burs) at 70,000 rpm, and transnasal cautery generated significant airborne aerosols (P < .001). In clinical simulations, nasal endoscopy (P < .05), speech (P < .01), and sneezing (P < .01) generated 1- to 10-μm airborne aerosols. Significant aerosol escape was seen even with utilization of a standard surgical mask (P < .05). Intact and VENT-modified (valved endoscopy of the nose and throat) N95 respirator use prevented significant airborne aerosol spread.

CONCLUSION

Transnasal drill and cautery use is associated with significant airborne particulate matter production in the range of 1 to 10 μm under surgical conditions. During simulated clinical activity, airborne aerosol generation was seen during nasal endoscopy, speech, and sneezing. Intact or VENT-modified N95 respirators mitigated airborne aerosol transmission, while standard surgical masks did not.

Authors+Show Affiliations

Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Harvard Medical School, Boston, Massachusetts, USA.Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Harvard Medical School, Boston, Massachusetts, USA.Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Harvard Medical School, Boston, Massachusetts, USA.Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Harvard Medical School, Boston, Massachusetts, USA.Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Harvard Medical School, Boston, Massachusetts, USA.Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Harvard Medical School, Boston, Massachusetts, USA.Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Harvard Medical School, Boston, Massachusetts, USA.Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Harvard Medical School, Boston, Massachusetts, USA.Harvard Medical School, Boston, Massachusetts, USA. Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.Harvard Medical School, Boston, Massachusetts, USA. Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Harvard Medical School, Boston, Massachusetts, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32452739

Citation

Workman, Alan D., et al. "Airborne Aerosol Generation During Endonasal Procedures in the Era of COVID-19: Risks and Recommendations." Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, vol. 163, no. 3, 2020, pp. 465-470.
Workman AD, Jafari A, Welling DB, et al. Airborne Aerosol Generation During Endonasal Procedures in the Era of COVID-19: Risks and Recommendations. Otolaryngol Head Neck Surg. 2020;163(3):465-470.
Workman, A. D., Jafari, A., Welling, D. B., Varvares, M. A., Gray, S. T., Holbrook, E. H., Scangas, G. A., Xiao, R., Carter, B. S., Curry, W. T., & Bleier, B. S. (2020). Airborne Aerosol Generation During Endonasal Procedures in the Era of COVID-19: Risks and Recommendations. Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 163(3), 465-470. https://doi.org/10.1177/0194599820931805
Workman AD, et al. Airborne Aerosol Generation During Endonasal Procedures in the Era of COVID-19: Risks and Recommendations. Otolaryngol Head Neck Surg. 2020;163(3):465-470. PubMed PMID: 32452739.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Airborne Aerosol Generation During Endonasal Procedures in the Era of COVID-19: Risks and Recommendations. AU - Workman,Alan D, AU - Jafari,Aria, AU - Welling,D Bradley, AU - Varvares,Mark A, AU - Gray,Stacey T, AU - Holbrook,Eric H, AU - Scangas,George A, AU - Xiao,Roy, AU - Carter,Bob S, AU - Curry,William T, AU - Bleier,Benjamin S, Y1 - 2020/05/26/ PY - 2020/5/27/pubmed PY - 2020/9/12/medline PY - 2020/5/27/entrez KW - COVID-19 KW - aerosol-generating procedure KW - aerosol-generating surgery KW - aerosolization KW - airborne KW - endoscopy KW - nasal endoscopy SP - 465 EP - 470 JF - Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery JO - Otolaryngol Head Neck Surg VL - 163 IS - 3 N2 - OBJECTIVE: In the era of SARS-CoV-2, the risk of infectious airborne aerosol generation during otolaryngologic procedures has been an area of increasing concern. The objective of this investigation was to quantify airborne aerosol production under clinical and surgical conditions and examine efficacy of mask mitigation strategies. STUDY DESIGN: Prospective quantification of airborne aerosol generation during surgical and clinical simulation. SETTING: Cadaver laboratory and clinical examination room. SUBJECTS AND METHODS: Airborne aerosol quantification with an optical particle sizer was performed in real time during cadaveric simulated endoscopic surgical conditions, including hand instrumentation, microdebrider use, high-speed drilling, and cautery. Aerosol sampling was additionally performed in simulated clinical and diagnostic settings. All clinical and surgical procedures were evaluated for propensity for significant airborne aerosol generation. RESULTS: Hand instrumentation and microdebridement did not produce detectable airborne aerosols in the range of 1 to 10 μm. Suction drilling at 12,000 rpm, high-speed drilling (4-mm diamond or cutting burs) at 70,000 rpm, and transnasal cautery generated significant airborne aerosols (P < .001). In clinical simulations, nasal endoscopy (P < .05), speech (P < .01), and sneezing (P < .01) generated 1- to 10-μm airborne aerosols. Significant aerosol escape was seen even with utilization of a standard surgical mask (P < .05). Intact and VENT-modified (valved endoscopy of the nose and throat) N95 respirator use prevented significant airborne aerosol spread. CONCLUSION: Transnasal drill and cautery use is associated with significant airborne particulate matter production in the range of 1 to 10 μm under surgical conditions. During simulated clinical activity, airborne aerosol generation was seen during nasal endoscopy, speech, and sneezing. Intact or VENT-modified N95 respirators mitigated airborne aerosol transmission, while standard surgical masks did not. SN - 1097-6817 UR - https://www.unboundmedicine.com/medline/citation/32452739/Airborne_Aerosol_Generation_During_Endonasal_Procedures_in_the_Era_of_COVID_19:_Risks_and_Recommendations_ DB - PRIME DP - Unbound Medicine ER -