Abstract:

Purpose: The COVID-19 pandemic has led to concerns over transmission risk from healthcare procedures, especially in head and neck procedures including endonasal, otologic, and facial surgery as well as in-office flexible laryngoscopy. It has also uncovered a critical lack of knowledge in the potential for droplet and aerosol generation due to these procedures. In order to help close this, a series of studies was performed in cadavers and live patients in order to quantify droplet and aerosol generation.
Materials and Methods: Cadaveric surgical sites were impregnated with a 0.1% fluorescein solution. Procedures performed include endoscopic sinus surgery, mastoidectomy, facial fracture repair, and rhinoplasty. Droplets were recorded against an impermeable blue background under ultraviolet-A (UV-A) light. Aerosol generation was measured using an optical particle sizer and a variety of suction devices were trialed for aerosol mitigation. Aerosol generation was measured alone in live patients during tympanostomy and myringotomy tube insertion and flexible laryngoscopy.
Results: Visible droplet contamination was observed following mastoid, endonasal, and orbital drilling but not after mandible fixation and rhinoplasty. Aerosol generation was associated with electrocautery use and drilling with powered burrs (p<0.05). This was successfully mitigated using suction devices including smoke-evacuating electrocautery handpieces and attachable systems (p<0.05). In live patients, tympanostomy and myringotomy tube insertion and flexible laryngoscopy did not elevate aerosol counts to above the threshold of detection (p>0.10) compared to the positive controls (p<0.05). Conclusions: Nosocomial viral spread from droplet and aerosol generation is a risk of several head and neck procedures including endonasal, otologic, and facial surgery. Aerosol generation was highest during electrocautery use and drilling with powered burrs. Suction devices were effective in mitigating the increase in airborne particles where tested. Key procedures including tympanostomy and myringotomy tube insertion and flexible laryngoscopy in live patients did not result in aerosol generation above the level of detection, suggesting that there may be a role for diversion of viral mitigation resources toward areas of higher risk. Biography:

Michael Ye, MD is a fourth-year resident with the Indiana University School of Medicine Department of Otolaryngology—Head and Neck Surgery. He received his undergraduate education at Northwestern University in Evanston, Illinois and his medical degree at the Indiana University School of Medicine in Indianapolis, Indiana. As a provider, he is passionate about serving the community he grew up in by treating the whole scope of head and neck pathologies. His broad research pursuits include advancing surgical safety, patient outcomes, patient education, and basic science in the field of otolaryngology. In his free time, he enjoys playing music, dance, cooking, and fitness.

X