BACKGROUND: International experience with coronavirus 2019 (COVID-19) suggests it poses a significant risk of infectious transmission to skull base surgeons, due to high nasal viral titers and the unknown potential for aerosol generation during endonasal instrumentation. The purpose of this study was to simulate aerosolization events over a range of endoscopic procedures to obtain an evidence-based aerosol risk assessment. METHODS: Aerosolization was simulated in a cadaver using fluorescein solution (0.2 mg per 10 mL) and quantified using a blue-light filter and digital image processing. Outpatient sneezing during endoscopy was simulated using an intranasal atomizer in the presence or absence of intact and modified surgical mask barriers. Surgical aerosolization was simulated during nonpowered instrumentation, suction microdebrider, and high-speed drilling after nasal fluorescein application. RESULTS: Among the outpatient conditions, a simulated sneeze event generated maximal aerosol distribution at 30 cm, extending to 66 cm. Both an intact surgical mask and a modified VENT mask (which enables endoscopy) eliminated all detectable aerosol spread. Among the surgical conditions, cold instrumentation and microdebrider use did not generate detectable aerosols. Conversely, use of a high-speed drill produced significant aerosol contamination in all conditions tested. CONCLUSION: We confirm that aerosolization presents a risk to the endonasal skull base surgeon. In the outpatient setting, use of a barrier significantly reduces aerosol spread. Cold surgical instrumentation and microdebrider use pose significantly less aerosolization risk than a high-speed drill. Procedures requiring drill use should carry a special designation as an "aerosol-generating surgery" to convey this unique risk, and this supports the need for protective personal protective equipment.
BACKGROUND: International experience with coronavirus 2019 (COVID-19) suggests it poses a significant risk of infectious transmission to skull base surgeons, due to high nasal viral titers and the unknown potential for aerosol generation during endonasal instrumentation. The purpose of this study was to simulate aerosolization events over a range of endoscopic procedures to obtain an evidence-based aerosol risk assessment. METHODS: Aerosolization was simulated in a cadaver using fluorescein solution (0.2 mg per 10 mL) and quantified using a blue-light filter and digital image processing. Outpatient sneezing during endoscopy was simulated using an intranasal atomizer in the presence or absence of intact and modified surgical mask barriers. Surgical aerosolization was simulated during nonpowered instrumentation, suction microdebrider, and high-speed drilling after nasal fluorescein application. RESULTS: Among the outpatient conditions, a simulated sneeze event generated maximal aerosol distribution at 30 cm, extending to 66 cm. Both an intact surgical mask and a modified VENT mask (which enables endoscopy) eliminated all detectable aerosol spread. Among the surgical conditions, cold instrumentation and microdebrider use did not generate detectable aerosols. Conversely, use of a high-speed drill produced significant aerosol contamination in all conditions tested. CONCLUSION: We confirm that aerosolization presents a risk to the endonasal skull base surgeon. In the outpatient setting, use of a barrier significantly reduces aerosol spread. Cold surgical instrumentation and microdebrider use pose significantly less aerosolization risk than a high-speed drill. Procedures requiring drill use should carry a special designation as an "aerosol-generating surgery" to convey this unique risk, and this supports the need for protective personal protective equipment.
Authors: Eric A Fried; George Zhou; Ronak Shah; Da Wi Shin; Anjan Shah; Daniel Katz; Garrett W Burnett Journal: Anesth Analg Date: 2020-09-15 Impact factor: 5.108
Authors: Yosef Dastagirzada; Olga Klauberg; Kathleen Sheerin; Seth Lieberman; Richard Lebowitz; Sean McMenomey; Chandranath Sen; J Thomas Roland; John G Golfinos; Donato Pacione Journal: J Neurol Surg B Skull Base Date: 2021-02-18
Authors: Lucia C Pérez-Herrera; Sergio Moreno-López; Daniel Peñaranda; Irene C Pérez-García; Elizabeth García; Gloria Corredor-Rojas; Edgardo Chapman; Augusto Peñaranda Journal: Int Forum Allergy Rhinol Date: 2021-06-08 Impact factor: 5.426
Authors: Sara Farsi; Nada Noaman; Auhood Bukhary; Wadeeah Bahaziq; Alaa Sabbahi; Ibrahim Abushoshah; Abdulaziz Boker Journal: Int J Gen Med Date: 2021-07-15
Authors: Elisabeth H Ference; Wihan Kim; John S Oghalai; Jee-Hong Kim; Brian E Applegate Journal: Otolaryngol Head Neck Surg Date: 2021-06-22 Impact factor: 5.591
Authors: Alex Murr; Nicholas R Lenze; William Colby Brown; Mark W Gelpi; Charles S Ebert; Brent A Senior; Brian D Thorp; Adam M Zanation; Adam J Kimple Journal: Am J Rhinol Allergy Date: 2020-10-04 Impact factor: 2.467