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Maalouf A, Palonen E, Geneid A, Lamminmäki S, Sanmark E. Aerosol generation during pediatric otolaryngological procedures. Int J Pediatr Otorhinolaryngol 2024; 183:112030. [PMID: 38991363 DOI: 10.1016/j.ijporl.2024.112030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/03/2024] [Accepted: 07/04/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES To assess the extent of staff exposure to aerosol generation in common pediatric otorhinolaryngological procedures (tonsillotomies, adenoidectomies, and tympanostomies) and determine the surgical phases responsible for most aerosol generation in these procedures. METHODS Aerosol generation was measured during 35 pediatric otolaryngological procedures using an Optical Particle Sizer that measures aerosol concentrations for particle sizes between 0.3 and 10.0 μm. The different phases of and instruments used in each procedure were logged. Operating room background aerosol levels and coughing were used as references. RESULTS Total aerosol concentrations were significantly higher during tonsillotomies and adenoidectomies when compared to tympanostomies (p = 0.011 and p = 0.042) and to empty room background aerosol concentrations (p = 0.0057 and p < 0.001). Aerosol concentration during tonsillotomies did not differ from coughing, which is considered as standard for high-risk aerosol procedures. During tympanostomies, aerosol concentrations were even lower than during perioperative concentrations. No statistically significant difference in aerosol generation comparing suction, electrocautery, cold instruments, and paracentesis was found. CONCLUSION According to the results of this study, tympanostomies are low-risk aerosol-generating procedures. On the other hand, pediatric tonsillotomies produced aerosols comparable to coughing, pointing to them being significantly aerosol-producing procedures and viral transmission is theoretically possible intraoperatively.
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Affiliation(s)
- Anthony Maalouf
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland.
| | - Essi Palonen
- Faculty of Medicine, University of Helsinki, Finland
| | - Ahmed Geneid
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland
| | - Satu Lamminmäki
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland
| | - Enni Sanmark
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland
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2
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Farsakh A, Li S, Toomey F, Castle-Kirszbaum M, Kam J, Goldschlager T. Pituitary surgery and COVID. Pituitary 2024:10.1007/s11102-024-01423-x. [PMID: 38967764 DOI: 10.1007/s11102-024-01423-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
An effect of the COVID-19 pandemic was the disruption of healthcare systems, especially surgical services provided to the community. Pituitary surgery was especially impacted, given the majority of cases were deemed non-urgent with very few exceptions, and the high risk of viral transmission conferred by the endoscopic endonasal transsphenoidal approach. Patients suffering from pituitary lesions with resultant endocrinopathy or visual symptoms saw their treatment delayed or altered, which had implications on their outcomes and care. This disruption extended to surgical training and the usual functioning of academic units, necessitating changes to curricula and implementation of novel methods of progressing surgical education. This review will explore the effect of the COVID pandemic on pituitary surgery, the experiences of various surgeons as well as the adaptations implemented on the frontlines. The lessons learned from the experience of the pandemic may assist specialists in gleaning insights regarding the care of patients in the future.
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Affiliation(s)
- Ameen Farsakh
- Department of Neurosurgery, Monash Medical Centre, Monash Health, Melbourne, Australia.
| | - Sandra Li
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Fidel Toomey
- Department of Neurosurgery, Monash Medical Centre, Monash Health, Melbourne, Australia
| | - Mendel Castle-Kirszbaum
- Department of Neurosurgery, Monash Medical Centre, Monash Health, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jeremy Kam
- Department of Neurosurgery, Monash Medical Centre, Monash Health, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Medical Centre, Monash Health, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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3
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Ye MJ, Campiti VJ, Falls M, Howser LA, Sharma D, Vadhul RB, Burgin SJ, Illing EA, Ting JY, Koehler KR, Park JH, Vernon DJ, Nesemeier BR, Johnson JD, Shipchandler TZ. Aerosol and Droplet Generation from Open Rhinoplasty: Surgical Risk in the Pandemic Era. Facial Plast Surg Aesthet Med 2024; 26:463-468. [PMID: 34964656 DOI: 10.1089/fpsam.2021.0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The coronavirus disease 2019 pandemic has led to concerns over transmission risk from head and neck operations including facial cosmetic surgeries. Objectives: To quantify droplet and aerosol generation from rhinoplasty techniques in a human anatomic specimen model using fluorescein staining and an optical particle sizer. Methods: Noses of human anatomic specimens were infiltrated using 0.1% fluorescein. Droplets and aerosols were measured during rhinoplasty techniques including opening the skin-soft tissue envelope, monopolar electrocautery, endonasal rasping, endonasal osteotomy, and percutaneous osteotomy. Results: No visible droplet contamination was observed for any rhinoplasty techniques investigated. Compared with the negative control of anterior rhinoscopy, total 0.300-10.000 μm aerosols were increased after monopolar electrocautery (p < 0.001) and endonasal rasp (p = 0.003). Opening the skin-soft tissue envelope, endonasal osteotomies, and percutaneous osteotomies did not generate a detectable increase in aerosols (p > 0.15). Discussion and Conclusions: In this investigation, droplets were not observed under ultraviolet light, and aerosol generation was noted only with cautery and endonasal rasping.
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Affiliation(s)
- Michael J Ye
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Vincent J Campiti
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Megan Falls
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lauren A Howser
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Dhruv Sharma
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Raghav B Vadhul
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sarah J Burgin
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Elisa A Illing
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Karl R Koehler
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jae Hong Park
- School of Health Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Dominic J Vernon
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Bradley R Nesemeier
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Jeffrey D Johnson
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Taha Z Shipchandler
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Sithole SP, Kuhn W, Sibiya LA. Variation in aerosol generation by surgical modality during oropharyngeal and laryngeal surgery. Laryngoscope Investig Otolaryngol 2024; 9:e1287. [PMID: 38835334 PMCID: PMC11149762 DOI: 10.1002/lio2.1287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/09/2024] [Indexed: 06/06/2024] Open
Abstract
Objectives The objectives were to determine the surgical modality with the lowest aerosol and droplets generated by commonly used modalities in oropharyngeal and laryngeal surgery. Methods A simulation of oropharyngeal and laryngeal surgery was set up using fresh sheep heads. Four common surgical modalities were utilized: cold steel, electrocautery, coblation, and microdebrider. The resultant aerosol generated was evaluated using two measurement modalities at two key positions in the theater. (1) DustTrak Pro Aerosol Monitor was used to measure the concentration of particles. (2) Fluorescein dye coated on the oropharynx and larynx, and the resultant scatter on paper. Results Electrocautery and coblation produced statistically significant increases in the concentration of aerosols (p < .001). Microdebrider and cold steel instrumentation produced the least aerosols. No measurable fluorescein droplets were noted for all four modalities. Conclusion Electrocautery and coblation produced higher concentrations of aerosols. Mitigation factors should be considered with instruments with increased aerosolization. These modalities show low droplet-related infection risk.
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Affiliation(s)
- S P Sithole
- University of KwaZulu-Natal, Nelson R. Mandela School of Medicine Durban South Africa
| | - W Kuhn
- University of KwaZulu-Natal, Nelson R. Mandela School of Medicine Durban South Africa
| | - L A Sibiya
- University of KwaZulu-Natal, Nelson R. Mandela School of Medicine Durban South Africa
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Gupta A, Goyal-Honavar A, Jonathan GE, Prabhu K, Varghese GM, Rupali P, Chacko AG. Adapting management strategies for sellar-suprasellar lesions during the COVID-19 pandemic: a pragmatic approach from the frontline. Br J Neurosurg 2024; 38:596-603. [PMID: 34148450 DOI: 10.1080/02688697.2021.1940852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/04/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE During the ongoing COVID-19 pandemic, endonasal surgeries for sellar-suprasellar lesions were discouraged due to the risk of transmission of the disease. We reviewed the changes in our management protocol for these lesions as our disease understanding and preparedness evolved. MATERIALS AND METHODS This was a retrospective observational study including patients with sellar-suprasellar and clival lesions presenting to us between March and October 2020. Management protocols were divided into three phases based on the prevalence of the disease and the number of mandatory preoperative COVID-19 tests being conducted. The surgical approach used was analyzed in relation to the preferred approach during pre-COVID times, and surgical outcomes and complications were noted. RESULTS A total of 31 cases were operated during this period. During Phase I (low prevalence; no preoperative COVID testing) endonasal surgeries were largely abandoned in favor of transcranial approaches. In Phase II (medium prevalence; one preoperative COVID test) we gradually resumed endonasal surgeries for 'emergent' and 'essential' cases, and subsequently in Phase III (high prevalence; two preoperative COVID tests), we had no hesitation in performing 'elective' endonasal surgeries with additional barriers for prevention of aerosol transmission. No patient developed COVID-19 infection postoperatively. Eight HCWs in our department acquired the disease during this period, none of whom were directly involved in the surgeries for the above cohort of patients. CONCLUSIONS With a strict preoperative COVID testing protocol, adherence to proper drilling techniques and using additional barriers to prevent droplet and aerosol spread, endonasal surgeries for sellar-suprasellar lesions are safe during this COVID-19 pandemic.
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Affiliation(s)
- Ankush Gupta
- Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
| | - Abhijit Goyal-Honavar
- Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
| | - Gandham Edmond Jonathan
- Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
| | - Krishna Prabhu
- Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
| | - George M Varghese
- Department of Infectious Diseases, Christian Medical College Hospital, Vellore, India
| | - Priscilla Rupali
- Department of Infectious Diseases and Hospital Infection Control Committee, Christian Medical College Hospital, Vellore, India
| | - Ari George Chacko
- Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
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Sutton SR, Taniguchi AN, Nguyen SA, Soler ZM, Schlosser RJ. Direct impact of the COVID-19 pandemic on rhinology practice. Int Forum Allergy Rhinol 2024; 14:738-740. [PMID: 37482946 DOI: 10.1002/alr.23245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 07/25/2023]
Abstract
KEY POINTS The pandemic caused an increase in computed tomography imaging in patients with sinusitis, which persisted post-COVID. Nasal endoscopies significantly decreased during COVID but returned to pre-COVID levels in 2022. The management of cerebrospinal fluid leaks, tumors, and orbital pathology was not impacted by the pandemic.
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Affiliation(s)
- Sarah R Sutton
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Reno School of Medicine, University of Nevada, Reno, Nevada, USA
| | - April N Taniguchi
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Zachary M Soler
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rodney J Schlosser
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Ference EH, Kim W, Oghalai JS, Walker CB, Badash I, Gallagher T, Ma HJ, Applegate BE. COVID-19 in the Clinic: Trial of an Aerosol Containment Mask for Endoscopic Clinic Procedures. Otolaryngol Head Neck Surg 2024; 170:265-271. [PMID: 37622584 DOI: 10.1002/ohn.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/02/2023] [Accepted: 07/14/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Create an aerosol containment mask (ACM) for common otolaryngologic endoscopic procedures which also provides nanoparticle-level protection to patients. STUDY DESIGN Prospective feasibility study. SETTING In-person testing with a novel ACM. METHODS The mask was designed in Solidworks and 3-dimensional printed. Measurements were made on 100 consecutive clinic patients who underwent medically necessarily endoscopy, 50 rigid nasal and 50 flexible, by 9 surgeons. RESULTS Of the 50 patients who underwent rigid nasal endoscopy with the ACM, 0 of 25 patients with the suction off and 0 of 25 patients with the suction on had evidence of leakage of 0.3 μm particles. Of the 50 patients who underwent flexible endoscopy with the ACM, 0 of 25 patients with the suction off and 0 of 25 patients with the suction on had evidence of leakage of 0.3 μm particles. In terms of comfort, 73% of patients found the ACM somewhat or very comfortable without suction, compared to 86% with the suction on. Surgeons were able to visualize all necessary anatomic areas in 98% of procedures. In 97% of procedures, the masks were able to be placed easily. CONCLUSION ACM can accommodate rigid nasal and flexible endoscopes and may prevent leakage of patient-generated aerosols, thus avoiding contamination of the room and protecting health care workers from airborne contagions. LEVEL OF EVIDENCE The level of evidence is 2.
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Affiliation(s)
- Elisabeth H Ference
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Wihan Kim
- Alfred Mann Institute for Biomedical Engineering, Los Angeles, California, USA
| | - John S Oghalai
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Clayton B Walker
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
- Alfred Mann Institute for Biomedical Engineering, Los Angeles, California, USA
| | - Ido Badash
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Tyler Gallagher
- Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Harrison J Ma
- Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Brian E Applegate
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
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8
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Nielson C, Kelly K, Attah R, Pei Z, Wang Y, Firpo MA, Park AH. Comparing Aerosol Generation in Human and Animal Tissues During Common Otolaryngology Procedures. Otolaryngol Head Neck Surg 2023; 169:1491-1498. [PMID: 37313962 DOI: 10.1002/ohn.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/19/2023] [Accepted: 05/18/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine whether hamster and human tissues generate similar amounts of aerosolized particles using common otolaryngology surgical techniques. STUDY DESIGN Quantitative experimental research. STUDY SETTING University research laboratory. METHODS Drilling, electrocautery, and coblation were performed on human and hamster tissues. Particle size and concentration were measured during the surgical procedures using a scanning mobility particle sizer and an aerosol particle sizer (SMPS-APS) and GRIMM aerosol particle spectrometer. RESULTS SMPS-APS and GRIMM measurements detected at least 2-fold increases in aerosol concentrations compared to baseline during all procedures. Procedures performed on human and hamster tissues produced similar trends and order of magnitude of aerosol concentrations. Generally, hamster tissues produced higher aerosol concentrations compared to human tissues, and some of these differences were statistically significant. Mean particle sizes for all procedures were small (<200 nm), although statistically significant differences in particle size were identified between human and hamster tissues during coblation and drilling. CONCLUSION Aerosol-generating procedures performed on human and hamster tissue produce similar trends in aerosol particle concentrations and sizes, although we observed some differences between the 2 tissue types. Further studies should be performed to understand the clinical significance of these differences.
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Affiliation(s)
- Christopher Nielson
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kerry Kelly
- Department of Chemical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Reuben Attah
- Department of Chemical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Zheyuan Pei
- Department of Chemical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Yong Wang
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Matthew A Firpo
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Albert H Park
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Casey VJ, McNamara LM. Instrumental in Surgery: A Narrative Review on Energy-based Surgical Cutting Devices and Surgical Smoke. Ann Surg 2023; 278:e457-e465. [PMID: 36762559 PMCID: PMC10414159 DOI: 10.1097/sla.0000000000005816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To provide an informed understanding of existing energy-based surgical cutting technologies and aerosol-generating surgical procedures. We provide a perspective on the future innovation and research potential in this space for the benefit of surgeons, physicians, engineers, and researchers alike. BACKGROUND Surgery is a treatment for many medical conditions, the success of which depends on surgical cutting instruments that enable surgeons to conduct surgical procedures for tissue cutting and manipulation. Energy-based surgical cutting tools improve accuracy and limit unnecessary destruction of healthy tissues and cells, but can generate surgical smoke and aerosols, which can be handled using surgical smoke evacuation technology. METHODS A narrative review was conducted to explore existing literature describing the history and development of energy-based surgical instruments, their mechanisms of action, aerosol-generating medical procedures, surgical smoke and aerosols from aerosol-generating medical procedures, and the recommended mitigation strategies, as well as research on rapid biological tissue analyzing devices to date. CONCLUSIONS Smoke evacuation technology may provide diagnostic information regarding tissue pathology, which could eliminate health concerns and revolutionize surgical accuracy. However, further research into surgical smoke is required to quantify the measurable risk to health it poses, the cutting conditions, under which it is generated and to develop advanced diagnostic approaches using this information.
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Affiliation(s)
- Vincent J. Casey
- Mechanobiology and Medical Devices Research Group (MMDRG), Biomedical Engineering, University of Galway, Ireland
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
| | - Laoise M. McNamara
- Mechanobiology and Medical Devices Research Group (MMDRG), Biomedical Engineering, University of Galway, Ireland
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
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10
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Wise SK, Damask C, Roland LT, Ebert C, Levy JM, Lin S, Luong A, Rodriguez K, Sedaghat AR, Toskala E, Villwock J, Abdullah B, Akdis C, Alt JA, Ansotegui IJ, Azar A, Baroody F, Benninger MS, Bernstein J, Brook C, Campbell R, Casale T, Chaaban MR, Chew FT, Chambliss J, Cianferoni A, Custovic A, Davis EM, DelGaudio JM, Ellis AK, Flanagan C, Fokkens WJ, Franzese C, Greenhawt M, Gill A, Halderman A, Hohlfeld JM, Incorvaia C, Joe SA, Joshi S, Kuruvilla ME, Kim J, Klein AM, Krouse HJ, Kuan EC, Lang D, Larenas-Linnemann D, Laury AM, Lechner M, Lee SE, Lee VS, Loftus P, Marcus S, Marzouk H, Mattos J, McCoul E, Melen E, Mims JW, Mullol J, Nayak JV, Oppenheimer J, Orlandi RR, Phillips K, Platt M, Ramanathan M, Raymond M, Rhee CS, Reitsma S, Ryan M, Sastre J, Schlosser RJ, Schuman TA, Shaker MS, Sheikh A, Smith KA, Soyka MB, Takashima M, Tang M, Tantilipikorn P, Taw MB, Tversky J, Tyler MA, Veling MC, Wallace D, Wang DY, White A, Zhang L. International consensus statement on allergy and rhinology: Allergic rhinitis - 2023. Int Forum Allergy Rhinol 2023; 13:293-859. [PMID: 36878860 DOI: 10.1002/alr.23090] [Citation(s) in RCA: 79] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 09/13/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document. METHODS ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. RESULTS ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. CONCLUSION The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.
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Affiliation(s)
- Sarah K Wise
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Cecelia Damask
- Otolaryngology-HNS, Private Practice, University of Central Florida, Lake Mary, Florida, USA
| | - Lauren T Roland
- Otolaryngology-HNS, Washington University, St. Louis, Missouri, USA
| | - Charles Ebert
- Otolaryngology-HNS, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joshua M Levy
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Sandra Lin
- Otolaryngology-HNS, University of Wisconsin, Madison, Wisconsin, USA
| | - Amber Luong
- Otolaryngology-HNS, McGovern Medical School of the University of Texas, Houston, Texas, USA
| | - Kenneth Rodriguez
- Otolaryngology-HNS, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ahmad R Sedaghat
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elina Toskala
- Otolaryngology-HNS, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Baharudin Abdullah
- Otolaryngology-HNS, Universiti Sains Malaysia, Kubang, Kerian, Kelantan, Malaysia
| | - Cezmi Akdis
- Immunology, Infectious Diseases, Swiss Institute of Allergy and Asthma Research, Davos, Switzerland
| | - Jeremiah A Alt
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fuad Baroody
- Otolaryngology-HNS, University of Chicago, Chicago, Illinois, USA
| | | | | | - Christopher Brook
- Otolaryngology-HNS, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Raewyn Campbell
- Otolaryngology-HNS, Macquarie University, Sydney, NSW, Australia
| | - Thomas Casale
- Allergy/Immunology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Mohamad R Chaaban
- Otolaryngology-HNS, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fook Tim Chew
- Allergy/Immunology, Genetics, National University of Singapore, Singapore, Singapore
| | - Jeffrey Chambliss
- Allergy/Immunology, University of Texas Southwestern, Dallas, Texas, USA
| | - Antonella Cianferoni
- Allergy/Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Anne K Ellis
- Allergy/Immunology, Queens University, Kingston, ON, Canada
| | | | - Wytske J Fokkens
- Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | | | - Matthew Greenhawt
- Allergy/Immunology, Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amarbir Gill
- Otolaryngology-HNS, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashleigh Halderman
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Jens M Hohlfeld
- Respiratory Medicine, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | | | - Stephanie A Joe
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Shyam Joshi
- Allergy/Immunology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Jean Kim
- Otolaryngology-HNS, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adam M Klein
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Helene J Krouse
- Otorhinolaryngology Nursing, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Edward C Kuan
- Otolaryngology-HNS, University of California Irvine, Orange, California, USA
| | - David Lang
- Allergy/Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Matt Lechner
- Otolaryngology-HNS, University College London, Barts Health NHS Trust, London, UK
| | - Stella E Lee
- Otolaryngology-HNS, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Victoria S Lee
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Patricia Loftus
- Otolaryngology-HNS, University of California San Francisco, San Francisco, California, USA
| | - Sonya Marcus
- Otolaryngology-HNS, Stony Brook University, Stony Brook, New York, USA
| | - Haidy Marzouk
- Otolaryngology-HNS, State University of New York Upstate, Syracuse, New York, USA
| | - Jose Mattos
- Otolaryngology-HNS, University of Virginia, Charlottesville, Virginia, USA
| | - Edward McCoul
- Otolaryngology-HNS, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Erik Melen
- Pediatric Allergy, Karolinska Institutet, Stockholm, Sweden
| | - James W Mims
- Otolaryngology-HNS, Wake Forest University, Winston Salem, North Carolina, USA
| | - Joaquim Mullol
- Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Jayakar V Nayak
- Otolaryngology-HNS, Stanford University, Palo Alto, California, USA
| | - John Oppenheimer
- Allergy/Immunology, Rutgers, State University of New Jersey, Newark, New Jersey, USA
| | | | - Katie Phillips
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael Platt
- Otolaryngology-HNS, Boston University, Boston, Massachusetts, USA
| | | | | | - Chae-Seo Rhee
- Rhinology/Allergy, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Sietze Reitsma
- Otolaryngology-HNS, University of Amsterdam, Amsterdam, Netherlands
| | - Matthew Ryan
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Joaquin Sastre
- Allergy, Fundacion Jiminez Diaz, University Autonoma de Madrid, Madrid, Spain
| | - Rodney J Schlosser
- Otolaryngology-HNS, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore A Schuman
- Otolaryngology-HNS, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marcus S Shaker
- Allergy/Immunology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Aziz Sheikh
- Primary Care, University of Edinburgh, Edinburgh, Scotland
| | - Kristine A Smith
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | - Michael B Soyka
- Otolaryngology-HNS, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Masayoshi Takashima
- Otolaryngology-HNS, Houston Methodist Academic Institute, Houston, Texas, USA
| | - Monica Tang
- Allergy/Immunology, University of California San Francisco, San Francisco, California, USA
| | | | - Malcolm B Taw
- Integrative East-West Medicine, University of California Los Angeles, Westlake Village, California, USA
| | - Jody Tversky
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew A Tyler
- Otolaryngology-HNS, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria C Veling
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Dana Wallace
- Allergy/Immunology, Nova Southeastern University, Ft. Lauderdale, Florida, USA
| | - De Yun Wang
- Otolaryngology-HNS, National University of Singapore, Singapore, Singapore
| | - Andrew White
- Allergy/Immunology, Scripps Clinic, San Diego, California, USA
| | - Luo Zhang
- Otolaryngology-HNS, Beijing Tongren Hospital, Beijing, China
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11
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Sayahi T, Workman AD, Kelly KE, Ardon-Dryer K, Presto AA, Bleier BS. Aerosol Generation During Nasal Airway Instrumentation. Otolaryngol Head Neck Surg 2023; 168:506-513. [PMID: 35503253 DOI: 10.1177/01945998221099028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 04/18/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Airborne aerosol transmission, an established mechanism of SARS-CoV-2 spread, has been successfully mitigated in the health care setting through the adoption of universal masking. Upper airway endoscopy, however, requires direct access to the face, thereby potentially exposing the clinic environment to infectious particles. This study quantifies aerosol production during rigid nasal endoscopy (RNE) and RNE with debridement (RNED) as compared with intubation, a posited gold standard aerosol-generating procedure. STUDY DESIGN Prospective cross-sectional study. SETTING Subspecialty single-center clinic and surgical study. METHOD Three aerosol detectors (NANOSCAN-3910, OPS-3330, and APS-3321) with a particle size sensitivity of 10 to 20,000 nm were utilized to detect particulate production during the clinical care of 209 patients undergoing RNE/RNED and 25 patients undergoing intubation. RESULTS RNE and RNED produced statistically significant particles over baseline in 29.3% and 51.0% of subjects (P = .003-.049 and .002-.047, respectively). Intubation produced statistically significant particles in 31.2% (P = .001-.015). The mean ± SD particle diameter in all tests was 69.9 ± 10.5 nm with 99.7% <300 nm. There were no statistical differences in particle production among RNE, RNED, and intubation. The presence of concomitant cough, sneeze, or prolonged speech similarly did not significantly affect particle production during any procedure. CONCLUSIONS Instrumentation of nasal airway produces airborne aerosols to a similar degree of those seen during intubation, independent of reactive patient behaviors such as cough or sneeze. These data suggest that an improved understanding is necessary of both the definition of an aerosol-generating procedure and the functional consequences of procedural aerosol generation in clinical settings.
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Affiliation(s)
- Tofigh Sayahi
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Alan D Workman
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kerry E Kelly
- Department of Chemical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Karin Ardon-Dryer
- Department of Geosciences, Texas Tech University, Lubbock, Texas, USA
| | - Albert A Presto
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Benjamin S Bleier
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Consultant for Inquis Medical, Inc, Redwood City, California, USA
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12
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Di Scenza G, Mason K, Oikonomou G. Analysis of penetrating neck injuries at a South London Trauma Centre before and after the first national lockdown of the coronavirus pandemic. Clin Otolaryngol 2023; 48:259-263. [PMID: 36539942 DOI: 10.1111/coa.14024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/19/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Affiliation(s)
| | - Katrina Mason
- Ear, Nose and Throat (ENT) Surgery Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Georgios Oikonomou
- Ear, Nose and Throat (ENT) Surgery Department, St George's University Hospitals NHS Foundation Trust, London, UK
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13
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Smith DH, Daines BS, Cazzaniga J, Bhandarkar ND. Surgical Management of Inferior Turbinate Hypertrophy in the Era of Widespread Communicable Disease. Cureus 2023; 15:e34280. [PMID: 36855496 PMCID: PMC9968500 DOI: 10.7759/cureus.34280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 01/28/2023] Open
Abstract
Inferior turbinate reduction procedures have been performed for decades. After significant evolution, turbinoplasty and other mucosal-sparing techniques have become the main method to successfully reduce turbinate hypertrophy. The debate of which technique produces the most effective and durable outcomes is ongoing. During this critical era of widespread communicable diseases, including but not limited to COVID-19, HIV, and hepatitis, additional attention is necessary to balance outcomes with a degree of generation of airborne particles when selecting a technique. This review article aims to identify the optimal method for inferior turbinate reduction that weighs both outcomes and aerosol production. The MEDLINE database was searched to discover relevant publications through August 2022. Key search terms included inferior turbinate hypertrophy, turbinate reduction surgery, turbinoplasty methods, surgical management of turbinate hypertrophy, surgical aerosol generation, COVID-19 surgery, surgery smoke plume, SARS-CoV-2 transmission during surgery, and nasal procedures COVID-19 aerosols. Surgical management of the inferior turbinates includes radiofrequency ablation (RFA), microdebrider-assisted turbinoplasty (MAIT), electrocautery, laser, and ultrasound. Piezo-assisted turbinoplasty and a turbinate-specific coblation wand are new additions to the literature. All techniques appear to improve patient symptoms of nasal obstruction. MAIT and RFA are comparable, although MAIT demonstrated better long-term outcomes in some studies and appears to generate fewer airborne particles. Studies evaluating the production of aerosols due to RFA are lacking. Ultrasound outcomes are also excellent and generate no aerosols, but the technique has not been compared against the microdebrider. Electrocautery can result in increased pain and crusting for patients and causes the highest amount of aerosols. Deficiencies of current studies, including a lack of comparison of aerosol generation, duration of follow-up, omission of outfracture, and inadequate randomized controlled trials among existing and new techniques, have limited the identification of the best inferior turbinate reduction method. Given the durability of MAIT and its minimal aerosol production, it can be reinforced as the most sensible technique until further evidence is available.
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Affiliation(s)
- Drew H Smith
- Department of Otolaryngology - Head and Neck Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Benjamin S Daines
- Department of Otolaryngology - Head and Neck Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Juliana Cazzaniga
- Department of Otolaryngology - Head and Neck Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Naveen D Bhandarkar
- Department of Otolaryngology - Head and Neck Surgery, University of California Irvine, Orange, USA
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14
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Passi M, Stadnytskyi V, Anfinrud P, Koh C. Visualizing endoscopy-generated aerosols with laser light scattering (with videos). Gastrointest Endosc 2022; 96:1072-1077. [PMID: 35932817 PMCID: PMC9596173 DOI: 10.1016/j.gie.2022.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/12/2022] [Accepted: 07/26/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Upper GI endoscopy is speculated to be an aerosol-generating procedure (AGP). Robust evidence exists for aerosol transmission of severe acute respiratory syndrome coronavirus 2. The quality of data available confirming aerosol generation during GI endoscopy is limited. We aimed to objectively demonstrate that GI endoscopy is an AGP and illustrate the mechanism by which the greatest risk for aerosolization of droplets during endoscopy may occur. METHODS Aerosolized droplets generated during insertion and withdrawal of an endoscope and with passage of various tools through the endoscopic working channel using 2 experimental apparatuses modeling an upper GI tract (ie, a fluid-filled tube and a lamb esophagus) were qualitatively assessed by laser light scattering. RESULTS Insertion and withdrawal of the upper endoscope into the upper GI tract models generated numerous aerosolized particles. A large number of brightly scattering particles were observed at the site of insertion and withdrawal of the endoscope. Passage of a cytology brush, biopsy forceps, and hemostatic clip through the working endoscope channel also generated aerosolized particles but in fewer numbers. There was no significant variation in quantity or brightness of droplets generated on testing different biopsy valve cap models or when suctioning fluid with an open versus closed biopsy valve cap. These results were reproducible over several trials. CONCLUSIONS We illustrate in an objective manner that upper GI endoscopy is an AGP. These findings may have implications for transmission of infectious airborne pathogens outside of severe acute respiratory syndrome coronavirus 2 and can help to inform guidance on appropriate personal protective equipment use and other measures for transmission risk mitigation during GI endoscopy.
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Affiliation(s)
- Monica Passi
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Valentyn Stadnytskyi
- Labratory of Chemical Physics, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Philip Anfinrud
- Labratory of Chemical Physics, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher Koh
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA,Reprint requests: Christopher Koh, MD, MHSc, FACP, FAASLD, Acting Clinical Director, Division of Intramural Research, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, 10 Center Dr, Bldg 10, Rm 9C-101, Bethesda, MD 20892
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15
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Bastien AJ, Wiredu K, Lee AY, Rees C, Hinchcliff MT, Paydarfar JA. Quantitative Evaluation of Aerosol Generation During In-Office Flexible Laryngoscopy. JAMA Otolaryngol Head Neck Surg 2022; 148:1140-1146. [PMID: 36301539 PMCID: PMC9614674 DOI: 10.1001/jamaoto.2022.3316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance Despite growing scientific knowledge and research, it is still unknown if office flexible laryngoscopy (FL) is aerosol generating and thereby potentially increases the risk of SARS-CoV-2 transmission. The limited literature that exists is conflicting, precluding formal conclusions. Objective To determine whether FL is aerosol generating. Design, Setting, and Participants This prospective cohort study included 134 patients seen in the otolaryngology clinic at a single tertiary care academic institution between February and May 2021. Two optical particle sizer instruments were used, quantifying particles ranging from 0.02 μm to 5 μm. Measurements were taken every 30 seconds, with sample periods of 15 seconds throughout the patient encounter. Instruments were located 12 inches from the patient's nares. Timing of events was recorded, including the start and end of physical examination, topical spray administration, start and end of laryngoscopy, and other potential aerosol-generating events (eg, coughing, sneezing). Data analysis was performed from February to May 2021. Exposures Office examination and office FL. Main Outcomes and Measures Bayesian online change point detection (OCPD) algorithm was used to detect significant change points (CPs) in this time-series data. The primary outcome was significant CP after FL compared with baseline physiologic variations, such as breathing and phonation. Results Data were collected from 134 patients between February and May 2021. Ninety-one encounters involved FL. Of this group, 51 patients (56%) wore no mask over their mouth during FL. There was no statistically significant CP in either visits involving FL or visits where FL was not performed. Use of nasal spray did not result in CP in aerosol levels. Overall, neither the number of people present in the examination room, masks over patients' mouth, the duration of the visit, nor the duration of FL were associated with mean aerosol counts, regardless of the exposure. For larger aerosol sizes (≥1 μm), however, rooms with higher air exchange rates had significantly higher reductions in mean aerosol counts for visits involving FL. Conclusions and Relevance The findings of this cohort study support that FL, including topical spray administration, is not a significant aerosol-generating procedure. The Bayesian OCPD model has a promising application for future aerosol studies in otolaryngology.
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Affiliation(s)
- Amanda J. Bastien
- Cedars-Sinai Medical Center, Los Angeles, California,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Kwame Wiredu
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Andrew Y. Lee
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Christiaan Rees
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire,Brigham and Women’s Hospital, Boston, Massachusetts
| | - Mason T. Hinchcliff
- Section of Otolaryngology, Audiology, & Maxillofacial Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Joseph A. Paydarfar
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire,Section of Otolaryngology, Audiology, & Maxillofacial Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
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16
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Al-Ani RM. Ear, nose, and throat manifestations of COVID-19 and its vaccines. World J Clin Cases 2022; 10:8808-8815. [PMID: 36157654 PMCID: PMC9477042 DOI: 10.12998/wjcc.v10.i25.8808] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/01/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a highly infectious disease and was designated a pandemic by the World Health Organization (WHO) on March 11, 2020. There are no classical manifestations of the disease. The most prevalent symptoms include fever, cough, dyspnea, myalgia and headache. The main route of transmission of the severe acute respiratory syndrome coronavirus-2 is through the upper respiratory tract. Therefore, it is not strange to find different ear, nose and throat (ENT) symptoms in individuals infected with this virus. Olfactory dysfunction is a common feature of COVID-19; either it is the only presenting symptom or it accompanies other manifestations of the disease. Other otolaryngological features such as sudden sensorineural hearing loss (SSNHL), dysphonia, nasal obstruction, sore throat, etc. are less frequent manifestations of COVID-19. These features, in addition, to being presented early in the disease process, certain long-standing symptoms like parosmia, dysphonia, and persistent deafness, are other characteristics of the disease. Geographical variation in otorhinolaryngological prevalence is another problem with this debilitating disease. Local and systemic adverse effects (local site injection pain, fever, myalgia, headache, and others) of the COVID-19 vaccines are more frequent than otolaryngological side effects (anosmia, hyposmia, Bell’s palsy, SSNHL, etc.). We aimed in this review to summarize the early and persistent ENT symptoms of COVID-19 or after the various COVID-19 vaccines.
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Affiliation(s)
- Raid M Al-Ani
- Department of Surgery/Otolaryngology, University of Anbar, College of Medicine, Ramadi 31001, Anbar, Iraq
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17
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Benner D, Hendricks BK, Elahi C, White MD, Kocharian G, Albertini Sanchez LE, Zappi KE, Garton AL, Carnevale JA, Schwartz TH, Dowlati E, Felbaum DR, Sack KD, Jean WC, Chan AK, Burke JF, Mummaneni PV, Strong MJ, Yee TJ, Oppenlander ME, Ishaque M, Shaffrey ME, Syed HR, Lawton MT. Neurosurgery Subspecialty Practice During a Pandemic: A Multicenter Analysis of Operative Practice in 7 U.S. Neurosurgery Departments During Coronavirus Disease 2019. World Neurosurg 2022; 165:e242-e250. [PMID: 35724884 PMCID: PMC9212868 DOI: 10.1016/j.wneu.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Changes to neurosurgical practices during the coronavirus disease 2019 (COVID-19) pandemic have not been thoroughly analyzed. We report the effects of operative restrictions imposed under variable local COVID-19 infection rates and health care policies using a retrospective multicenter cohort study and highlight shifts in operative volumes and subspecialty practice. METHODS Seven academic neurosurgery departments' neurosurgical case logs were collected; procedures in April 2020 (COVID-19 surge) and April 2019 (historical control) were analyzed overall and by 6 subspecialties. Patient acuity, surgical scheduling policies, and local surge levels were assessed. RESULTS Operative volume during the COVID-19 surge decreased 58.5% from the previous year (602 vs. 1449, P = 0.001). COVID-19 infection rates within departments' counties correlated with decreased operative volume (r = 0.695, P = 0.04) and increased patient categorical acuity (P = 0.001). Spine procedure volume decreased by 63.9% (220 vs. 609, P = 0.002), for a significantly smaller proportion of overall practice during the COVID-19 surge (36.5%) versus the control period (42.0%) (P = 0.02). Vascular volume decreased by 39.5% (72 vs. 119, P = 0.01) but increased as a percentage of caseload (8.2% in 2019 vs. 12.0% in 2020, P = 0.04). Neuro-oncology procedure volume decreased by 45.5% (174 vs. 318, P = 0.04) but maintained a consistent proportion of all neurosurgeries (28.9% in 2020 vs. 21.9% in 2019, P = 0.09). Functional neurosurgery volume, which declined by 81.4% (41 vs. 220, P = 0.008), represented only 6.8% of cases during the pandemic versus 15.2% in 2019 (P = 0.02). CONCLUSIONS Operative restrictions during the COVID-19 surge led to distinct shifts in neurosurgical practice, and local infective burden played a significant role in operative volume and patient acuity.
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Affiliation(s)
- Dimitri Benner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Benjamin K. Hendricks
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Cyrus Elahi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael D. White
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Gary Kocharian
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | | | - Kyle E. Zappi
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | - Andrew L.A. Garton
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | - Joseph A. Carnevale
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | - Theodore H. Schwartz
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | - Ehsan Dowlati
- Department of Neurosurgery, Georgetown University, Washington, DC, USA
| | - Daniel R. Felbaum
- Department of Neurosurgery, Georgetown University, Washington, DC, USA
| | - Kenneth D. Sack
- Department of Neurosurgery, The George Washington University, Washington, DC, USA
| | - Walter C. Jean
- Department of Neurosurgery, The George Washington University, Washington, DC, USA
| | - Andrew K. Chan
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - John F. Burke
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Praveen V. Mummaneni
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael J. Strong
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy J. Yee
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark E. Oppenlander
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mariam Ishaque
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Mark E. Shaffrey
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Hasan R. Syed
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA,To whom correspondence should be addressed: Michael T. Lawton, M.D
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18
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Heatherington E, Zhao X, Goyal N, Ounaies Z, Frecker M. On the Design and Testing of an Origami Inspired Nasal Cover: Mitigating Aerosol Risks During Endoscopic Sinus Procedures. J Med Device 2022. [DOI: 10.1115/1.4055251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Aerosols generated during endoscopic sinus procedures present a concern to the health and safety of healthcare personnel especially with the presence of COVID-19. The purpose of this study is to describe the design and testing of a nasal cover to restrict aerosolized pathogens. The nasal cover was designed to sit overtop the nose with conformal slits for insertion of endoscopic instrumentation. Polydimethylsiloxane (PDMS) was chosen as the nasal mask material and its composition, thickness, and slit geometry were selected using a Taguchi experimental design and survey with clinical collaborators at Penn State Milton S. Hershey Medical Center. The nasal cover was designed using principles of origami engineering to be manufactured flat then folded into its operating state. Form and functionality were evaluated by surgeons, fellows, and residents in the aforementioned survey. Aerosol containment was evaluated by measuring smoke, representative of surgical aerosols, with an optical particle counter. A 25:1 composition PDMS with 3mm thickness and vertical slit geometry was chosen for the nasal cover design. Survey results demonstrated that the origami cover sat well on the nose and did not significantly impact the surgical conditions with single instrumentation. On average, this nasal cover was found to restrict more than 93% of 0.3µm aerosols, and more than 99% of all aerosols larger than 0.5µm in size. Use of a patient worn nasal cover has the potential to drastically reduce the risk to hospital personnel during endonasal surgeries by reducing aerosol generation and potential pathogen spread.
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Affiliation(s)
- Evan Heatherington
- Department of Mechanical Engineering, The Pennsylvania State University, University Park , PA, USA
| | - Xiaoyue Zhao
- Department of Mechanical Engineering, The Pennsylvania State University, University Park , PA, USA
| | - Neerav Goyal
- Department of Otolaryngology-Head and Neck Surgery, Penn State College of Medicine , 500 University Dr, MC, Hershey, PA 17033, USA
| | - Zoubeida Ounaies
- Department of Mechanical Engineering, The Pennsylvania State University, University Park , PA, USA
| | - Mary Frecker
- Department of Mechanical Engineering, The Pennsylvania State University, University Park , PA, USA
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19
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Veltrup R, Kniesburges S, Döllinger M, Falk S, Mueller SK. Evaluation of Respiratory Particle Emission during Otorhinolaryngological Procedures in the Context of the SARS-CoV-2 Pandemic. Diagnostics (Basel) 2022; 12:diagnostics12071603. [PMID: 35885507 PMCID: PMC9315468 DOI: 10.3390/diagnostics12071603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
Understanding the risk of infection by routine medical examination is important for the protection of the medical personnel. In this study we investigated respiratory particles emitted by patients during routine otolaryngologic procedures and assessed the risks for the performing physician. We developed two experimental setups to measure aerosol and droplet emission during rigid/flexible laryngoscopy, rhinoscopy, pharyngoscopy, otoscopy, sonography and patient interview for subjects with and without masks. A high-speed-camera setup was used to detect ballistic droplets (approx. > 100 µm) and an aerosol-particle-sizer was used to detect aerosol particles in the range of 0.3 µm to 10 µm. Aerosol particle counts were highly increased for coughing and slightly increased for heavy breathing in subjects without masks. The highest aerosol particle counts occurred during rigid laryngoscopy. During laryngoscopy and rhinoscopy, the examiner was exposed to increased particle emission due to close proximity to the patient’s face and provoked events such as coughing. However, even during sonography or otoscopy without a mask, aerosol particles were expelled close to the examiner. The physician’s exposure to respiratory particles can be reduced by deliberate choice of examination technique depending on medical indication and the use of appropriate equipment for the examiners and the patients (e.g., FFP2 masks for both).
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20
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Patel R, Fang CH, Grube JG, Eloy JA, Hsueh WD. COVID-19 and rhinological surgery. OPERATIVE TECHNIQUES IN OTOLARYNGOLOGY--HEAD AND NECK SURGERY 2022; 33:103-111. [PMID: 35502266 PMCID: PMC9046134 DOI: 10.1016/j.otot.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The Coronavirus-19 (COVID-19) pandemic has caused disruptions in the normal patient care workflow, necessitating adaptations within the healthcare profession. The objective of this article is to outline some of these adaptations and considerations necessitated by COVID-19 within the subspeciality of rhinology and endoscopic skull base surgery.
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Affiliation(s)
- Rushi Patel
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Christina H Fang
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, New York
| | - Jordon G Grube
- Division of Otolaryngology, Albany Medical College, Albany, New York
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center - RWJ Barnabas Health, Livingston, New Jersey
| | - Wayne D Hsueh
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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21
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Chronic Rhinosinusitis and COVID-19. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1423-1432. [PMID: 35307579 PMCID: PMC8926942 DOI: 10.1016/j.jaip.2022.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic has raised awareness about olfactory dysfunction, although a loss of smell was present in the general population before COVID-19. Chronic rhinosinusitis (CRS) is a common upper airway chronic inflammatory disease that is also one of the most common causes of olfactory dysfunction. It can be classified into different phenotypes (ie, with and without nasal polyps) and endotypes (ie, type 2 and non-type 2 inflammation). However, scientific information regarding CRS within the context of COVID-19 is still scarce. This review focuses on (1) the potential effects of severe acute respiratory syndrome coronavirus 2 infection on CRS symptoms, including a loss of smell, and comorbidities; (2) the pathophysiologic mechanisms involved in the olfactory dysfunction; (3) CRS diagnosis in the context of COVID-19, including telemedicine; (4) the protective hypothesis of CRS in COVID-19; and (5) the efficacy and safety of therapeutic options for CRS within the context of COVID-19.
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22
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Hussein K, Geoghegan A, Hassan M, Moore M. The impact of COVID-19 on neurosurgical theatre activity in the National Neurosurgical Centre of Ireland. Ir J Med Sci 2022; 192:823-827. [PMID: 35593997 DOI: 10.1007/s11845-022-03028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The global healthcare activity including neurosurgical services has been significantly impacted by the COVID-19 pandemic. AIM Compare neurosurgical theatre activity from 2019 (pre-pandemic) to that of the subsequent pandemic years (2020-2021) and explore how each wave of COVID-19 infection impacted activity levels. METHODS A retrospective analysis of neurosurgical theatre activity at the National Neurosurgical Centre of Ireland was performed from 1 January 2019 till 31 December 2021. The extracted data included date, surgical procedure, demographics of the patient and case scheduling (elective or emergency). RESULTS In total, 6139 neurosurgical procedures were recorded throughout the study period. Two thousand one hundred forty-four neurosurgical procedures were recorded in 2019, 2052 in 2020 and 1943 in 2021 corresponding to a reduction in theatre activity by 4.3% and 9.4% in 2020 and 2021 respectively. The lowest number of monthly caseloads was recorded in April 2020 during the first wave of the pandemic. The first quarter of 2021 recorded the lowest number of quarterly surgical procedures over the entire 3-year period contributing to just 19.4% of 2021 caseload. Subgroup analysis showed a significant reduction in trans-sphenoidal pituitary surgeries post-pandemic by 36% and 44% in 2020 and 2021 respectively. CONCLUSIONS Despite the exceptional stress imposed on our institution by COVID-19, the neurosurgical service managed to maintain comparable activity levels to 2019. The 2021 activity levels were more significantly impacted with 9.4% reduction when compared with pre-pandemic figures in 2019. Institutions need to develop a robust emergency plan to reduce the impact of any subsequent pandemics on healthcare delivery.
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Affiliation(s)
- Kareem Hussein
- Department of Anaesthesia, Beaumont Hospital, Dublin, Ireland.
| | - Aoife Geoghegan
- Department of Anaesthesia, Beaumont Hospital, Dublin, Ireland
| | - Mohammed Hassan
- Department of Anaesthesia, Beaumont Hospital, Dublin, Ireland
| | - Michael Moore
- Department of Anaesthesia, Beaumont Hospital, Dublin, Ireland
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23
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Loizidou A, Tatla TS, Harvey I, Aibibula M, Roe J, Sethi N, Schilder AGM. COVID-VU - ENT-UK national survey of flexible nasendoscopy in the upper aerodigestive tract amidst the COVID-19 pandemic. BMC Health Serv Res 2022; 22:625. [PMID: 35534827 PMCID: PMC9083478 DOI: 10.1186/s12913-021-07416-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 12/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Flexible nasendoscopy (FNE) is an invaluable multi-disciplinary tool for upper aerodigestive tract (UADT) examination. During the COVID-19 pandemic concerns were raised that FNE had the potential of generating aerosols resulting in human cross-contamination when performed on SARS-COV2 carriers. In the UK, and other European countries, national guidelines were issued restricting FNE to essential cases. We surveyed ENT-UK members and Royal College of Speech and Language Therapists (RCSLT) members to determine the impact of the COVID-19 pandemic (first peak) on FNE practice in the UK. Methods An observational internet-based survey constructed in accordance to the CHERRIES checklist and setup in SurveyMonkey of FNE practice amongst UK-based ENT surgeons and speech and language therapists in community clinics, the outpatient department, inpatient wards, ICU, emergency department and operating theatres (through the NHS and private sector) prior to, during and following the first COVID-19 wave in the UK. Results 314 responses collected (24% response rate), 82% from ENT clinicians, 17% from SLTs and 1% from other allied healthcare professionals. Overall, there has been a large reduction in the volume and indications for FNE during the first peak of the COVID-19 pandemic with limited recovery by mid-August 2020. Cancer and airway assessments were impacted less. A wide range of FNE protocols influenced by local factors are reported, varying in endoscope preference, Personal Protective Equipment (PPE) and sterilization methods. Where dedicated Aerosol Generating Procedure (AGP) rooms were unavailable, clinicians resorted to window opening and variable room “down-time” between patients. Endoscope preference reflected availability and user familiarity, ENT trainees favoring the use of single-use video endoscopes. Conclusion Despite national guidance, local practice of FNE remains interrupted and highly variable in the UK. A collaborative inter-disciplinary approach is required to re-introduce FNE safely in volume across healthcare settings, re-establishing timely endoscopic diagnosis and pre-pandemic levels of patient care.
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Affiliation(s)
- Avgi Loizidou
- Deptment of ENT-Head & Neck Surgery, London North West University Healthcare NHS Trust, London, Harrow, HA1 3UJ, UK.
| | - Taranjit Singh Tatla
- Deptment of ENT-Head & Neck Surgery, London North West University Healthcare NHS Trust, London, Harrow, HA1 3UJ, UK
| | - Ian Harvey
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Miriayi Aibibula
- Ambu Limited, Incubator 2, Alconbury Weald Enterprise Campus, Alconbury Weald, Cambridgeshire, PE28 4XA, UK
| | - Justin Roe
- Department of Speech, Voice and Swallowing, The Royal Marsden NHS Foundation Trust, London, UK.,National Centre for Airway Reconstruction, Department of Otolaryngology, Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Neeraj Sethi
- Dept of Otolaryngology-Head & Neck Surgery, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Anne G M Schilder
- evidENT, Ear Institute, University College London, London, UK.,National Institute for Health Research University College London Biomedical Research Centre, London, UK
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24
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Tüzemen G, Tüzemen NÜ. Particle scattering during otolaryngological examinations. Am J Otolaryngol 2022; 43:103358. [PMID: 34973663 DOI: 10.1016/j.amjoto.2021.103358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE We aimed to analyze particle scattering during common otolaryngology examination procedures which are associated with aerosol-generating procedures. MATERIALS AND METHODS This study was conducted with 109 volunteer patients who have participated between October 2020 and January 2021. We measured aerosol and droplet production during oropharyngeal examination, anterior rhinoscopy, rigid nasopharyngoscopy, and rigid laryngoscopy. Measurements were calculated at the beginning of the examinations and during the otolaryngological examination procedures. RESULTS There was no significant increase when we compared the particle scattering in each examination procedure with the basal measurements. But at the end of all examination methods for each patient, there was a significant increase at each micrometer. When all examination methods are compared with each other, particle increases in the oropharyngeal examination with larger particle sizes than 0,5 μm were found to be higher than other examination methods. We analyzed six patients' measurements, who coughed, gagged, or sneezed during the nasal endoscopy procedure, there was a significant increase in terms of 0,3 μm particle scattering. CONCLUSION When all examination methods are performed together, there is a significant particle increase in all particle sizes in the examination room at the end of the examinations. This causes otolaryngologists to be exposed to a significant particle increase at each micrometer. Because of this reason, otolaryngologists should be careful and should wear personal protective equipment while examining patients.
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Affiliation(s)
- Gökhan Tüzemen
- Mınıstry of Health, Bursa City Hospital, Department of Otorhinolaryngology- Head and Neck Surgery, Bursa, Turkey.
| | - Nazmiye Ülkü Tüzemen
- Faculty of Medicine, Department of Medical Microbiology, Bursa Uludag University, Bursa, Turkey
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25
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Practice Patterns in Surgical Neuro-Oncology Among Low- and Middle-Income Countries During the Coronavirus Disease 2019 Pandemic: A Scoping Review and Situational Report from the Philippines. World Neurosurg 2022; 159:189-197.e7. [PMID: 34902600 PMCID: PMC8709263 DOI: 10.1016/j.wneu.2021.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has negatively affected the outcomes of surgical neuro-oncology patients worldwide. We aimed to review the practice patterns in surgical neuro-oncology in low- and middle-income countries (LMICs). We also present a situational report from our own country. METHODS A scoping review was performed following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. RESULTS Twelve studies were included in the review. Most of the studies were from Asia (India, China, Iran, and Turkey), and 1 was from Brazil. Quantitative reports showed a decrease in the number of surgical neuro-oncology operations between pre-COVID-19 and post-COVID-19 time frames, but similar proportions of neuro-oncology procedures. Qualitative review showed similar practice patterns between LMICs and high-income countries, except for limitations in resources such as negative-pressure operating rooms and intensive care units, and maintenance of face-to-face consults despite the adoption of telemedicine. Limited data on adjuvant therapy were available in LMICs. CONCLUSIONS In our review, we found that the practice patterns in surgical neuro-oncology in LMICs during the COVID-19 pandemic are similar to those in high-income countries, except for a few modifications because of resource limitation and patient preferences.
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26
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Gandham EJ, Goyal-Honavar A, Johnson LR, Gupta A, Thomas R, Devasahayam SR, Prabhu K, Chacko AG. A negative-pressure face-mounted system reduces aerosol spread during endonasal endoscopic surgery. J Neurol Surg B Skull Base 2022; 84:217-224. [PMID: 37187478 PMCID: PMC10171932 DOI: 10.1055/a-1774-6091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/14/2022] [Indexed: 10/19/2022] Open
Abstract
Purpose: As there is a potential risk of Covid-19 transmission during endonasal surgery we studied methods to reduce droplet and aerosol generation during these procedures.
Methods: Droplet spread was assessed using ultraviolet light and a camera that detected fluorescence in the operative field and surgeon’s personal protective equipment. Density of aerosols sized <10µ was measured using a photometric particle counter. We designed a face-mounted negative-pressure mask placed on the patients face during endoscopic endonasal surgery. Sixteen patients were recruited between October 2020 to March 2021 and randomly assigned to the mask and no-mask groups. We compared droplet spread and aerosols generated in both groups, with copious irrigation and continuous suction during drilling forming the mainstay of surgical technique in all cases.
Results: Droplet contamination due to direct spillage of fluorescein from the syringe was noted in two patients. Aerosol density rose during sphenoid drilling in both groups, with no significant difference when continuous suction and irrigation were employed (1.27 times vs. 1.07 times the baseline, p=0.248). Aerosol density rose significantly when suction and irrigation were interrupted in the no-mask group (44.9 times vs. 1.2 times, p=0.028), which was not seen when the mask was used.
Conclusions: Aerosol generation increases during drilling in endonasal procedures and is a concern during this pandemic. The use of a rigid suction close to the drill along with copious irrigation is effective in reducing aerosol spread. The use of a negative pressure mask provides additional safety when inadvertent blockage of suction and inadequate irrigation occur.
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Affiliation(s)
| | | | | | - Ankush Gupta
- Neurosurgery, Christian Medical College and Hospital Vellore, Vellore, India
| | - Regi Thomas
- Department of Otorhinolaryngology, Christian Medical College and Hospital Vellore, Vellore, India
| | | | - Krishna Prabhu
- Neurosurgery, Christian Medical College and Hospital Vellore, Vellore, India
| | - Ari George Chacko
- Neurosurgery, Christian Medical College and Hospital Vellore, Vellore, India
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Kosugi EM, Villa JF, Ramos HF, Luz-Matsumoto GR, Serrano TLI, Campos CACD, Barreto CC, Lima CM, Fornazieri MA, Piltcher O, Lessa MM, Romano FR. Safety for the Rhinologist in the Age of COVID-19: Mask Use, Nasal Corticosteroids, Saline Irrigation, and Endoscopic Procedures – Literature Review. Int Arch Otorhinolaryngol 2022; 26:e137-e147. [PMID: 35096171 PMCID: PMC8789504 DOI: 10.1055/s-0041-1740988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 09/23/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction
Coronavirus disease 2019 (COVID-19) has claimed millions of lives. Adequate protection of the professionals involved in patient care is essential in the battle against this disease. However, there is much uncertainty involving safety-relarted topics that are of particular interest to the rhinologist in the context of COVID-19.
Objective
To evaluate the current evidence regarding three safety-related topics: mask and respirator use, performance of nasal endoscopic procedures, and use of topical nasal and intranasal medications (saline irrigation and nasal corticosteroids).
Methods
A literature review was performed on the PubMed, Scopus, and Cochrane databases, with standardized search queries for each of the three topics of interest.
Results
In total, 13 articles on mask use, 6 articles on the safety of nasal corticosteroids, 6 articles on the safety of nasal endoscopic procedures, and 1 article on nasal irrigation with saline solution were included in the final analysis.
Conclusion
N95 respirators are essential for the adequate protection of otolaryngologists. If reuse is necessary, physical methods of sterilization must be employed. No evidence was found to contraindicate the use of nasal corticosteroids, whether acute (in the management of sinonasal inflammatory conditions) or continued (in patients who use them chronically). Nasal irrigation with saline solution apparently does not increase the risk in the context of COVID-19. Nasal endoscopic procedures should only be performed after testing the patient for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the surgical team must wear full personal protective equipment to prevent aerosol exposure.
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Affiliation(s)
| | | | - Henrique Faria Ramos
- Scientific Committee, Academia Brasileira de Rinologia (ABR), São Paulo, SP, Brazil
| | | | | | | | | | - Clara Mônica Lima
- Scientific Committee, Academia Brasileira de Rinologia (ABR), São Paulo, SP, Brazil
| | | | - Otavio Piltcher
- Scientific Committee, Academia Brasileira de Rinologia (ABR), São Paulo, SP, Brazil
| | - Marcus Miranda Lessa
- Scientific Committee, Academia Brasileira de Rinologia (ABR), São Paulo, SP, Brazil
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Lee M, Rivera-Rosario HT, Kim MH, Bewley GP, Wang J, Warhaft Z, Stylman B, Park AI, MacMahon A, Kacker A, Schwartz TH. Development and validation of a patient face-mounted, negative-pressure antechamber for reducing exposure of healthcare workers to aerosolized particles during endonasal surgery. J Neurosurg 2021; 135:1825-1832. [PMID: 33990082 DOI: 10.3171/2020.10.jns202745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/13/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors developed a negative-pressure, patient face-mounted antechamber and tested its efficacy as a tool for sequestering aerated particles and improving the safety of endonasal surgical procedures. METHODS Antechamber prototyping was performed with 3D printing and silicone-elastomer molding. The lowest vacuum settings needed to meet specifications for class I biosafety cabinets (flow rate ≥ 0.38 m/sec) were determined using an anemometer. A cross-validation approach with two different techniques, optical particle sizing and high-speed videography/shadowgraphy, was used to identify the minimum pressures required to sequester aerosolized materials. At the minimum vacuum settings identified, physical parameters were quantified, including flow rate, antechamber pressure, and time to clearance. RESULTS The minimum tube pressures needed to meet specifications for class I biosafety cabinets were -1.0 and -14.5 mm Hg for the surgical chambers with ("closed face") and without ("open face") the silicone diaphragm covering the operative port, respectively. Optical particle sizing did not detect aerosol generation from surgical drilling at these vacuum settings; however, videography estimated higher thresholds required to contain aerosols, at -6 and -35 mm Hg. Simulation of surgical movement disrupted aerosol containment visualized by shadowgraphy in the open-faced but not the closed-faced version of the mask; however, the closed-face version of the mask required increased negative pressure (-15 mm Hg) to contain aerosols during surgical simulation. CONCLUSIONS Portable, negative-pressure surgical compartments can contain aerosols from surgical drilling with pressures attainable by standard hospital and clinic vacuums. Future studies are needed to carefully consider the reliability of different techniques for detecting aerosols.
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Affiliation(s)
- Mark Lee
- 1Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York
| | | | - Matthew H Kim
- 1Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York
| | - Gregory P Bewley
- 2Department of Mechanical and Aerospace Engineering, Cornell University, Ithaca; and
| | - Jane Wang
- 2Department of Mechanical and Aerospace Engineering, Cornell University, Ithaca; and
| | - Zellman Warhaft
- 2Department of Mechanical and Aerospace Engineering, Cornell University, Ithaca; and
| | | | | | - Aoife MacMahon
- 1Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York
| | - Ashutosh Kacker
- 1Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York
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Abdala Vargas N, Ordóñez Rubiano EG, Rueda Esteban R, Bigio Roitman D, Sánchez Rentería S, Pinzón Navarro M. Desarrollo de una máscara de bajo costo para prevenir la propagación de aerosoles en endoscopia endonasal en la base del cráneo durante la pandemia del COVID-19. REPERTORIO DE MEDICINA Y CIRUGÍA 2021. [DOI: 10.31260/repertmedcir.01217372.1286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo: desarrollar una máscara que sea reutilizable, esterilizable, fácil de usar y económica para reducir los riesgos de transmisión del COVID-19 durante los procedimientos endoscópicos endonasales. Métodos: modelo diseñado en Autodesk Fusion 360 y Meshmixer, construido con ácido poliláctico (PLA) utilizando una impresora 3D (PRUSA IK3 MK3s, Praga, República Checa) en el laboratorio de Anatomía de la Universidad de los Andes, Bogotá, Colombia. Se ajustaron tres orificios a la mascarilla, uno para el tubo endotraqueal, otro más grande en el medio para la instrumentación quirúrgica que permite la adaptación de una membrana translúcida estéril y el superior para adaptar la punta de la succión y generar un ambiente de presión negativa dentro de la máscara. Se utilizó un colchón de silicona y tres puntos para sujetar tiras y crear un ajuste a la cabeza durante largos períodos sin causar lesiones en la piel. Se realizaron diferentes pruebas, incluida la verificación con luz ultravioleta de la propagación de la fluoresceína después de la perforación ósea, la esterilización química y por calor de la máscara, y la succión de los aerosoles producidos al fumar un cigarrillo electrónico. Ambiente: laboratorio experimental. Resultados: las pruebas demostraron una reducción del efecto aerosol y de la dispersión de las gotas cuando se usa la máscara ventilada. Se consiguió una excelente maniobrabilidad y libertad. Sin embargo, fue limitado en términos de visualización durante la entrada nasal de los instrumentos al cráneo. Conclusiones: los resultados preliminares muestran que esta máscara ventilada permite una barrera quirúrgica para disminuir la transmisión del SARS-COV-2 durante los procedimientos endoscópicos endonasales.
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Sudhan MD, Singh RK, Yadav R, Sivasankar R, Mathai SS, Shankaran R, Kulkarni SN, Shanthanu CP, Sandhya LM, Shaikh A. Neurosurgical Outcomes, Protocols, and Resource Management During Lockdown: Early Institutional Experience from One of the World's Largest COVID 19 Hotspots. World Neurosurg 2021; 155:e34-e40. [PMID: 34325030 PMCID: PMC8312048 DOI: 10.1016/j.wneu.2021.07.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND As the COVID-19 pandemic surpasses 1 year, it is prudent to reflect on the challenges faced and the management strategies employed to tackle this overwhelming health care crisis. We undertook this study to validate our institutional protocols, which were formulated to cater to the change in volume and pattern of neurosurgical cases during the raging pandemic. METHODS All admitted patients scheduled to undergo major neurosurgical intervention during the lockdown period (15 March 2020 to 15 September 2020) were included in the study. The data involving surgery outcomes, disease pattern, anesthesia techniques, patient demographics, as well as COVID-19 status, were analyzed and compared with similar retrospective data of neurosurgical patients operated during the same time period in the previous year (15 March 2019 to 15 September 2019). RESULTS Barring significant increase in surgery for stroke (P = 0.008) and hydrocephalus (P <0.001), the overall case load of neurosurgery during the study period in 2020 was 42.75% of that in 2019 (P < 0.001), attributable to a significant reduction in elective spine surgeries (P < 0.001). However, no significant difference was observed in the overall incidence of emergency and essential surgeries undertaken during the 2 time periods (P = 0.482). There was an increased incidence in the use of monitored anesthesia care techniques during emergency and essential neurosurgical procedures by the anesthesia team in 2020 (P < 0.001). COVID-19 patients had overall poor outcomes (P = 0.003), with significant increase in mortality among those subjected to general anesthesia vis-a-vis monitored anesthesia care (P = 0.014). CONCLUSIONS Despite a significant decrease in neurosurgical workload during the COVID-19 lockdown period in 2020, the volume of emergency and essential surgeries did not change much compared with the previous year. Surgery in COVID-19 patients is best avoided, unless critical, as the outcome in these patients is not favorable. The employment of monitored anesthesia care techniques like awake craniotomy and regional anesthesia facilitate a better outcome in the ongoing COVID-19 era.
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Affiliation(s)
| | | | - Rahul Yadav
- Department of Neuroanaesthesiology, INHS Asvini, Colaba, Mumbai, India.
| | - Rajeev Sivasankar
- Department of Radiodiagnosis and Interventional Radiology, INHS Asvini, Colaba, Mumbai, India
| | - Sheila Samanta Mathai
- Commanding Officer and Chairperson, COVID-19 Protocol Committee, INHS Asvini, Colaba, Mumbai, India
| | - Ramakrishnan Shankaran
- Department of Surgery and Senior Member, COVID-19 Protocol Committee, INHS Asvini, Colaba, Mumbai, India
| | | | | | | | - Azimuddin Shaikh
- Department of Neuroanaesthesiology, INHS Asvini, Colaba, Mumbai, India
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31
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Hara T, Zachariah MA, Li R, Martinez-Perez R, Carrau RL, Prevedello DM. Suction mask device: a simple, inexpensive, and effective method of reducing spread of aerosolized particles during endoscopic endonasal surgery in the era of COVID-19. J Neurosurg 2021; 135:1328-1334. [PMID: 33892478 DOI: 10.3171/2020.10.jns203196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Aerosol-generating procedures, including endoscopic endonasal surgery (EES), are a major risk for physicians during the COVID-19 pandemic. Techniques for reducing aerosolization and risk of transmission of COVID-19 during these procedures would be valuable to the neurosurgical community. The authors aimed to simulate the generation of small-particle aerosols during EES and craniectomy in order to develop methods to reduce the spread of aerosolized particles, and to test the effectiveness of these methods. METHODS This study was performed at the Anatomical Laboratory for Visuospatial Innovations in Otolaryngology and Neurosurgery at The Ohio State University. The following two scenarios were used to measure three different particle sizes (0.3, 2.5, and 10 µm) generated: 1) drilling frontotemporal bone, simulating a craniectomy; and 2) drilling sphenoid bone, simulating an endonasal approach. A suction mask device was created with the aim of reducing particle release. The presence of particles was measured without suction, with a single Frazier tip suction in the field, and with the suction mask device in addition to the Frazier suction tip. Particles were measured 12 cm from the craniectomy or endonasal drilling region. RESULTS In the absence of any aerosol-reducing devices, the number of particles measured during craniectomy was significantly higher than that generated by endonasal drilling. This was true regardless of the particle size measured (0.3 µm, p < 0.001; 2.5 µm, p < 0.001; and 10 µm, p < 0.001). The suction mask device reduced the release of particles of all sizes measured in the craniectomy simulation (0.3 µm, p < 0.001; 2.5 µm, p < 0.001; and 10 µm, p < 0.001) and particles of 0.3 µm and 2.5 µm in the single Frazier suction simulation (0.3 µm, p = 0.031; and 2.5 µm, p = 0.026). The suction mask device further reduced the release of particles of all sizes during EES simulation (0.3 µm, p < 0.001; and 2.5 µm, p < 0.001) and particles of 0.3 µm and 2.5 µm in the single Frazier suction simulation (0.3 µm, p = 0.033; and 2.5 µm, p = 0.048). Large particles (10 µm) were not detected during EES. CONCLUSIONS The suction mask device is a simple and effective means of reducing aerosol release during EES, and it could potentially be used during mastoidectomies. This could be a valuable tool to reduce the risk of procedure-associated viral transmission during the COVID-19 pandemic.
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Affiliation(s)
- Takuma Hara
- Departments of1Neurosurgery and
- 4Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Marcus A Zachariah
- 3Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi; and
| | | | | | - Ricardo L Carrau
- Departments of1Neurosurgery and
- 2Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Daniel M Prevedello
- Departments of1Neurosurgery and
- 2Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
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Arteaga AA, Tran J, Frey H, Lewis AF. Rapidly Progressive Complicated Acute Bacterial Sinusitis in the Setting of Severe Pediatric SARS-CoV-2 Infection. Ann Otol Rhinol Laryngol 2021; 131:1158-1163. [PMID: 34706569 DOI: 10.1177/00034894211055337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This case report presents a case of a rapidly progressive complicated sinus infection in a child with the multisystem inflammatory syndrome in children. METHODS Case report with literature review. RESULTS/CASE REPORT We present a novel case of severe rapidly progressive complicated sinusitis in a 14-year-old African American male diagnosed with the multisystem inflammatory syndrome in children. Infection was caused by an aggressive pathogen, Streptococcus intermedius (anginosus), and within 48 hours progressed to orbital, subgaleal, and intracranial abscess, requiring multidisciplinary intervention by ophthalmology, neurosurgery, and otolaryngology. Following surgical intervention and a 4-week course of intravenous antibiotic therapy, the patient had resolution of the infection with no neurologic sequelae. CONCLUSION Despite the low incidence of multisystem inflammatory syndrome in children, physicians should be aware that immunologic changes and the cytokine storm induced by severe acute respiratory syndrome coronavirus 2 can potentially predispose patients to severe bacterial or opportunistic infections. As more cases of MIS-C develop, associated complications can become evident. Similar cases of SARS-CoV-2 and severe bacterial sinusitis have been published in the literature, but it remains unclear if there is an association between SARS-CoV-2 disease and an increased risk of complicated sinusitis in children.
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Affiliation(s)
- Alberto A Arteaga
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jessica Tran
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Hudson Frey
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Andrea F Lewis
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS, USA
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Matos S, Sharma A, Crosby D. Objective Assessment of Aerosolization During Transnasal Endoscopy: A Systematic Review. Otolaryngol Head Neck Surg 2021; 167:417-424. [PMID: 34637376 DOI: 10.1177/01945998211050632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The goal of this systematic review is to assimilate the literature on objective assessment of particulate aerosolization during transnasal endoscopic procedures. DATA SOURCES PubMed and hand-searched articles. REVIEW METHODS The PubMed electronic database was searched using Medical Subject Headings and free-text search terms relating to aerosolization and transnasal endoscopic procedures from inception to November 16, 2020. References were hand-searched to identify additional publications for consideration. Inclusion in the systematic review required quantification of aerosol generation during clinic transnasal endoscopic procedures. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and flowchart were followed during the systematic review. RESULTS Eight of 900 studies met criteria for inclusion in the systematic review. Five studies tested nasal endoscopy with mixed findings on the risk of aerosol generation during this procedure. Two studies assessed flexible fiberoptic laryngoscopy and also reported mixed findings. Breathing, sneezing, speech, and spray anesthetic/decongestants were found to consistently increase aerosol generation above baseline. A number of studies tested new and general mitigation strategies and were found to be effective in decreasing aerosol generation. CONCLUSIONS The coronavirus disease 2019 pandemic has informed many considerations regarding patient and provider safety. It is valuable to understand the risk during outpatient otolaryngology procedures through the quantification of aerosolization. There are several effective methods to control aerosolization during these procedures. The findings of this systematic review will inform appropriate precautions to protect against spread of infectious agents by aerosolization.
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Affiliation(s)
- Sophia Matos
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Arun Sharma
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University School of Medicine, Illinois, USA
| | - Dana Crosby
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University School of Medicine, Illinois, USA
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Microdebrider is less aerosol-generating than CO 2 laser and cold instruments in microlaryngoscopy. Eur Arch Otorhinolaryngol 2021; 279:825-834. [PMID: 34623498 PMCID: PMC8498765 DOI: 10.1007/s00405-021-07105-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022]
Abstract
Objective COVID-19 spreads through aerosols produced in coughing, talking, exhalation, and also in some surgical procedures. Use of CO2 laser in laryngeal surgery has been observed to generate aerosols, however, other techniques, such cold dissection and microdebrider, have not been sufficiently investigated. We aimed to assess whether aerosol generation occurs during laryngeal operations and the effect of different instruments on aerosol production. Methods We measured particle concentration generated during surgeries with an Optical Particle Sizer. Cough data collected from volunteers and aerosol concentration of an empty operating room served as references. Aerosol concentrations when using different techniques and equipment were compared with references as well as with each other. Results Thirteen laryngological surgeries were evaluated. The highest total aerosol concentrations were observed when using CO2 laser and these were significantly higher than the concentrations when using microdebrider or cold dissection (p < 0.0001, p < 0.0001) or in the background or during coughing (p < 0.0001, p < 0.0001). In contrast, neither microdebrider nor cold dissection produced significant concentrations of aerosol compared with coughing (p = 0.146, p = 0.753). In comparing all three techniques, microdebrider produced the least aerosol particles. Conclusions Microdebrider and cold dissection can be regarded as aerosol-generating relative to background reference concentrations, but they should not be considered as high-risk aerosol-generating procedures, as the concentrations are low and do not exceed those of coughing. A step-down algorithm from CO2 laser to cold instruments and microdebrider is recommended to lower the risk of airborne infections among medical staff.
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Chen DA, Lee M, Lelli GJ, Kacker A. Evaluation of the aerosol generating potential of endoscopic dacryocystorhinostomy. Laryngoscope Investig Otolaryngol 2021; 6:948-951. [PMID: 34667836 PMCID: PMC8513416 DOI: 10.1002/lio2.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/29/2021] [Accepted: 08/08/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The COVID-19 pandemic gave rise to renewed concerns of the transmission risks posed by surgeries on sites of high viral colonization such as the nasopharynx. Endoscopic dacryocystorhinostomy (DCR) involves the creation of a new tear duct from the lacrimal sac to the nasal cavity. The purpose of this project is to determine if endoscopic DCR is an aerosol generating procedure (AGP). METHODS An optical particle sizer (OPS) was used to intraoperatively quantify aerosol concentrations during four cases of endoscopic DCR. The OPS sampled the air once every 60 seconds throughout the operations. The time of important operative steps were documented and correlated with OPS readings. Particle concentrations during each major surgical step were compared to baseline readings by the Mann Whitney U Test. RESULTS There were statistically significant increases in median particle concentrations during laryngeal mask airway intubations for both particles 0.3 to 5.0 μm and >5.0 μm (P < .001 and P = .023, respectively). Median particle concentrations during nasolacrimal duct probing, middle meatal debridement, drilling, balloon insertion, tube insertion, and Posisef insertion were not statistically different from baseline. CONCLUSIONS Endoscopic DCR in itself does not appear to be an AGP. It is, however, associated with other aerosol generating events such as laryngeal mask intubation, and thus requires appropriate personal protective equipment. Cautious interpretation of the results is encouraged given the limitations of OPS. LEVEL OF EVIDENCE 4.
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Affiliation(s)
| | - Mark Lee
- Weill Cornell Medicine OtolaryngologyNew YorkNew YorkUSA
| | - Gary J. Lelli
- Weill Cornell Medicine OphthalmologyNew YorkNew YorkUSA
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Wilson J, Carson G, Fitzgerald S, Llewelyn MJ, Jenkins D, Parker S, Boies A, Thomas J, Sutcliffe K, Sowden AJ, O'Mara-Eves A, Stansfield C, Harriss E, Reilly J. Are medical procedures that induce coughing or involve respiratory suctioning associated with increased generation of aerosols and risk of SARS-CoV-2 infection? A rapid systematic review. J Hosp Infect 2021; 116:37-46. [PMID: 34245806 PMCID: PMC8264274 DOI: 10.1016/j.jhin.2021.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The risk of transmission of SARS-CoV-2 from aerosols generated by medical procedures is a cause for concern. AIM To evaluate the evidence for aerosol production and transmission of respiratory infection associated with procedures that involve airway suctioning or induce coughing/sneezing. METHODS The review was informed by PRISMA guidelines. Searches were conducted in PubMed for studies published between January 1st, 2003 and October 6th, 2020. Included studies examined whether nasogastric tube insertion, lung function tests, nasendoscopy, dysphagia assessment, or suctioning for airway clearance result in aerosol generation or transmission of SARS-CoV-2, SARS-CoV, MERS, or influenza. Risk of bias assessment focused on robustness of measurement, control for confounding, and applicability to clinical practice. FINDINGS Eighteen primary studies and two systematic reviews were included. Three epidemiological studies found no association between nasogastric tube insertion and acquisition of respiratory infections. One simulation study found low/very low production of aerosols associated with pulmonary lung function tests. Seven simulation studies of endoscopic sinus surgery suggested significant increases in aerosols but findings were inconsistent; two clinical studies found airborne particles associated with the use of microdebriders/drills. Some simulation studies did not use robust measures to detect particles and are difficult to equate to clinical conditions. CONCLUSION There was an absence of evidence to suggest that the procedures included in the review were associated with an increased risk of transmission of respiratory infection. In order to better target precautions to mitigate risk, more research is required to determine the characteristics of medical procedures and patients that increase the risk of transmission of SARS-CoV-2.
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Affiliation(s)
- J Wilson
- Richard Wells Research Centre, University of West London, London, UK.
| | - G Carson
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - S Fitzgerald
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - M J Llewelyn
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - D Jenkins
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - S Parker
- Defence Science and Technology Laboratory, Porton Down, Salisbury, UK
| | - A Boies
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - J Thomas
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK
| | - K Sutcliffe
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK
| | - A J Sowden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - A O'Mara-Eves
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK
| | - C Stansfield
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK
| | - E Harriss
- Bodleian Health Care Libraries, John Radcliffe Hospital, Oxford, UK
| | - J Reilly
- Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK
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The UK national registry of ENT surgeons with coronavirus disease 2019: one year on. The Journal of Laryngology & Otology 2021; 136:79-81. [PMID: 34593060 PMCID: PMC8632415 DOI: 10.1017/s0022215121002644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To report the one-year findings of the UK national registry of ENT surgeons with suspected or confirmed coronavirus disease 2019, and the results of a survey on the coronavirus disease 2019 experience of UK ENT trainees. METHOD An online registry was created in April 2020. A separate survey was circulated electronically to all members of the Association of Otolaryngologists in Training. RESULTS The registry recorded 98 clinicians with confirmed or suspected coronavirus disease 2019. The majority of infections were reported in the first wave of spring 2020. Two ENT surgeons were hospitalised and one died. The majority suspected workplace exposure, with a significant proportion attributing this to a lack of personal protective equipment at a time before formal guidance had been introduced. Of the ENT trainees surveyed, almost one-third believed that they had contracted coronavirus disease 2019. CONCLUSION This highlights the importance of ongoing risk-reduction measures, including optimal personal protective equipment and vaccination.
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Murr AT, Bacon DR, Onuorah PC, Zeatoun A, Morse JC, Miller C, Thorp BD, Zanation AM, Ebert CS, Kimple AJ, Senior BA. Effect of nasal suction catheter use on aerosol generation during endoscopic sinus surgery. Int Forum Allergy Rhinol 2021; 11:1494-1496. [PMID: 34021534 DOI: 10.1002/alr.22812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/05/2021] [Accepted: 04/14/2021] [Indexed: 01/05/2023]
Affiliation(s)
- Alexander T Murr
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel R Bacon
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Princess C Onuorah
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Abdullah Zeatoun
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Justin C Morse
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Craig Miller
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian D Thorp
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adam M Zanation
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Charles S Ebert
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brent A Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Workman AD, Varvares MA, Bhattacharyya N. Rate of COVID-19 Infection in Patients Following Otolaryngology vs Non-otolaryngology Outpatient Encounters. Otolaryngol Head Neck Surg 2021; 167:266-267. [PMID: 34582288 DOI: 10.1177/01945998211049702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Routine outpatient otolaryngology visits have been identified as potential vectors for increased transmission of COVID-19 relative to other medical encounters. This is in part due to the inability of patients to mask during comprehensive otolaryngology examination and potential propensity for aerosolization during upper airway procedures, including endoscopy and nasopharyngoscopy. Using a matched-cohort sampling of >20,000 patients seen between April 2020 and January 2021, we found no increased rate of postvisit COVID-19 positivity following an in-office otolaryngology encounter relative to other non-otolaryngology outpatient encounters. This suggests that the perceived elevated risk of provider-to-patient and patient-to-patient transmission during outpatient otolaryngologic care may be unfounded.
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Affiliation(s)
- Alan D Workman
- Department of Otolaryngology, Massachusetts Eye & Ear, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye & Ear, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Neil Bhattacharyya
- Department of Otolaryngology, Massachusetts Eye & Ear, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Russo F, Valentini M, Sabatino D, Cerati M, Facco C, Battaglia P, Turri-Zanoni M, Castelnuovo P, Karligkiotis A. Aerosolization risk during endoscopic transnasal surgery: a prospective qualitative and quantitative microscopic analysis of particles spreading in the operating room. J Neurosurg 2021; 136:822-830. [PMID: 34534965 DOI: 10.3171/2021.3.jns204415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/29/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic represents the greatest public health emergency of this century. The primary mode of viral transmission is droplet transmission through direct contact with large droplets generated during breathing, talking, coughing, and sneezing. However, the virus can also demonstrate airborne transmission through smaller droplets (< 5 μm in diameter) generated during various medical procedures, collectively termed aerosol-generating procedures. The aim of this study was to analyze droplet contamination of healthcare workers and splatter patterns in the operating theater that resulted from endoscopic transnasal procedures in noninfected patients. METHODS A prospective nonrandomized microscopic evaluation of contaminants generated during 10 endoscopic transnasal procedures performed from May 14 to June 11, 2020, in the same operating theater was carried out. A dilution of monosodium fluorescein, repeatedly instilled through nasal irrigation, was used as a marker of contaminants generated during surgical procedures. Contaminants were collected on detectors worn by healthcare workers and placed in standard points in the operating theater. Analysis of number, dimensions, and characteristics of contaminants was carried out with fluorescence microscopy. RESULTS A total of 70 samples collected from 10 surgical procedures were analyzed. Liquid droplets and solid-tissue fragments were identified as contaminants on all detectors analyzed. All healthcare workers appeared to have been exposed to a significant number of contaminants. A significant degree of contamination was observed in every site of the operating room. The mean (range) diameter of liquid droplets was 4.1 (1.0-26.6) μm and that of solid fragments was 23.6 (3.5-263.3) μm. CONCLUSIONS Endoscopic endonasal surgery is associated with the generation of large amounts of contaminants, some of which measure less than 5 μm. All healthcare workers in the surgical room are exposed to a significant and similar risk of contamination; therefore, adequate personal protective equipment should be employed when performing endoscopic endonasal surgical procedures.
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Affiliation(s)
- Federico Russo
- 1Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Marco Valentini
- 1Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,2Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Daniele Sabatino
- 3Division of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; and
| | - Michele Cerati
- 3Division of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; and
| | - Carla Facco
- 3Division of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; and
| | - Paolo Battaglia
- 1Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,2Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,4Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- 1Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,4Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- 1Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,2Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,4Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Apostolos Karligkiotis
- 1Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
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Chhibber A, Kharat A, Kneale D, Welch V, Bangpan M, Chaiyakunapruk N. Assessment of health equity consideration in masking/PPE policies to contain COVID-19 using PROGRESS-plus framework: a systematic review. BMC Public Health 2021; 21:1682. [PMID: 34525995 PMCID: PMC8443429 DOI: 10.1186/s12889-021-11688-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/29/2021] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION There is increasing evidence that COVID-19 has unmasked the true magnitude of health inequity worldwide. Policies and guidance for containing the infection and reducing the COVID-19 related deaths have proven to be effective, however the extent to which health inequity factors were considered in these policies is rather unknown. The aim of this study is to measure the extent to which COVID-19 related policies reflect equity considerations by focusing on the global policy landscape around wearing masks and personal protection equipment (PPE). METHODS A systematic search for published documents on COVID-19 and masks/PPE was conducted across six databases: PubMed, EMBASE, CINAHL, ERIC, ASSIA and Psycinfo. Reviews, policy documents, briefs related to COVID-19 and masks/PPE were included in the review. To assess the extent of incorporation of equity in the policy documents, a guidance framework known as 'PROGRESS-Plus': Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital, Plus (age, disability etc.) was utilized. RESULTS This review included 212 policy documents. Out of 212 policy documents, 190 policy documents (89.62%) included at least one PROGRESS-plus component. Most of the policy documents (n = 163, 85.79%) focused on "occupation" component of the PROGRESS-plus followed by personal characteristics associated with discrimination (n = 4;2.11%), place of residence (n = 2;1.05%) and education (n = 1;0.53%). Subgroup analysis revealed that most of the policy documents (n = 176, 83.01%) were focused on "workers" such as healthcare workers, mortuary workers, school workers, transportation workers, essential workers etc. Of the remaining policy documents, most were targeted towards whole population (n = 30; 14.15%). Contrary to "worker focused" policy documents, most of the 'whole population focused' policy documents didn't have a PROGRESS-plus equity component rendering them equity limiting for the society. CONCLUSION Our review highlights even if policies considered health inequity during the design/implementation, this consideration was often one dimensional in nature. In addition, population wide policies should be carefully designed and implemented after identifying relevant equity related barriers in order to produce better outcomes for the whole society.
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Affiliation(s)
| | - Aditi Kharat
- School of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Dylan Kneale
- The Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), UCL Social Research Institute, University College London, London, UK
| | - Vivian Welch
- Bruyere Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Mukdarut Bangpan
- The Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), UCL Social Research Institute, University College London, London, UK
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, University of Utah, Salt Lake City, UT, USA.
- School of Pharmacy, Monash University, Subang Jaya, Malaysia.
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Williams SP, Leong SC. One year into the COVID-19 pandemic: What do we know so far from studies assessing risk and mitigation of droplet aerosolisation during endonasal surgery? A systematic review. Clin Otolaryngol 2021; 46:1368-1378. [PMID: 34473910 PMCID: PMC8653184 DOI: 10.1111/coa.13854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/26/2021] [Accepted: 08/22/2021] [Indexed: 01/14/2023]
Abstract
Objectives As we pass the anniversary of the declaration of a global pandemic by the World Health Organisation, it invites us to reflect upon the inescapable changes that coronavirus has wrought upon ENT and, in particular, rhinological practice. As it remains unclear when we will emerge from the shadow of COVID‐19, a critical analysis of the evidence base on both the assessment and mitigation of risk is vital for ENT departments worldwide. This article presents a systematic review of the literature examining articles which consider either the quantification of risk or strategies to mitigate risk specifically in the setting of rhinological surgery. Design Systematic literature review. Results The literature search yielded a total of 3406 returns with 24 articles meeting eligibility criteria. A narrative synthesis stratified results into two broad themes: (1) those which made an assessment as to the aerosolisation of droplets during sinus surgery, further sub‐divided into work which considered macroscopically visible droplets and that which considered smaller particles; (2) and those studies which examined the mitigation of this risk. Conclusion Studies considering the aerosolisation of both droplets and smaller particles suggest endonasal surgery carries significant risk. While results both highlight a range of innovative adjunctive strategies and support suction as an important intervention to reduce aerosolisation, appropriate use of personal protective equipment (PPE) should be considered mandatory for all healthcare professionals involved in rhinological surgery. Studies have demonstrated that close adherence to PPE use is effective in preventing COVID‐19 infection.
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Affiliation(s)
- Stephen P Williams
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Samuel C Leong
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Naunheim MR, Bock J, Doucette PA, Hoch M, Howell I, Johns MM, Johnson AM, Krishna P, Meyer D, Milstein CF, Nix J, Pitman MJ, Robinson-Martin T, Rubin AD, Sataloff RT, Sims HS, Titze IR, Carroll TL. Safer Singing During the SARS-CoV-2 Pandemic: What We Know and What We Don't. J Voice 2021; 35:765-771. [PMID: 32753296 PMCID: PMC7330568 DOI: 10.1016/j.jvoice.2020.06.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 01/12/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - John Nix
- University of Texas at San Antonio, San Antonio, TX
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Manzanares‐Céspedes M, Dalmau‐Pastor M, Simon de Blas C, Vázquez‐Osorio MT. Body Donation, Teaching, and Research in Dissection Rooms in Spain in Times of Covid-19. ANATOMICAL SCIENCES EDUCATION 2021; 14:562-571. [PMID: 33891806 PMCID: PMC8250704 DOI: 10.1002/ase.2093] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 04/09/2021] [Accepted: 04/18/2021] [Indexed: 05/09/2023]
Abstract
The state of alarm due to Covid-19 pandemic in Spain stopped all educational and most university research activities. The Spanish Anatomical Society (SAE) Consensus Expert Group on Body Donations piloted a study based on a questionnaire to know the status of body donations and dissection activities during the lockdown, as well as the future implications of Covid-19 pandemic for body donation programs and anatomy teaching. The questionnaire results show that Spanish Universities refused body donations and stopped all dissection research and teaching. The Covid-19 expected influence on anatomy teaching was referred to the increase in teaching workforce and resources required to apply the new safety measures to future practical activities, as well as to prepare and adapt teaching material for online-only programs. The application of reinforced safety measures was expected to be perceived by the respondent's students as a gain in teaching quality, while the transformation of the anatomy courses in online-only programs will be perceived as a quality decrease. The respondent's concerns about future institutional implications of the pandemic were related to increased costs of the adaptation of the facilities and the reinforced preventive measures, as well as the eventual decrease in donations. The complete lockdown applied to dissection rooms was not justified by scientific evidence and represented a break of the confidence deposed in the institutions by the donors. A consensus is required for the adoption of a renewed, comprehensive protocol for present and future body donations including the evidence Covid-19 pandemic has contributed to create.
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Affiliation(s)
- Maria‐Cristina Manzanares‐Céspedes
- Human Anatomy and Embryology UnitDepartment of Pathology and Experimental TherapeuticsFaculty of Medicine and Health SciencesUniversity of BarcelonaBarcelonaSpain
| | - Miki Dalmau‐Pastor
- Human Anatomy and Embryology UnitDepartment of Pathology and Experimental TherapeuticsFaculty of Medicine and Health SciencesUniversity of BarcelonaBarcelonaSpain
- Minimally Invasive Foot and Ankle Society (MIFAS)Group of Research and Study in Minimally Invasive Surgery of the Foot (GRECMIP)MerignacFrance
| | - Clara Simon de Blas
- Department of Statistics and Operations Research, Computer Science SchoolRey Juan Carlos UniversityMadridSpain
| | - María Teresa Vázquez‐Osorio
- Bodies Donation and Dissection Room CenterDepartment of Anatomy and EmbryologyFaculty of MedicineComplutense University of MadridMadridSpain
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Andrews P, Anschuetz L, Baptista PM, Bast F, Beule AG, De Carpentier J, Fitzgerald D, Furtado LMPC, Knox B, Marzetti A, Perkins NW, Randhawa PS. Awake Rhinology Surgery in Response to the COVID-19 Pandemic in Europe. ORL J Otorhinolaryngol Relat Spec 2021; 84:93-102. [PMID: 34464957 PMCID: PMC8450852 DOI: 10.1159/000517155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 05/10/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND European health-care systems are faced with a backlog of surgical procedures following the suspension of routine surgery during the COVID-19 crisis. Routine rhinology surgery under general anaesthetic (GA) is now faced with significant challenges which include limited theatre capacity, the negative ramifications of surgical prioritization, reduced patient throughput in secondary care, and additional personal protective equipment requirements. Delayed surgery in rhinology, particularly with regards to chronic rhinosinusitis, has previously been shown to have poorer surgical outcomes, a detrimental effect on quality of life and long-term negative health socio-economic effects. Awake rhinology surgery under local anaesthetic (LA) provides an ideal alternative to GA. It provides a means of operating on patients in a setting alternative to currently oversubscribed main theatres, by utilizing satellite facilities, while ensuring identical surgical outcomes for patients who may otherwise have been forced to wait a long time for their procedure. It also confers additional benefits in terms of shorter recovery time and hospital stay for patients. OBJECTIVES We have developed a set of recommendations that are intended to help support clinicians and managers to better adopt LA rhinology protocols and minimize the risk to the patient and health-care professionals involved. METHODOLOGY International roundtable forums were conducted and supplemented by individual interviews. The international board consisted of 12 rhinologists experienced in awake rhinology surgery. Feedback was analysed and shared to develop a consensus of best practice. RECOMMENDATIONS Local and national guidelines need to be adhered to with specific focus on patient and clinician safety. When performing awake rhinology procedures in the COVID-19 recovery process, consider implementing specific safety measures and workflow practices to safeguard patients and staff and minimize the risk of infection. CONCLUSION Awake surgery potentially provides quicker access to routine rhinology surgery in the post-COVID-19 recovery phase, ensuring patients are treated in a timely matter, thereby avoiding higher downstream costs, and improving outcomes.
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Affiliation(s)
- Peter Andrews
- Department of Rhinology, Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | | | - Florian Bast
- ENT Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Achim G. Beule
- Klinik für Hals-Nasen-und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsmedizin Greifswald, Münster, Germany
| | - John De Carpentier
- ENT Department, Lancashire Teaching Hospitals NHS Trust, Preston, United Kingdom
| | - Deirdre Fitzgerald
- ENT Department, Beacon Hospital & Fitzgerald Private Clinic, Dublin, Ireland
| | | | - Barton Knox
- Partner Colorado ENT & Allergy, Colorado Springs, Colorado, USA
| | - Andrea Marzetti
- Frosinone-Alatri Unified Hospital Group, ASL, Frosinone, Italy
| | | | - Prem Singh Randhawa
- Department of Rhinology, Royal National Throat, Nose and Ear Hospital, London, United Kingdom
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Poorna T A, J R L, Ek J, John B. Ludwig's angina in a COVID positive patient-An atypical case report. SPECIAL CARE IN DENTISTRY 2021; 42:99-102. [PMID: 34448220 PMCID: PMC8662242 DOI: 10.1111/scd.12643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 01/10/2023]
Abstract
The management of odontogenic infections is established and several guidelines have been proposed for its effective treatment. Outbreak of COVID‐19 has posed serious challenge in the management of odontogenic infections, further complicated by immunocompromised status of the patient, where adequate evaluation and prompt attention is mandatory to avoid untoward consequences. Ludwig's angina being a life threatening infection by itself, association or simultaneous presentation with COVID‐19 infection can add further complexity in the management for a maxillofacial surgeon. Here we present a case report of Ludwig's angina in a patient who tested positive for Coronavirus infection and how we treated her successfully.
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Affiliation(s)
- Anish Poorna T
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kottayam, Kerala, India
| | - Lokesh J R
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kottayam, Kerala, India
| | - Joshna Ek
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kottayam, Kerala, India
| | - Bobby John
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kottayam, Kerala, India
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Kim M, Lee M, Schwarz J, Kacker A, Schwartz TH. A Novel Negative Pressure, Face-Mounted Antechamber to Minimize Aerosolization of Particles During Endoscopic Skull Base Surgery. Oper Neurosurg (Hagerstown) 2021; 21:131-136. [PMID: 34017990 PMCID: PMC8194582 DOI: 10.1093/ons/opab173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/19/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has revealed deficiencies in the adequacy of personal protective equipment (PPE) for healthcare workers. Endoscopic endonasal skull base surgery is thought to be among the highest-risk aerosol-generating procedures for surgeons and operating room personnel. OBJECTIVE To validate the efficacy and clinical feasibility of a novel surgical device. METHODS A low-cost, modifiable, and easily producible negative pressure, face-mounted antechamber was developed utilizing 3D printing and silicone molding. Efficacy was evaluated using an optical particle sizer to quantify aerosols generated during both cadaver and intraoperative human use with high-speed drilling. RESULTS Particle counts in the cadaver showed that drilling led to a 2.49-fold increase in particles 0.3 to 5 μm (P = .001) and that the chamber was effective at reducing particles to levels not significantly different than baseline. In humans, drilling led to a 37-fold increase in particles 0.3 to 5 μm (P < .001), and the chamber was effective at reducing particles to a level not significantly different than baseline. Use of the antechamber in 6 complex cases did not interfere with the ability to perform surgery. Patients did not report any facial discomfort after surgery related to antechamber use. CONCLUSION The use of a negative pressure facial antechamber can effectively reduce aerosolization from endoscopic drilling without disturbing the flow of the operation. The antechamber, in conjunction with appropriate PPE, will be useful during the COVID-19 pandemic, as well as during flu season and any future viral outbreaks.
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Affiliation(s)
- Matthew Kim
- Department of Otolaryngology—Head and Neck Surgery, New York Medical College, Westchester Medical Center, Valhalla, New York, USA
| | - Mark Lee
- Department of Otolaryngology—Head and Neck Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York, USA
| | - Justin Schwarz
- Department of Neurosurgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Ashutosh Kacker
- Department of Otolaryngology—Head and Neck Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York, USA
| | - Theodore H Schwartz
- Department of Otolaryngology—Head and Neck Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York, USA
- Department of Neurosurgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York, USA
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Gill AS, Kaur K, Shipman P, Sumsion J, Error M, Kelly K, Alt JA. Nasal endoscopy, room filtration, and aerosol concentrations during live outpatient encounters: a prospective, case-control study. Int Forum Allergy Rhinol 2021; 12:71-82. [PMID: 34355871 PMCID: PMC8427097 DOI: 10.1002/alr.22874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/23/2021] [Accepted: 07/11/2021] [Indexed: 12/11/2022]
Abstract
Background The coronavirus disease 2019 (COVID‐19) pandemic has highlighted safety concerns surrounding possible aerosol‐generating procedures, but comparative data on the smallest particles capable of transmitting this virus remain limited. We evaluated the effect of nasal endoscopy on aerosol concentration and the role of a high‐efficiency particulate air (HEPA) filter in reducing aerosol concentration. Methods Otolaryngology patients were prospectively enrolled in an outpatient, cross‐sectional study. Demographic information and clinic room characteristics were recorded. A scanning mobility particle sizer and GRIMM aerosol monitor measured aerosols 14.3 nm to 34 μm in diameter (i.e., particles smaller than those currently examined in the literature) during (1) nasal endoscopy (± debridement) and (2) no nasal endoscopy encounters. One‐way analysis of variance (ANOVA) and Student's t test were performed to compare aerosol concentrations and impact of HEPA filtration. Results Sixty‐two patients met inclusion criteria (25 nasal endoscopy without debridement; 18 nasal endoscopy with debridement; 19 no nasal endoscopy). There was no significant difference in age or gender across cohorts. Aerosol concentration in the nasal endoscopy cohort (± debridement) was not greater than the no nasal endoscopy cohort (p = 0.36; confidence interval [95% CI], −1.76 to 0.17 μg/m3; and p = 0.12; 95% CI, −0.11 to 2.14 μg/m3, respectively). Aerosol concentrations returned to baseline after 8.76 min without a HEPA filter versus 4.75 min with a HEPA filter (p = 0.001; 95% CI, 1.73–6.3 min). Conclusion Using advanced instrumentation and a comparative study design, aerosol concentration was shown to be no greater during nasal endoscopy versus no endoscopy encounters. HEPA filter utilization reduced aerosol concentrations significantly faster than no HEPA filter.
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Affiliation(s)
- Amarbir S Gill
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Kamaljeet Kaur
- Department of Chemical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Paige Shipman
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Jorgen Sumsion
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Marc Error
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Kerry Kelly
- Department of Chemical Engineering, University of Utah, Salt Lake City, Utah, USA.,Utah Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, Utah, USA
| | - Jeremiah A Alt
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
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Dhillon RS, Nguyen LV, Rowin WA, Humphries RS, Kevin K, Ward JD, Yule A, Phan TD, Zhao YC, Wynne D, McNeill PM, Hutchins N, Scott DA. Aerosolisation in endonasal endoscopic pituitary surgery. Pituitary 2021; 24:499-506. [PMID: 33469830 PMCID: PMC7814858 DOI: 10.1007/s11102-021-01125-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 12/03/2022]
Abstract
PURPOSE To determine the particle size, concentration, airborne duration and spread during endoscopic endonasal pituitary surgery in actual patients in a theatre setting. METHODS This observational study recruited a convenience sample of three patients. Procedures were performed in a positive pressure operating room. Particle image velocimetry and spectrometry with air sampling were used for aerosol detection. RESULTS Intubation and extubation generated small particles (< 5 µm) in mean concentrations 12 times greater than background noise (p < 0.001). The mean particle concentrations during endonasal access were 4.5 times greater than background (p = 0.01). Particles were typically large (> 75 µm), remained airborne for up to 10 s and travelled up to 1.1 m. Use of a microdebrider generated mean aerosol concentrations 18 times above baseline (p = 0.005). High-speed drilling did not produce aerosols greater than baseline. Pituitary tumour resection generated mean aerosol concentrations less than background (p = 0.18). Surgical drape removal generated small and large particles in mean concentrations 6.4 times greater than background (p < 0.001). CONCLUSION Intubation and extubation generate large amounts of small particles that remain suspended in air for long durations and disperse through theatre. Endonasal access and pituitary tumour resection generate smaller concentrations of larger particles which are airborne for shorter periods and travel shorter distances.
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Affiliation(s)
- Rana S Dhillon
- Department of Neurosurgery, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
| | - Lana V Nguyen
- Department of Neurosurgery, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Wagih Abu Rowin
- Department of Mechanical Engineering, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - Ruhi S Humphries
- Climate Science Centre, CSIRO Oceans and Atmosphere, 107 Station Street, Aspendale, VIC, 3195, Australia
| | - Kevin Kevin
- Department of Mechanical Engineering, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - Jason D Ward
- Climate Science Centre, CSIRO Oceans and Atmosphere, 107 Station Street, Aspendale, VIC, 3195, Australia
| | - Andrew Yule
- ARPANSA (Australian Radiation Protection and Nuclear Safety Agency), 619 Lower Plenty Road, Yallambie, VIC, 3085, Australia
| | - Tuong D Phan
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
- University of Melbourne, Parkville, Australia
| | - Yi Chen Zhao
- Department of Ear, Nose and Throat Surgery, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - David Wynne
- Department of Neurosurgery, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Peter M McNeill
- Department of Neurosurgery, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Nicholas Hutchins
- Department of Mechanical Engineering, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - David A Scott
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
- University of Melbourne, Parkville, Australia
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Herzog M, Beule AG, Lüers JC, Guntinas-Lichius O, Grafmans D, Deitmer T. [The first year of the SARS-CoV-2 pandemic-impact on otorhinolaryngology]. HNO 2021; 69:615-622. [PMID: 33620505 PMCID: PMC7900796 DOI: 10.1007/s00106-021-01015-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The first year of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has already affected our public health care system to an enormous extent and will continue to do so in the future. Otorhinolaryngologists (ORLs) are suspected to be at high risk of infection, due to the high viral load in the mucosa of the upper airways. The current review evaluates the impact of the pandemic on ORLs' activities and assesses the risk infection. METHODS A selective literature research was conducted using relevant English and German terms for ORL, SARS-CoV‑2, risk, and infection at PubMed, medRxiv, and bioRxiv, as well as in the Deutsches Ärzteblatt and on the websites of the Robert Koch Institute and the Johns Hopkins University. RESULTS Protection recommendations for ORL include general hygiene measures and wearing KN95 masks for routine professional activities. When in contact with coronavirus disease 2019 (COVID-19) patients, it is recommended to extend the personal protective equipment by eye protection, gloves, cap, and gown. International otorhinolaryngology societies have released guidelines for procedures (e.g., tracheostomy, sinus surgery), propagating personal protection for the surgical team and reduction of aerosols. Testing for SARS-CoV‑2 in patients and medical staff can contribute to reducing the risk of infection. Vaccination would provide some additional protection for ORLs and other health care professionals with increased exposure to aerosols. There is increasing evidence that ORLs are at a high risk of contracting SARS-CoV‑2. CONCLUSION Consequent personal protection, frequent testing of patients and health care professionals, and the promised SARS-CoV‑2 vaccinations may provide adequate protection for highly exposed persons.
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Affiliation(s)
- M Herzog
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Carl-Thiem-Klinikum, Thiemstraße 111, 03048, Cottbus, Deutschland.
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - A G Beule
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster, Münster, Deutschland
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenkrankheiten, Kopf- und Halschirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - J-C Lüers
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Medizinische Fakultät, Uniklinik Köln, Köln, Deutschland
| | - O Guntinas-Lichius
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Jena, Jena, Deutschland
| | - D Grafmans
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Carl-Thiem-Klinikum, Thiemstraße 111, 03048, Cottbus, Deutschland
| | - T Deitmer
- Deutsche Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie e. V., Bonn, Deutschland
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