Mitigation of Aerosols Generated During Rhinologic Surgery: A Pandemic-Era Cadaveric Simulation

• Published in: Otolaryngology-head and neck surgery Vol. 164; no. 2; pp. 433 - 442
• Main Authors: Sharma, Dhruv, Ye, Michael J., Campiti, Vincent J., Rubel, Kolin E., Higgins, Thomas S., Wu, Arthur W., Shipchandler, Taha Z., Sim, Michael W., Burgin, Sarah J., Illing, Elisa A., Park, Jae Hong, Ting, Jonathan Y.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.02.2021
• Subjects: aerosol particles; Aerosols; aerosol‐generating procedure; airborne; Cadaver; COVID-19 - prevention & control; COVID-19 - transmission; COVID‐19; endonasal drilling; Humans; Models, Biological; Nasal Surgical Procedures - adverse effects; SARS‐CoV‐2; sinus surgery; skull base surgery; COVID-19; SARS-CoV-2; airborne; skull base surgery; sinus surgery; endonasal drilling; aerosol particles; aerosol-generating procedure
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599820951169

Objective After significant restrictions initially due to the COVID-19 pandemic, otolaryngologists have begun resuming normal clinical practice. However, the risk of SARS-CoV-2 transmission to health care workers through aerosolization and airborne transmission during rhinologic surgery remains incompletely characterized. The objective of this study was to quantify the number concentrations of aerosols generated during rhinologic surgery with and without interventions involving 3 passive suction devices. Study Design Cadaver simulation. Setting Dedicated surgical laboratory. Subjects and Methods In a simulation of rhinologic procedures with and without different passive suction interventions, the concentrations of generated aerosols in the particle size range of 0.30 to 10.0 µm were quantified with an optical particle sizer. Results Functional endoscopic sinus surgery with and without microdebrider, high-speed powered drilling, use of an ultrasonic aspirator, and electrocautery all produced statistically significant increases in concentrations of aerosols of various sizes (P < .05). Powered drilling, ultrasonic aspirator, and electrocautery generated the highest concentration of aerosols, predominantly submicroparticles <1 µm. All interventions with a suction device were effective in reducing aerosols, though the surgical smoke evacuation system was the most effective passive suction method in 2 of the 5 surgical conditions with statistical significance (P < .05). Conclusion Significant aerosol concentrations were produced in the range of 0.30 to 10.0 µm during all rhinologic procedures in this cadaver simulation. Rhinologic surgery with a passive suction device results in significant mitigation of generated aerosols.