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. 2021 Feb;164(2):433-442.
doi: 10.1177/0194599820951169. Epub 2020 Aug 11.

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

Dhruv Sharma  1   2 , Michael J Ye  1   2 , Vincent J Campiti  2 , Kolin E Rubel  1   2 , Thomas S Higgins  3   4 , Arthur W Wu  5 , Taha Z Shipchandler  1 , Michael W Sim  1 , Sarah J Burgin  1 , Elisa A Illing  1 , Jae Hong Park  6 , Jonathan Y Ting  1
Affiliations

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

Dhruv Sharma et al. Otolaryngol Head Neck Surg. 2021 Feb.

Abstract

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.

Keywords: COVID-19; SARS-CoV-2; aerosol particles; aerosol-generating procedure; airborne; endonasal drilling; sinus surgery; skull base surgery.

PubMed Disclaimer

Conflict of interest statement

Disclosures: Competing interests: None.

Sponsorships: None.

Funding source: None.

Figures

Figure 1.
Figure 1.
Experimental setup. (A) The optical particle sizer was positioned 15 cm from the midline columella. (B) The suction ring was manually held at the level of the nasal tip. (C) Placement of the smoke evacuation system.
Figure 2.
Figure 2.
Mean concentration of generated aerosols over baseline levels for common rhinologic procedures. FESS, functional endoscopic sinus surgery.
Figure 3.
Figure 3.
Mean concentration of generated aerosols over baseline with and without passive suction interventions: (A) cold FESS, (B) microdebrider FESS, (C) powered drilling, (D) needle tip electrocautery, (E) ultrasonic aspirator. FESS, functional endoscopic sinus surgery.
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