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
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
globally 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: those which made an assessment
as to the aerosolisation of droplets during sinus surgery, further
subdivided into work which considered macroscopically visible droplets
and that which considered smaller particles, 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. Whilst results both highlight a range
of innovative adjunctive strategies and support suction as an important
variable to reduce aerosolisation, appropriate use of personal
protective equipment (PPE) should be considered mandatory for all
healthcare professionals involved in rhinological surgery given studies
have demonstrated that close adherence to PPE use is effective at
preventing COVID-19 infection.