Reducing Aerosolised Particles and Droplet Spread in Endoscopic Sinus Surgery during COVID-19.

OBJECTIVES: The presence of high SARS-Cov-2 viral loads in the upper airway, including the potential for aerosolised transmission of viral particles, has generated significant concern amongst Otolaryngologists worldwide, particularly those performing Endoscopic Sinus Surgery (ESS). We evaluated a simple negative pressure mask technique to reduce viral exposure. METHODS: Two models simulating respiratory droplets >5-10 µm and fine respiratory nuclei <5 µm using fluorescein dye and wood smoke respectively were utilised in a fixed cadaveric study in a controlled environment. Using Ultra-Violet light, fluorescein droplet spread was assessed during simulated ESS with powered microdebrider and powered drilling. Wood smoke ejection was used to evaluate fine particulate escape from a negative pressure mask using digital subtraction image processing. RESULTS: The use of a negative pressure mask technique resulted in a 98% reduction in the fine particulate aerosol simulation, and eliminated larger respiratory droplet spread during simulated ESS, including during external drill activation. CONCLUSIONS: As global ENT services resume routine elective operating, we demonstrate the potential use of a simple negative pressure mask technique to reduce the risk of viral exposure for the operator and theatre staff during ESS.