Journal
OTOLARYNGOLOGY-HEAD AND NECK SURGERY
Volume 163, Issue 4, Pages 676-681Publisher
WILEY
DOI: 10.1177/0194599820933169
Keywords
SARS-CoV-2; COVID; COVID-19; rhinology; rhinologic; otolaryngology; personal protective equipment; PPE; aerosol-generating procedure; environmental safety; environmental control; testing; visit planning; planning; high-risk aerosol; eye protection; respiratory protection; air handling; air changes per hour; oropharyngeal swab
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As rhinologists return to practice amid SARS-CoV-2, special considerations are warranted given the unique features of their subspecialty. Rhinologist manipulation of nasal tissue, proximity, and frequent aerosol-generating procedures (AGPs) create high risk for infection transmission. There are 4 areas of special consideration to mitigate risk: (1) previsit planning for risk stratification/mitigation, (2) appropriate personal protective equipment, (3) preprocedural testing, and (4) environmental controls. During previsit planning, risk factors of the patient and procedures are considered. High-risk AGPs are identified by duration, proximity, manipulation of high-viral load tissue, and use of powered instrumentation. Appropriate personal protective equipment includes selection of respiratory and eye protection. COVID-19 testing can screen for asymptomatic carriers prior to high-risk procedures; however, alternative testing methods are required in rhinologic patients not eligible for nasopharyngeal testing due to nasal obstruction or skull base defects. Last, AGPs in rhinologic practices require considerations of room air handling and environmental controls.
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