Rhinological procedures result in minimal generation of aerosols

Abstract

Background: COVID-19 and other respiratory infections spread through aerosols produced in respiratory activities and in certain surgical procedures considered as aerosol-generating procedures (AGP). Due to manipulation of the upper airway mucosa, rhinosurgery has been considered a particular risk for spread of respiratory infections. Our aim was to assess staff exposure to aerosols during common rhinosurgical procedures Methods: Staff exposure to generated particle concentrations and size distributions between 0.3 μm and 10 μm were measured during rhinosurgery using an optical particle sizer without any additional collection methods. Similarly measured aerosol exposure during coughing (a commonly used risk reference for aerosol generation) and the operating room’s background concentration were chosen as reference values. Results: Altogether 16 common rhinological surgeries (septoplasties and endoscopic sinus surgery) were measured. The use of suction produced significantly lower aerosol concentration compared to coughing. Low aerosol generation was observed during injection anaesthesia of the nasal mucosa. Instrument comparison revealed that the microdebrider produced fewer aerosols than cold dissection in particles of 1-5 μm and >5 μm. Conclusions: Common rhinosurgeries do not seem to generate as high aerosol concentration exposures as previously believed. Rather, the observed aerosol exposure is lower or similar to exposures during coughing. Therefore, the classification of common rhinosurgeries as AGPs should be re-assessed or possibly discarded.