Droplet Exposure Risk to Providers From In‐Office Flexible Laryngoscopy: A COVID‐19 Simulation

Abstract

To provide data on risk of respiratory droplets from common otolaryngologic procedures during the COVID-19 pandemic, a novel simulation of droplet exposure from flexible laryngoscopy was performed. After completion of a nasal symptom questionnaire, topical fluorescein spray was administered into the nasal and oropharynx of 10 healthy volunteers, who then underwent flexible laryngoscopy under 2 conditions: routine without provoked response and with prompted sneeze/cough. After each, droplets on the proceduralist and participant were counted under ultraviolet A light. Droplets were observed on 1 of 10 volunteers after routine laryngoscopy and 4 of 10 during laryngoscopy with sneeze/cough. A nasal symptom score based on congestion and rhinorrhea was significantly elevated among droplet producers after sneeze/cough ( P = .0164). No droplets were observed on the provider. Overall, with adequate personal protective equipment, flexible laryngoscopy poses minimal droplet risk to providers. Nasal symptoms can identify patients more likely to produce droplets after sneeze/cough.

Development and Assessment of an Inexpensive Smartphone-Based Respiratory Droplet Simulation Model

“…Similar to previously described platforms, our setup simulates coughing episodes through the use of a MAD and fluorescein dye. [2][3][4][7][8][9] What makes our model unique is that it is constructed from items that are readily accessible, it is reusable, and it incorporates an inexpensive smartphone-based cobalt blue light for fluorescein illumination. The polystyrene mannequin head replaced cadaver heads or medical mannequins which are costly and may not be necessary for PPE assessment studies similar to ours.…”

“…Nevertheless, there has still been great interest in evaluating the spread of larger droplets as well as the coalescence of smaller droplets that may result from different clinical scenarios. [2][3][4][7][8][9] Further refinements in cough simulation technology are required to assess the dispersion of smaller droplets in relation to PPE evaluations. The MAD in our simulation may be readily replaced by such devices in future simulation endeavors.…”

“…1 Such studies model droplet size and/or dispersion through ultraviolet (UV)-visible cough simulators (e.g., fluorescein emitted from a mucosal atomization device (MAD), spray gun, or pressurized canister) placed within cadaver heads, medical mannequins, or human subjects. [2][3][4] However, these modes of simulation are often expensive, single-use, uncomfortable for human participants, and not readily accessible to researchers. Subsequently, we sought to identify an inexpensive, easily replicable means of assessing respiratory droplet spread using readily available materials, open-source software, and a smartphone-based cobalt blue light application.…”

Office‐Based Removal of Vocal Fold Polyp During the COVID‐19 Pandemic

“…9,10 However, in patients with larger polyps or in patients who wish immediate relief of symptoms, alternative office-based surgical procedures should be considered, as the office laryngoscopy is regarded as a minimal risk procedure for SARS-CoV-2 transmission to the provider. 9,11 Preoperative epidemiologic questionnaires and testing for SARS-CoV-2 should be performed in all patients based on the local health authorities' or institutional recommendations. Although the negative preoperative screening for SARS-CoV-2 mitigates the risk of possible transmission, there is a possibility of false-negative results of RT-PCR testing, and even asymptomatic individuals may harbor significant viral loads in the nasopharynx.…”

Risk of disease transmission from flexible nasoendoscopy during the coronavirus disease 2019 pandemic

“…3,4 Endoscopes are in close contact with the patient's airway, and can easily be contaminated with respiratory secretions by either direct contact or droplets. 5 In addition, stimulation and irritation of the upper airway can provoke the expulsion of droplets and aerosols through sneezing, coughing and gagging, in an uncontrolled fashion. Simulated sneeze events have generated maximal aerosol distribution at 30 cm, extending up to 66 cm.…”