Evaluation of Respiratory Particle Emission during Otorhinolaryngological Procedures in the Context of the SARS-CoV-2 Pandemic

Abstract

Understanding the risk of infection by routine medical examination is important for the protection of the medical personnel. In this study we investigated respiratory particles emitted by patients during routine otolaryngologic procedures and assessed the risks for the performing physician. We developed two experimental setups to measure aerosol and droplet emission during rigid/flexible laryngoscopy, rhinoscopy, pharyngoscopy, otoscopy, sonography and patient interview for subjects with and without masks. A high-speed-camera setup was used to detect ballistic droplets (approx. > 100 µm) and an aerosol-particle-sizer was used to detect aerosol particles in the range of 0.3 µm to 10 µm. Aerosol particle counts were highly increased for coughing and slightly increased for heavy breathing in subjects without masks. The highest aerosol particle counts occurred during rigid laryngoscopy. During laryngoscopy and rhinoscopy, the examiner was exposed to increased particle emission due to close proximity to the patient’s face and provoked events such as coughing. However, even during sonography or otoscopy without a mask, aerosol particles were expelled close to the examiner. The physician’s exposure to respiratory particles can be reduced by deliberate choice of examination technique depending on medical indication and the use of appropriate equipment for the examiners and the patients (e.g., FFP2 masks for both).

Direct impact of the COVID‐19 pandemic on rhinology practice

“…Transmission concerns were heightened within otolaryngology, especially within the rhinology subspecialty. 1,2 A survey of rhinologists during the pandemic suggested that significant impacts to rhinologic practice were ongoing; however, impacts to clinical care have not been directly assessed longitudinally. 3 The goal of this study was to quantitatively analyze the real-world impact of the COVID-19 pandemic on tertiary rhinology practice.…”

“…Coronavirus disease 2019 (COVID‐19) infamously lead to a global pandemic, where social distancing orders were needed to control its spread. Transmission concerns were heightened within otolaryngology, especially within the rhinology subspecialty 1,2 . A survey of rhinologists during the pandemic suggested that significant impacts to rhinologic practice were ongoing; however, impacts to clinical care have not been directly assessed longitudinally 3 .…”