Endonasal Surgery
At this time, several national and regional otolaryngology organizations
have released statements regarding endonasal and nasopharyngeal surgery
(functional endoscopic sinus surgery, endonasal skull base surgery,
adenoidectomy, etc.) and the risk of COVID-19
spread.30,31 In a preliminary study of 17 symptomatic
COVID-19 patients, high viral loads were detected soon after symptom
onset, with higher viral loads in the nasal cavity compared to the
oropharynx.22 Increasing reports of hyposmia and
anosmia as cardinal symptoms of CVOID-19 further suggest that the virus
is highly active in the nasal cavity.11 Aerosolized
viral particles are viable for up to 3 hours and may be disseminated by
sinus instrumentation such as balloons, drills, microdebriders, and
suction electrocautery.7,32 Elective sinonasal cases
should be canceled for at least 1 month, and potentially longer. Urgent
endonasal surgery cases mandate preoperative COVID-19 testing 48 hours
prior to the procedure with the patient remaining in strict quarantine
pending test results and appropriate PPE for all operating room
personnel. Consideration should be given to postponing surgery for
COVID-19 positive patients. Finally, emergent sinonasal cases require
enhanced PPE for all operating room staff until further information is
available 32.