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.