The Risk of Transmission during Otolaryngologic Surgery
SARS-CoV-2 is characterized by rapid human-to-human transmission from
droplet contamination arising from the upper aerodigestive
tract.27 Early reports also suggest the possibility of
aerosol transmission in the setting of aerosol-generating procedures,
such as any instrumentation of the upper aerodigestive
tract.28 Otolaryngologists, with frequent contact with
the upper aerodigestive tract, are at particularly high risk for
nosocomial transmission, as seen during the Wuhan
outbreak.29 Any trans-mucosal head and neck procedure,
including flexible fiberoptic nasolaryngoscopy, should be considered
high-risk and appropriate PPE must be worn by all team members in the
clinic exam room or operative suite. A thorough discussion of what
constitutes appropriate PPE for these procedures is out of the scope of
this commentary; however, in the authors’ opinion, PPE should include
N95 respirator, face shield, surgical gown, and gloves. Additional
safety recommendations for the otolaryngologist have recently been made
available30. Given that the viral load of SARS-CoV-2
is higher in the nasal cavity than in the pharynx31,
endoscopic or open sinus and skull base surgery should be considered an
extremely high-risk procedure.32 In Wuhan, there is a
report of a single patient who underwent endoscopic endonasal pituitary
surgery, resulting in SARS-CoV-2 infection of at least 14 providers
involved in intra-operative and perioperative care.33