What are the recommendations for performing nasal endoscopy surgery in COVID-19 patients?
Diagnostic procedures involving upper airway manipulation, such as nasal endoscopy, should be considered high risk for viral transmission. Before clinical examination, it is recommended to question all patients about contact with confirmed COVID-19 patients, fever, respiratory symptoms and recent sudden loss of smell and/or taste. During nasal endoscopy, distance between the endoscopist and patient can be maximized by using a tower with a camera, screen and light source, rather than using an eyepiece. Also, manipulations should be limited if possible, (i.e. nasal inspection vs debridement with suction and/or forceps). The use of local anesthetic sprays can be replaced by alternatives such as soaked pledgets because atomized anesthesia can aerosolize the virus.123 Given that the COVID-19 status of patients consulting the outpatient rhinology clinic is often unknown and the risk of transmission through clinical procedures is high, wearing adequate PPE is mandatory.108,124 For all surgical cases, pre-operative screening of the COVID-19 status of the patient is recommended to adapt the PPE accordingly. In case of an emergency where COVID-19 screening would imply an unacceptable time-delay, the patient should be considered as COVID-19 positive and PPE used.123