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