PPE for Endoscopic Sinus or Skull Base Surgery
The nasopharynx and nasal cavity are known to harbor significant viral loads, and in concentrations potentially proportionate to the severity of COVID-19 symptoms.26 In a commonly cited case, a patient with either no symptoms or mild flu symptoms in Wuhan underwent a trans-sphenoidal pituitary surgery in January 2020; 14 healthcare workers who were involved in the patient’s care (either in the operating room or outside of it) were reported to have tested positive for COVID-19. The precise circumstances surrounding exposure of the 14 healthcare workers, however, are uncertain, and their COVID-19 positivity may or may not have been due to their interaction with the patient who underwent the trans-sphenoidal procedure. The CDC currently characterizes open suctioning in a COVID-19 positive patient as an AGP; as such, endoscopic transnasal procedures (e.g. endoscopic sinus surgery), with suctioning and concomitant mucosal instrumentation in a florid field, should warrant at least standard airborne-level PPE. In fact, the CDC recommends an N95 or higher-level respiratory for providers obtaining nasopharyngeal swabs in COVID-19-suspicious patients, resources permitting, reflecting the greater relative degree of caution the CDC exercises with nasal or nasopharyngeal instrumentation.22 (Table 1)