Clinical applicability of this review
Regardless of vaccination status and testing, appropriate PPE use should
remain mandatory for all healthcare professionals involved in endonasal
rhinological and skull base surgery. Indeed, studies have demonstrated
that close adherence to PPE use, particularly with use of FFP3 level
masks, is effective at preventing COVID-19
infection.12,25-27
Results propose suction as an important variable to reduce
aerosolisation.14,15,20,21,24 Accordingly, surgeons
should consider introducing a second suction device via a three-hand
technique. When using devices with in-built suction capabilities,
surgeons must be aware of techniques to unblock instruments safely and
to prevent blockage (e.g. adequate irrigation, reducing oscillations to
allow suction to work). Furthermore, there is evidence to suggest that a
greater understanding of both the design and functionality of
instruments used during rhinological surgery can also be beneficial to
not only optimize operational capability but also reduce aerosolisation
of fluid from the surgical field.
The addition of a variety of adjunctive techniques (e.g.
drapes,29-35 negative-pressure
masks16.18,28) reflect the ingenuity of clinical
groups across the world. Though innovative, such ideas would benefit
from extended real-life testing and should also be balanced with their
practicality and cost given that results suggest they do not eliminate
aerosolisation to the point where staff would not wear higher levels of
PPE.