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.