Safety for the Rhinologist in the Age of COVID-19: Mask Use, Nasal Corticosteroids, Saline Irrigation, and Endoscopic Procedures – Literature Review

 

 Permissions and Reprints

Abstract

Introduction Coronavirus disease 2019 (COVID-19) has claimed millions of lives. Adequate protection of the professionals involved in patient care is essential in the battle against this disease. However, there is much uncertainty involving safety-relarted topics that are of particular interest to the rhinologist in the context of COVID-19.

Objective To evaluate the current evidence regarding three safety-related topics: mask and respirator use, performance of nasal endoscopic procedures, and use of topical nasal and intranasal medications (saline irrigation and nasal corticosteroids).

Methods A literature review was performed on the PubMed, Scopus, and Cochrane databases, with standardized search queries for each of the three topics of interest.

Results In total, 13 articles on mask use, 6 articles on the safety of nasal corticosteroids, 6 articles on the safety of nasal endoscopic procedures, and 1 article on nasal irrigation with saline solution were included in the final analysis.

Conclusion N95 respirators are essential for the adequate protection of otolaryngologists. If reuse is necessary, physical methods of sterilization must be employed. No evidence was found to contraindicate the use of nasal corticosteroids, whether acute (in the management of sinonasal inflammatory conditions) or continued (in patients who use them chronically). Nasal irrigation with saline solution apparently does not increase the risk in the context of COVID-19. Nasal endoscopic procedures should only be performed after testing the patient for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the surgical team must wear full personal protective equipment to prevent aerosol exposure.

Publication History

Received: 11 January 2021

Accepted: 23 September 2021

Article published online:
25 January 2022

© 2022. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

• References

• 1 Liu YC, Kuo RL, Shih SR. COVID-19: The first documented coronavirus pandemic in history. [published online ahead of print, 2020 May 5] Biomed J 2020; 43 (04) 328-333 DOI: 10.1016/j.bj.2020.04.007.
  CrossrefPubMedGoogle Scholar
• 2 WHO, World Health Organization. Weekly epidemiological update——5 January 2021. Accessed 5 January 2021 online: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20210105_weekly_epi_update_21.pdf
  Google Scholar
• 3 Brazilian Ministry of Health. Brazil. Relatório epidemiológico - COVID-19 no Brasil. Accessed 5 January 2021 online: https://covid.saude.gov.br
  Google Scholar
• 4 The Lancet. COVID-19: protecting health-care workers. Lancet 2020; 395 (10228): 922 DOI: 10.1016/S0140-6736(20)30644-9.
  CrossrefPubMedGoogle Scholar
• 5 Tysome JR, Bhutta MF. COVID-19: Protecting our ENT Workforce. Clin Otolaryngol 2020; 45 (03) 311-312 DOI: 10.1111/coa.13542.
  CrossrefPubMedGoogle Scholar
• 6 Hu Z, Song C, Xu C. et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Sci China Life Sci 2020; 63 (05) 706-711 DOI: 10.1007/s11427-020-1661-4.
  CrossrefPubMedGoogle Scholar
• 7 Yang W, Cao Q, Qin L. et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19):A multi-center study in Wenzhou city, Zhejiang, China. J Infect 2020; 80 (04) 388-393 DOI: 10.1016/j.jinf.2020.02.016.
  CrossrefPubMedGoogle Scholar
• 8 Reinhard A, Ikonomidis C, Broome M, Gorostidi F. Anosmia and COVID-19. Rev Med Suisse 2020; 16 (691-2): 849-851
  PubMedGoogle Scholar
• 9 ABORL-CCF. Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. 4ª nota de orientação aos médicos otorrinolaringologistas em relação à doença causada pelo novo coronavírus (Covid-19). Accessed 29 June 2020 online: https://www.aborlccf.org.br/secao_detalhes.asp?s=51&id=5951
  Google Scholar
• 10 Kanjanawasee D, Seresirikachorn K, Chitsuthipakorn W, Snidvongs K. Hypertonic Saline Versus Isotonic Saline Nasal Irrigation: Systematic Review and Meta-analysis. Am J Rhinol Allergy 2018; 32 (04) 269-279 DOI: 10.1177/1945892418773566.
  CrossrefPubMedGoogle Scholar
• 11 Rosenfeld RM, Piccirillo JF, Chandrasekhar SS. et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg 2015; 152 (2, Suppl) S1-S39 DOI: 10.1177/0194599815572097.
  CrossrefPubMedGoogle Scholar
• 12 Di Maio P, Traverso D, Iocca O, De Virgilio A, Spriano G, Giudice M. Endoscopic nasopharyngoscopy and ENT specialist safety in the COVID 19 era: the back endoscopy approach to the patient. [published online ahead of print, 2020 Jun 4] Eur Arch Otorhinolaryngol 2020; 277 (09) 2647-2648 DOI: 10.1007/s00405-020-06093-6.
  CrossrefPubMedGoogle Scholar
• 13 Bartoszko JJ, Farooqi MAM, Alhazzani W, Loeb M. Medical masks vs N95 respirators for preventing COVID-19 in healthcare workers: A systematic review and meta-analysis of randomized trials. Influenza Other Respir Viruses 2020; 14 (04) 365-373 DOI: 10.1111/irv.12745.
  CrossrefPubMedGoogle Scholar
• 14 Boškoski I, Gallo C, Wallace MB, Costamagna G. COVID-19 pandemic and personal protective equipment shortage: protective efficacy comparing masks and scientific methods for respirator reuse. [published online ahead of print, 2020 Apr 27] Gastrointest Endosc 2020; 92 (03) 519-523 DOI: 10.1016/j.gie.2020.04.048.
  CrossrefPubMedGoogle Scholar
• 15 Ha JF. The COVID-19 pandemic, personal protective equipment and respirator: A narrative review. [published online ahead of print, 2020 Jun 8] Int J Clin Pract 2020; 74 (10) e13578 DOI: 10.1111/ijcp.13578.
  CrossrefPubMedGoogle Scholar
• 16 Iannone P, Castellini G, Coclite D. et al. The need of health policy perspective to protect Healthcare Workers during COVID-19 pandemic. A GRADE rapid review on the N95 respirators effectiveness. [published online ahead of print, 2020 Jun 3] PLoS One 2020; 15 (06) e0234025 DOI: 10.1371/journal.pone.0234025.
  CrossrefPubMedGoogle Scholar
• 17 MacIntyre CR, Chughtai AA, Seale H, Dwyer DE, Quanyi W. Human coronavirus data from four clinical trials of masks and respirators. Int J Infect Dis 2020; 96: 631-633 DOI: 10.1016/j.ijid.2020.05.092.
  CrossrefPubMedGoogle Scholar
• 18 Ippolito M, Vitale F, Accurso G. et al. Medical masks and Respirators for the Protection of Healthcare Workers from SARS-CoV-2 and other viruses. Pulmonology 2020; 26 (04) 204-212 DOI: 10.1016/j.pulmoe.2020.04.009.
  CrossrefPubMedGoogle Scholar
• 19 Garcia Godoy LR, Jones AE, Anderson TN. et al. Facial protection for healthcare workers during pandemics: a scoping review. [published online ahead of print, 2020 May 5] BMJ Glob Health 2020; 5 (05) e002553 DOI: 10.1136/ bmjgh-2020–002553.
  CrossrefPubMedGoogle Scholar
• 20 Mick P, Murphy R. Aerosol-generating otolaryngology procedures and the need for enhanced PPE during the COVID-19 pandemic: a literature review. [published online ahead of print, 2020 May 11] J Otolaryngol Head Neck Surg 2020; 49 (01) 29 DOI: 10.1186/s40463-020-00424-7.
  CrossrefPubMedGoogle Scholar
• 21 Bann DV, Patel VA, Saadi R. et al. Impact of coronavirus (COVID-19) on otolaryngologic surgery: Brief commentary. Head Neck 2020; 42 (06) 1227-1234 DOI: 10.1002/hed.26162.
  CrossrefPubMedGoogle Scholar
• 22 Lammers MJW, Lea J, Westerberg BD. Guidance for otolaryngology health care workers performing aerosol generating medical procedures during the COVID-19 pandemic. [published online ahead of print, 2020 Jun 3] J Otolaryngol Head Neck Surg 2020; 49 (01) 36 DOI: 10.1186/s40463-020-00429-2.
  CrossrefPubMedGoogle Scholar
• 23 Ma QX, Shan H, Zhang CM. et al. Decontamination of face masks with steam for mask reuse in fighting the pandemic COVID-19: Experimental supports. [published online ahead of print, 2020 Apr 22] J Med Virol 2020; 92 (10) 1971-1974 DOI: 10.1002/jmv.25921.
  CrossrefPubMedGoogle Scholar
• 24 Kim HP, Jo MS, Kim CH, Choi JS, Yu IJ. Re-use of health masks after autoclaving. NanoImpact 2020; 19: 100231 DOI: 10.1016/j.impact.2020.100231.
  CrossrefPubMedGoogle Scholar
• 25 Liao L, Xiao W, Zhao M. et al. Can N95 Respirators Be Reused after Disinfection? How Many Times?. ACS Nano 2020; 14 (05) 6348-6356 DOI: 10.1021/acsnano.0c03597.
  CrossrefPubMedGoogle Scholar
• 26 Gong Y, Guan L, Jin Z, Chen S, Xiang G, Gao B. Effects of methylprednisolone use on viral genomic nucleic acid negative conversion and CT imaging lesion absorption in COVID-19 patients under 50 years old. [published online ahead of print, 2020 May 22] J Med Virol 2020; 92 (11) 2551-2555 DOI: 10.1002/jmv.26052.
  CrossrefPubMedGoogle Scholar
• 27 Li H, Chen C, Hu F. et al. Impact of corticosteroid therapy on outcomes of persons with SARS-CoV-2, SARS-CoV, or MERS-CoV infection: a systematic review and meta-analysis. Leukemia 2020; 34 (06) 1503-1511 DOI: 10.1038/s41375-020-0848-3.
  CrossrefPubMedGoogle Scholar
• 28 Jian L, Yi W, Zhang N. et al. Perspective: COVID-19, implications of nasal diseases and consequences for their management. J Allergy Clin Immunol 2020; 146 (01) 67-69 DOI: 10.1016/j.jaci.2020.04.030.
  CrossrefPubMedGoogle Scholar
• 29 Hasan SS, Capstick T, Zaidi STR, Kow CS, Merchant HA. Use of corticosteroids in asthma and COPD patients with or without COVID-19. [published online ahead of print, 2020 May 26] Respir Med 2020; 170: 106045 DOI: 10.1016/j.rmed.2020.106045.
  CrossrefPubMedGoogle Scholar
• 30 Herman P, Vincent C, Parietti Winkler C. et al. Consensus statement. Corticosteroid therapy in ENT in the context of the COVID-19 pandemic. [published online ahead of print, 2020 May 4] Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137 (04) 315-317 DOI: 10.1016/j.anorl.2020.04.014.
  CrossrefPubMedGoogle Scholar
• 31 Ramalingam S, Graham C, Dove J, Morrice L, Sheikh A. Hypertonic saline nasal irrigation and gargling should be considered as a treatment option for COVID-19. J Glob Health 2020; 10 (01) 010332 DOI: 10.7189/jogh.10.010332.
  CrossrefPubMedGoogle Scholar
• 32 Workman AD, Welling DB, Carter BS. et al. Endonasal instrumentation and aerosolization risk in the era of COVID-19: simulation, literature review, and proposed mitigation strategies. Int Forum Allergy Rhinol 2020; 10 (07) 798-805 DOI: 10.1002/alr.22577.
  CrossrefPubMedGoogle Scholar
• 33 Workman AD, Jafari A, Welling DB. et al. Airborne Aerosol Generation During Endonasal Procedures in the Era of COVID-19: Risks and Recommendations. [published online ahead of print, 2020 May 26] Otolaryngol Head Neck Surg 2020; 163 (03) 465-470 DOI: 10.1177/0194599820931805.
  CrossrefPubMedGoogle Scholar
• 34 Workman AD, Xiao R, Feng A. et al. Suction mitigation of airborne particulate generated during sinonasal drilling and cautery. [published online ahead of print, 2020 Jun 18] Int Forum Allergy Rhinol 2020; 10 (10) 1136-1140 DOI: 10.1002/alr.22644.
  CrossrefPubMedGoogle Scholar
• 35 Sharma D, Rubel KE, Ye MJ. et al. Cadaveric Simulation of Endoscopic Endonasal Procedures: Analysis of Droplet Splatter Patterns During the COVID-19 Pandemic. Otolaryngol Head Neck Surg 2020; 163 (01) 145-150 DOI: 10.1177/0194599820929274.
  CrossrefPubMedGoogle Scholar
• 36 David AP, Jiam NT, Reither JM, Gurrola II JG, Aghi MK, El-Sayed IH. Endoscopic skull base and transoral surgery during COVID-19 pandemic: Minimizing droplet spread with negative-pressure otolaryngology viral isolation drape. Head Neck 2020; 42 (07) 1577-1582 DOI: 10.1002/hed.26239.
  CrossrefPubMedGoogle Scholar
• 37 Taha MA, Hall CA, Rathbone RF. et al. Rhinologic Procedures in the Era of COVID-19: Health-care Provider Protection Protocol. Am J Rhinol Allergy 2020; 34 (04) 451-455 DOI: 10.1177/1945892420927178.
  CrossrefPubMedGoogle Scholar
• 38 ABORL-CCF. Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. 2a nota de orientação aos médicos otorrinolaringologistas em relação à doença causada pelo novo coronavírus (Covid-19). Accessed 29 June 2020 online: https://www.aborlccf.org.br/secao_detalhes.asp?s=51&id=5946
  Google Scholar
• 39 ABORL-CCF. Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. 3a nota de orientação aos médicos otorrinolaringologistas em relação à doença causada pelo novo coronavírus (Covid-19). Accessed 29 June 2020 online: https://www.aborlccf.org.br/secao_detalhes.asp?s=51&id=5948
  Google Scholar
• 40 King D, Mitchell B, Williams CP, Spurling GK. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev 2015; CD006821 (04) CD006821 DOI: 10.1002/14651858.CD006821.pub3.
  CrossrefPubMedGoogle Scholar
• 41 Fokkens WJ, Lund VJ, Hopkins C. et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology 2020; 58 (Suppl S29): 1-464 DOI: 10.4193/Rhin20.600.
  Google Scholar
• 42 Zou L, Ruan F, Huang M. et al. SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. N Engl J Med 2020; 382 (12) 1177-1179 DOI: 10.1056/NEJMc2001737.
  CrossrefPubMedGoogle Scholar
• 43 Ong SWX, Tan YK, Chia PY. et al. Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient. [published online ahead of print, 2020 Mar 4] JAMA 2020; 323 (16) 1610-1612 DOI: 10.1001/jama.2020.3227.
  CrossrefPubMedGoogle Scholar
• 44 Turri-Zanoni M, Battaglia P, Karligkiotis A, Locatelli D, Castelnuovo P. Managing care for patients with sinonasal and anterior skull base cancers during the COVID-19 pandemic. Head Neck 2020; 42 (07) 1503-1506 DOI: 10.1002/hed.26257.
  CrossrefPubMedGoogle Scholar
• 45 Van Gerven L, Hellings PW, Cox T. et al. Personal protection and delivery of rhinologic and endoscopic skull base procedures during the COVID-19 outbreak. Rhinology 2020; 58 (03) 289-294 DOI: 10.4193/Rhin20.119.
  CrossrefPubMedGoogle Scholar
• 46 ENT UK - British Association for Paediatric Otolaryngology (BAPO). BAPO statement on SARS Cov2 and Paediatric Otolaryngology Provision. Accessed 29 June 2020 online: https://www.entuk.org/covid-19
  Google Scholar
• 47 Patel ZM, Fernandez-Miranda J, Hwang PH. et al. Letter: Precautions for Endoscopic Transnasal Skull Base Surgery During the COVID-19 Pandemic. Neurosurgery 2020; 87 (01) E66-E67 DOI: 10.1093/neuros/nyaa125.
  CrossrefPubMedGoogle Scholar
• 48 Zhao C, Viana Jr A, Wang Y, Wei HQ, Yan AH, Capasso R. Otolaryngology during COVID-19: Preventive care and precautionary measures. Am J Otolaryngol 2020; 41 (04) 102508 DOI: 10.1016/j.amjoto.2020.102508.
  CrossrefPubMedGoogle Scholar