Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.
Otolaryngol Head Neck Surg. 2020 Oct;163(4):676-681. doi: 10.1177/0194599820933169. Epub 2020 Jun 2.
As rhinologists return to practice amid SARS-CoV-2, special considerations are warranted given the unique features of their subspecialty. Rhinologist manipulation of nasal tissue, proximity, and frequent aerosol-generating procedures (AGPs) create high risk for infection transmission. There are 4 areas of special consideration to mitigate risk: (1) previsit planning for risk stratification/mitigation, (2) appropriate personal protective equipment, (3) preprocedural testing, and (4) environmental controls. During previsit planning, risk factors of the patient and procedures are considered. High-risk AGPs are identified by duration, proximity, manipulation of high-viral load tissue, and use of powered instrumentation. Appropriate personal protective equipment includes selection of respiratory and eye protection. COVID-19 testing can screen for asymptomatic carriers prior to high-risk procedures; however, alternative testing methods are required in rhinologic patients not eligible for nasopharyngeal testing due to nasal obstruction or skull base defects. Last, AGPs in rhinologic practices require considerations of room air handling and environmental controls.
随着 SARS-CoV-2 大流行，鼻科医生恢复执业，鉴于其亚专业的独特性，需要特别考虑一些因素。鼻科医生对鼻腔组织的操作、近距离接触以及频繁产生气溶胶的操作程序（AGP）会大大增加感染传播的风险。有 4 个需要特别考虑的方面来降低风险：（1）就诊前的风险分层/缓解规划，（2）适当的个人防护设备，（3）术前检查，以及（4）环境控制。在就诊前规划中，需要考虑患者的风险因素和操作程序。高风险的 AGP 通过持续时间、近距离接触、对高病毒载量组织的操作以及使用动力器械来确定。适当的个人防护设备包括选择呼吸和眼部防护。COVID-19 检测可在高风险操作前筛查无症状携带者；然而，由于鼻腔阻塞或颅底缺陷而不适合鼻咽检测的鼻科患者需要其他替代检测方法。最后，鼻科操作中的 AGP 需要考虑房间空气处理和环境控制。
