Introduction
Fibreoptic nasoendoscopy (FNE) and laryngoscopy (FOL) are essential
items in the Otolaryngologist’s toolkit. They allow rapid diagnosis in
both the emergency and elective settings. However, in the COVID-19
(Corona Virus Disease 19) era, changes to practice are necessary to
protect both the patient and healthcare provider. Many ENT procedures
require personal protective equipment (PPE). Public Health England and
ENTUK have published guidance identifying ”Higher risk” clinical areas.
These include areas where nasendoscopy is performed regularly (1).
Moreover, ENT clinics do not have laminar airflow rooms thus room
ventilation is dependent on the frequency of air changes. A standard
room has 4 to 6 air changes per hour, thus a room where an aerosol
generating procedure has been performed may be empty for at least an
hour prior to cleaning to reduce the risk from cross contamination due
to aerosols.
It is best practice to presume there is a degree of aerosolization given
the concentration of virus particles in the nasal cavity and the
potential to cause coughing or sneezing. FOL procedures have the
potential to produce aerosols when the patient coughs, sneezes, talks,
or when suction is used. Further, droplets are detectable from the
patient in the air when they are speaking, which is often part of the
FOL assessment (2).
Current guidance is that all persons performing an aerosol generating
procedure must wear PPE consisting of a filtering face piece 3 (FFP3)
mask, adequate eye protection (3), gloves and fluid resistant gown (1).
In the context of an upper airway procedure requiring suction it is
recommended that a telemonitor and camera should be used instead of the
eyepiece on the endoscope to increase the distance between operator and
patient and minimise aerosol inhalation. These utilise a barrier
strategy to prevent viral transmission to the operator. Reducing escape
of aerosols from the patient to surroundings might add more safety and
might lessen time lag in use of clinic rooms. We describe a barrier
device for patients that is easily made from available materials in
hospitals with an anaesthetic or emergency department, cost effective,
easy to use and well tolerated by the patient.