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.