Discussion
The ENT surgeon is at risk of COVID -19 infection during this pandemic
both in OPD(outpatient) and the operation room(4). It
is known that almost all ENT surgeries are aerosol generating, or
surgeries are performed in areas which have close contact with
nasopharynx or oropharynx. With an intent to reduce viral load in the
patient, and to reduce the infection rate amongst the treating doctors,
Povidone iodine has been suggested as a nasal spray and a mouth wash to
health care workers to reduce the risk of infection(5).
In vitro studies on the efficacy of povidone iodine show that a
concentration of 0.23 % has good bactericidal and virucidal
property(6).
Povidone-iodine irrigation has been used in surgery and has proven to
reduce surgical site infection. Although it is a simple technique,
concerns were raised regarding absorption and impaired thyroid function,
but until now, no serious concerns have been reported other than
allergy(7).
Contamination of the povidone-iodine solution has been associated with
infections with Pseudomonas, therefore, precautions should be taken to
ensure its sterility before use(8),(9). In general, povidone-iodine
irrigation can be used for wound irrigation in all patients except in
patients with iodine sensitivity, burns, thyroid disease or renal
disease .
We recommend a novel technique of wet tonsillectomy with povidone iodine
flush, which would possibly reduce the viral load at the source before
aerosol generation, thereby reducing risk to health care workers.
Povidone iodine is easily available, economical, and is fairly safe in
low concentrations, thus this could be a safe way to restart elective
oral, ear and nasal procedures in asymptomatic patients during the
pandemic. This is in adjunct to the recommended personal protective
equipment and other safety measures in the operating room.