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.