Search strategy
This review was performed in keeping with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidance.3 Under institutional licensing agreement, the Ovid (Wolters Kluwer N.V.) portal was used to search the MEDLINE database (U.S. National Library of Medicine) between 1 December 2020 and 4 March 2021. Search terms used were ”covid-19” OR ”SARS-CoV-2” AND ”sinus surgery” OR ”endonasal” OR ”transnasal” OR ”rhinology” OR ”skull base” OR ”nasal surgery”. Results were restricted to those in the English language.
All studies relating to either the assessment or mitigation of aerosolisation risk, in the setting of rhinological surgery in COVID-19 were included. It was stipulated studies either provide some form of empirical data or propose a specific novel intervention. Both clinical and simulation studies were included. Opinion and editorial pieces were excluded.
In this review, the term “aerosol” is used to refer to both droplets and smaller airborne particles (<10μm), though they are referenced separately where possible.
Database searches were performed and screened by both authors with discrepancies resolved through discussion. Reference lists of included papers were scrutinised for further studies. The heterogeneous nature of the studies included precluded meta-analysis and so a qualitative synthesis was chosen to present the results. Where possible, risk of bias assessment was performed using ROBINS-I (Risk of Bias In Nonrandomised Studies) criteria.4 Studies were also graded as to their level of evidence using the Oxford Centre for Evidence-Based Medicine criteria.5