Comparison of aerosol generation between electrocautery and cold dissection tonsillectomy.

OBJECTIVE: Coronavirus disease 2019 can spread through aerosols produced by surgical procedures, but knowledge of the extent of aerosol production and the risk posed by many common procedures does not exist. This study analysed aerosol generation during tonsillectomy and how it differs between distinct surgical techniques and instruments. The results can be used in risk assessment during current and future pandemics and epidemics. METHOD: An optical particle sizer was used to measure particle concentrations generated during tonsillectomy from the perspectives of the surgeon and other staff. Coughing is commonly used as a reference for high-risk aerosol generation; therefore, coughing and the operating theatre's background concentration were chosen as reference values. Different instruments were also compared to find the safest way to perform the tonsillectomy from the perspective of airborne transmission. RESULTS: Eighteen tonsillectomies were evaluated; all techniques mostly generated less than 1 µm particles. For the surgeon, bipolar electrocautery significantly exceeded the particle generation of coughing in both total and less than 1 µm particles and was found to produce significantly higher total and less than 1 µm aerosol concentrations than cold dissection and BiZact. No technique exposed other staff to a greater aerosol concentration than is generated by a cough. CONCLUSION: Bipolar electrocautery generated high aerosol concentrations during tonsillectomy; cold dissection generated significantly less. The results support cold dissection as the primary tonsillectomy technique, particularly during the epidemics of airborne diseases.

Rhinological procedures result in minimal generation of aerosols.

BACKGROUND: COVID-19 and other respiratory infections spread through aerosols produced in respiratory activities and in certain surgical procedures considered as aerosol-generating procedures (AGP). Due to manipulation of the upper airway mucosa, rhinosurgery has been considered a particular risk for spread of respiratory infections. Our aim was to assess staff exposure to aerosols during common rhinosurgical procedures METHODS: Staff exposure to generated particle concentrations and size distributions between 0.3 λm and 10 λm were measured during rhinosurgery using an optical particle sizer without any additional collection methods. Similarly measured aerosol exposure during coughing (a commonly used risk reference for aerosol generation) and the operating room’s background concentration were chosen as reference values. RESULTS: Altogether 16 common rhinological surgeries (septoplasties and endoscopic sinus surgery) were measured. The use of suction produced significantly lower aerosol concentration compared to coughing. Low aerosol generation was observed during injection anaesthesia of the nasal mucosa. Instrument comparison revealed that the microdebrider produced fewer aerosols than cold dissection in particles of 1-5 λm and >5 λm. CONCLUSIONS: Common rhinosurgeries do not seem to generate as high aerosol concentration exposures as previously believed. Rather, the observed aerosol exposure is lower or similar to exposures during coughing. Therefore, the classification of common rhinosurgeries as AGPs should be re-assessed or possibly discarded.

Aerosol generation during coughing: an observational study.

OBJECTIVE: Coronavirus disease 2019 has highlighted the lack of knowledge on aerosol exposure during respiratory activity and aerosol-generating procedures. This study sought to determine the aerosol concentrations generated by coughing to better understand, and to set a standard for studying, aerosols generated in medical procedures. METHODS: Aerosol exposure during coughing was measured in 37 healthy volunteers in the operating theatre with an optical particle sizer, from 40 cm, 70 cm and 100 cm distances. RESULTS: Altogether, 306 volitional and 15 involuntary coughs were measured. No differences between groups were observed. CONCLUSION: Many medical procedures are expected to generate aerosols; it is unclear whether they are higher risk than normal respiratory activity. The measured aerosol exposure can be used to determine the risk for significant aerosol generation during medical procedures. Considerable variation of aerosol generation during cough was observed between individuals, but whether cough was volitional or involuntary made no difference to aerosol production.

Voice symptoms in teachers during distance teaching: a survey during the COVID-19 pandemic in Finland.

PURPOSE: Due to the coronavirus disease of 2019 (COVID-19), teachers during the pandemic have had to adapt to online teaching at short notice. This study aims to investigate the voice symptoms and their environmental risk factors as well as the work ability associated with distance teaching and to compare these with symptoms in previous contact teaching. METHODS: We conducted a survey of 121 primary and secondary school teachers across Finland. The survey was advertised online through social media and the replies collected from voluntarily participating teachers. RESULTS: During distance teaching vocal symptoms appeared less often than in school with 71% teachers experiencing them in regular teaching and 44% in distance teaching, VHI result decreased from 7.88 in school teaching to 4.58 in distance teaching. Acoustic conditions were reported to be more suitable in distance teaching with 73% of teachers finding them adequate during distance teaching in comparison to 46% for those in regular teaching. Background noise was the most disturbing factor for a teacher's voice in the classroom and in distance teaching and this was even more conspicuous in the classroom. Also, subjectively experienced poor indoor air quality at school influenced the voice negatively. Further, voice problems were associated with increased subjective stress levels and reduced ability to work. CONCLUSION: Distance teaching has affected teachers' voices in a positive way compared with regular teaching. This difference is likely to be due to better acoustics and indoor air quality in distance teaching conditions.

Union of the European Phoniatricians' position statement on the exit strategy of phoniatric and laryngological services: staying safe and getting back to normal after the peak of coronavirus disease 2019 (issued on 25th May 2020).

BACKGROUND: The following position statement from the Union of the European Phoniatricians, updated on 25th May 2020 (superseding the previous statement issued on 21st April 2020), contains a series of recommendations for phoniatricians and ENT surgeons who provide and/or run voice, swallowing, speech and language, or paediatric audiology services. OBJECTIVES: This material specifically aims to inform clinical practices in countries where clinics and operating theatres are reopening for elective work. It endeavours to present a current European view in relation to common procedures, many of which fall under the aegis of aerosol generating procedures. CONCLUSION: As evidence continues to build, some of the recommended practices will undoubtedly evolve, but it is hoped that the updated position statement will offer clinicians precepts on safe clinical practice.

Subjective evaluation of voice and working conditions and phoniatric examination in kindergarten teachers.

AIMS: This study evaluated the prevalence of voice problems in kindergarten teachers and investigated some background factors affecting vocal health. METHODS: One hundred and nineteen female kindergarten teachers volunteered by responding to an Internet questionnaire on voice habits, voice symptoms, and the amount of negative impact various working conditions may have on their voices. Phoniatric examination was carried out with a rigid laryngoscope. RESULTS: Of the subjects, 71.5% reported frequent strain on the voice (monthly or more often), and 56.3% reported hoarseness without infection. Eighty-six percent reported that when their voice got tired during the working day it recovered quite well, well or remarkably well by the next day. Noise at work was considered most detrimental to the voice. Clear organic findings were observed in 10.9% of the cases and did not correlate with subjective voice symptoms. CONCLUSIONS: The results confirmed earlier findings that a remarkable number of kindergarten teachers suffer from voice problems and consider noise in the environment especially to be harmful to their voices. However, the majority reported recovering well from vocal symptoms. Further studies are needed on individual speech habits, working day-related voice evaluation, recovery time and work-environmental factors. A follow-up is warranted to identify the main factors leading to voice problems.