The following is a summary of “Quantitative Evaluation of Aerosol Generation During In-Office Flexible Laryngoscopy” published in the October 2022 issue of Otolaryngol Head Neck Surgery by Bastien et al.


However, whether or not office flexible laryngoscopy (FL) generates aerosols and hence potentially raises the risk of SARS-CoV-2 transmission remains unknown despite expanding scientific understanding and research. There is a lack of consensus in the scant literature that does exist, making it impossible to draw any firm conclusions. With the hope of figuring out if FL produces aerosols.  Between February 2021 and May 2021, 134 participants were included in this prospective cohort research from a single tertiary care academic institution’s otolaryngology clinic. Particles from 0.02 μm to 5 μm were measured with 2 different optical particle sizer devices. Throughout the whole patient interaction, measurements were taken at regular intervals of 30 seconds, with 15-second sample pauses in between. The nares of the patient were spaced at least 12 inches from the instruments. 

The beginning and ending times of procedures that could produce aerosols were noted, such as the physical examination, the use of topical sprays, laryngoscopy, and others (eg, coughing, sneezing). Analysis of the data took place between February and May of 2021. Risks posed by office FL and examination. Significant change points (CPs) in this time series were identified using a Bayesian online change point detection (OCPD) technique. Important CP after FL relative to baseline physiologic variables like breathing and phonation was the primary outcome. During the time period of February 2021 and May 2021, data were gathered from a total of 134 patients. 91  of these interactions included FL. About 51  (56% of the total) of these patients did not protect their mouths with a mask during FL. Neither the presence nor absence of FL at a visit was associated with a statistically significant increase in CP. In addition, there was no increase in aerosol concentration due to nasal spray use. 

Overall, regardless of exposure, there was no correlation between the number of individuals in the exam room, the use of masks over patients’ mouths, the length of the visit, or the amount of time spent in FL and the average number of aerosol counts. However, for bigger aerosol sizes (≥1μm), the mean aerosol count was reduced by a much greater amount in rooms with higher air exchange rates during visits involving FL. This cohort study provides more evidence that FL, including the application of topical sprays, does not produce appreciable amounts of aerosol. For upcoming otolaryngology aerosol research, the Bayesian OCPD model shows promise.

Source: jamanetwork.com/journals/jamaotolaryngology/fullarticle/2797692