Airborne Aerosol Generation During Endonasal Procedures in the Era of COVID-19: Risks and Recommendations

Objective In the era of SARS-CoV-2, the risk of infectious airborne aerosol generation during otolaryngologic procedures has been an area of increasing concern. The objective of this investigation was to quantify airborne aerosol production under clinical and surgical conditions and examine efficacy of mask mitigation strategies. Study Design Prospective quantification of airborne aerosol generation during surgical and clinical simulation. Setting Cadaver laboratory and clinical examination room. Subjects and Methods Airborne aerosol quantification with an optical particle sizer was performed in real time during cadaveric simulated endoscopic surgical conditions, including hand instrumentation, microdebrider use, high-speed drilling, and cautery. Aerosol sampling was additionally performed in simulated clinical and diagnostic settings. All clinical and surgical procedures were evaluated for propensity for significant airborne aerosol generation. Results Hand instrumentation and microdebridement did not produce detectable airborne aerosols in the range of 1 to 10 μm. Suction drilling at 12,000 rpm, high-speed drilling (4-mm diamond or cutting burs) at 70,000 rpm, and transnasal cautery generated significant airborne aerosols ( P < .001). In clinical simulations, nasal endoscopy ( P < .05), speech ( P < .01), and sneezing ( P < .01) generated 1- to 10-μm airborne aerosols. Significant aerosol escape was seen even with utilization of a standard surgical mask ( P < .05). Intact and VENT-modified (valved endoscopy of the nose and throat) N95 respirator use prevented significant airborne aerosol spread. Conclusion Transnasal drill and cautery use is associated with significant airborne particulate matter production in the range of 1 to 10 μm under surgical conditions. During simulated clinical activity, airborne aerosol generation was seen during nasal endoscopy, speech, and sneezing. Intact or VENT-modified N95 respirators mitigated airborne aerosol transmission, while standard surgical masks did not.

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Droplet and bone dust contamination from high‐speed drilling during mastoidectomy

Clinical Otolaryngology ◽

10.1111/coa.13725 ◽

2021 ◽

Vol 46 (3) ◽

pp. 614-618

Author(s):

Anne L. Markey ◽

Samuel C. Leong ◽

Casey Vaughan

Keyword(s):

High Speed ◽

High Speed Drilling

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Dynamic characteristics of a drill in the drilling process

Proceedings of the Institution of Mechanical Engineers Part B Journal of Engineering Manufacture ◽

10.1243/095440503321148803 ◽

2003 ◽

Vol 217 (2) ◽

pp. 161-167 ◽

Cited By ~ 10

Author(s):

B W Huang

Keyword(s):

Dynamic Characteristics ◽

High Speed ◽

Thrust Force ◽

Time Dependent ◽

Drilling Process ◽

Improve Quality ◽

Vibration Model ◽

High Speed Drilling ◽

Spinning Speed ◽

Twisted Beam

The dynamic characteristics of high-speed drilling were investigated in this study. To improve quality and produce a higher production rate, the dynamic characteristics of the drilling process need to be studied. A pre-twisted beam is used to simulate the drill. The moving Winkler-type elastic foundation is used to approximate the drilling process. A time-dependent vibration model for drilling is presented. The spinning speed, pre-twisted angle and thrust force effects of the drill are considered. The numerical analysis indicates that the natural frequency is suddenly reduced as the drill moves into a workpiece.

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An Innovative Approach to Exploration and Exploitation Drilling: The Slim-Hole High-Speed Drilling System

Journal of Petroleum Technology ◽

10.2118/19525-pa ◽

1990 ◽

Vol 42 (09) ◽

pp. 1184-1191 ◽

Cited By ~ 4

Author(s):

Scott H. Walker ◽

Keith K. Millheim

Keyword(s):

High Speed ◽

Innovative Approach ◽

Exploration And Exploitation ◽

High Speed Drilling ◽

Drilling System

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Kinematic and dynamic synthesis of a parallel kinematic high speed drilling machine

International Journal of Machine Tools and Manufacture ◽

10.1016/j.ijmachtools.2004.04.007 ◽

2004 ◽

Vol 44 (12-13) ◽

pp. 1381-1389 ◽

Cited By ~ 13

Author(s):

Reuven Katz ◽

Zhe Li

Keyword(s):

High Speed ◽

Drilling Machine ◽

Dynamic Synthesis ◽

High Speed Drilling ◽

Parallel Kinematic

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Multi objective optimisation of machining parameters during high speed drilling of Ti6Al4V alloy under dry condition

International Journal of Materials Engineering Innovation ◽

10.1504/ijmatei.2018.096042 ◽

2018 ◽

Vol 9 (3) ◽

pp. 195

Author(s):

V. Krishnaraj ◽

R. Sindhumathi ◽

A. Prabukarthi ◽

S. Harichealvan

Keyword(s):

High Speed ◽

Ti6al4v Alloy ◽

Machining Parameters ◽

Multi Objective ◽

High Speed Drilling

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Wear mechanisms of micro-drills during dry high speed drilling of PCB

Journal of Materials Processing Technology ◽

10.1016/j.jmatprotec.2012.05.004 ◽

2012 ◽

Vol 212 (10) ◽

pp. 1989-1997 ◽

Cited By ~ 34

Author(s):

L.J. Zheng ◽

C.Y. Wang ◽

L.Y. Fu ◽

L.P. Yang ◽

Y.P. Qu ◽

...

Keyword(s):

Wear Mechanisms ◽

High Speed ◽

High Speed Drilling

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Factors affecting aerosol size distribution during various dental procedures

10.1101/2021.07.30.21261399 ◽

2021 ◽

Author(s):

Shruti Choudhary ◽

Michael J Durkin ◽

Daniel C Stoeckel ◽

Heidi M Steinkamp ◽

Martin H Thornhill ◽

...

Keyword(s):

Particulate Matter ◽

High Speed ◽

High Volume ◽

Routine Care ◽

Mitigation Strategies ◽

Aerosol Size Distribution ◽

Dental Clinic ◽

Factors Affecting ◽

Dental Procedures ◽

The Impact

Objectives: To determine the impact of various aerosol mitigation interventions and establish duration of aerosol persistence in a variety of dental clinic configurations. Methods: We performed aerosol measurement studies in endodontic, orthodontic, periodontic, pediatric, and general dentistry clinics. We used an optical aerosol spectrometer and wearable particulate matter sensors to measure real-time aerosol concentration from the vantage point of the dentist during routine care in a variety of clinic configurations (e.g, open bay, single room, partitioned operatories). We compared the impact of aerosol mitigation strategies [ventilation and high-volume evacuation (HVE)] and prevalence of particulate matter in the dental clinic environment before, during and after high-speed drilling, slow speed drilling and ultrasonic scaling procedures. Results: Conical and ISOVAC HVE were superior to standard tip evacuation for aerosol-generating procedures. When aerosols were detected in the environment, they were rapidly dispersed within minutes of completing the aerosol-generating procedure. Few aerosols were detected in dental clinics, regardless of configuration, when conical and ISOVAC HVE were used. Conclusions: Dentists should consider using conical or ISOVAC HVE rather than standard tip evacuators to reduce aerosols generated during routine clinical practice. Furthermore, when such effective aerosol mitigation strategies are employed, dentists need not leave dental chairs fallow between patients as aerosols are rapidly dispersed. Clinical Significance: ISOVAC HVE is highly effective in reducing aerosol emissions. With adequate ventilation and HVE use, dental fallow time can be reduced to 5 minutes.

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