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Nasal Endoscopy During the COVID‐19 Pandemic: Mitigating Risk with 3D Printed Masks

INTRODUCTION Following the declaration from the World Health Organization that the COVID-19 outbreak was a pandemic, the number of cases worldwide has accelerated. To date, there are over 8 million cases worldwide and approximately 450,000 deaths. There has been a considerable amount of literature published to help guide physicians in managing the outbreak at the front lines, protect themselves, and provide direction in determining a gradual return to hospital operations. Otolaryngologists have been disproportionately affected by COVID-19 due to higher viral loads within the nasal cavity and upper aerodigestive tract. Once viral particles have become aerosolized, they have been reported to stay within the air for up to 3 hours. As such, many guidelines and recommendations have advised against performing routine nasolaryngoscopy. In the event that it is required, most guidelines have suggested the use of full personal protective equipment (PPE) including N95 mask, face shield, gown and gloves. As the pandemic continues, we must determine safe and efficacious means of completing necessary examinations, including nasal endoscopy. With the various challenges that this pandemic has created, ingenuity and creativity has been stimulated as solutions have been devised to perform procedures that are essential, yet high risk; one such example is endotracheal intubation. Endotracheal intubation remains a high-risk procedure due to direct exposure to the oral cavity, oropharynx, larynx, and trachea. Some anesthetists have begun using physical barrier systems to minimize exposure. One commonly utilized technique involves performing direct laryngoscopy and intubation within an enclosed barrier called an “aerosol box.” This box is a plastic cube with holes designed for placing one’s hands while intubating and is effective in reducing exposure to droplets/aerosols. A similar solution using a physical barrier system for nasal endoscopy has not yet been described in the literature. The purpose of our study was to design nasal endoscopy masks/adapters that would permit an adequate endoscopic examination and most importantly provide necessary protection to the endoscopist.