xRead - Nasal Obstruction (September 2024) Full Articles

20426984, 2021, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.22741 by Stanford University, Wiley Online Library on [01/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

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Orlandi et al.

well tolerated in post-surgical CRS patients and achieved similar SNOT-20 and Lund-Kennedy scores compared to mupirocin rinses though with lower bacterial culture neg ativity rates. 2495 However, it is important to note that PVP 1 at higher concentrations (5-10%) have demonstrated cil iotoxicity in vitro and increase risk of iodine toxity. 2499 In vitro efficacy furthermore, may not guarantee clinical anti-viral protection as mucosal coverage by topical rinses may be incomplete and can diverge from that of inhaled, aerosolized particles. Biologic therapy targeting type 2 inflammation may also be considered an option for recalcitrant cases of CRS unwilling or unable to undergo surgical therapy. 2462,2500 The European Academy of Allergy and Clinical Immunol ogy (EEACI) has recommended that non-infected patients on biologics continue their therapy. However, in case of an active SARS-CoV-2 infection, the authors recommended biological treatment be stopped until clinical recovery and confirmed SARS-CoV-2 negativity. 2501 The implications on viral transmissibility for AGPs remain controversial. 122–125,127,128 Both high-speed drill and bipolar electrocautery are considered aerosol-generating devices, and are often required in extended surgical approaches for recalcitrant CRS. 123,128 The use of constant suction ing during these procedures may help mitigate particle transmission. 122,125 Notably the microdebrider, with its in line suction, was not a significant aerosol producer. 123,128 Other aerosol-generating in-office devices include bipo lar RF ablation (coblation) and cryotherapy, both used for treatment of rhinitis. 128 While acknowledging the risks of endonasal instrumen tation and mitigating unnecessary exposure, the otolaryn gology field has continued to utilize AGPs in patient treat ment. Comprehensive pre-visit patient screening, SARS CoV-2 PCR testing, environmental safety, and full PPE uti lization are recommended as appropriate precautions. 129 FUNDING SOURCES FOR THE STUDY None. ORCID Richard R. Orlandi MD https://orcid.org/0000-0001 5374-9144 Timothy L. Smith MD, MPH https://orcid.org/0000 0002-6424-7083 Benjamin Bleier MD https://orcid.org/0000-0003-0783 8861 XVI.E Surgical Treatment of CRS in the Setting of COVID-19 Pandemic

Jeremiah A. Alt MD, PhD https://orcid.org/0000-0003 0560-5028 Daniel Beswick MD https://orcid.org/0000-0001-8612 5442 Jean Anderson Eloy MD https://orcid.org/0000-0003 2893-7818 David A. Gudis MD https://orcid.org/0000-0002-1938 9349 Eric H. Holbrook MD https://orcid.org/0000-0002-7632 2204 Claire Hopkins MD https://orcid.org/0000-0003-3993 1569 Amin R. Javer MD https://orcid.org/0000-0001-9427 1853 Rong-San Jiang MD, PhD https://orcid.org/0000-0002 8280-6029 Devyani Lal MD https://orcid.org/0000-0002-7593-2385 Heung-Man Lee MD, PhD https://orcid.org/0000-0002 0688-7672 Joshua M. Levy MD, MPH https://orcid.org/0000-0001 5907-3421 Zara Patel MD https://orcid.org/0000-0003-2072-982X Carl Philpott MD https://orcid.org/0000-0002-1125-3236 Vijay R. Ramakrishnan MD https://orcid.org/0000 0003-2748-0705 Kristine Smith MD https://orcid.org/0000-0002-7026 5819 Carol Yan MD https://orcid.org/0000-0003-1934-4922 Luo Zhang MD, PhD https://orcid.org/0000-0002-0910 9884 REFERENCES 1. Orlandi RR, Kingdom TT, Hwang PH, et al. International con sensus statement on allergy and rhinology: rhinosinusitis. Int Forum Allergy Rhinol . 2016;6(Suppl 1):S22-S209. 2. Zou L, Ruan F, Huang M, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med . 2020;382(12):1177-1179. 3. Yan C, Faraji F, Prajapati D, Boone C, DeConde A. Associ ation of chemosensory dysfunction and Covid-19 in patients presenting with influenza-like symptoms. Int Forum Allergy Rhinol . 10(7):806-813 4. Rudmik L, Smith TL. Development of an evidence-based review with recommendations using an online iterative pro cess. Int Forum Allergy Rhinol . 2011;1(6):431-437. 5. Brozek JL, Akl EA, Alonso-Coello P, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. Allergy . 2009;64(5):669-677. 6. Neumark T, Brudin L, Engstrom S, Molstad S. Trends in num ber of consultations and antibiotic prescriptions for respira tory tract infections between 1999 and 2005 in primary health care in Kalmar County, Southern Sweden. Scand J Prim health Care . 2009;27(1):18-24.