Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May 6;49(1):28.
doi: 10.1186/s40463-020-00425-6.

Clinical Evidence Based Review and Recommendations of Aerosol Generating Medical Procedures in Otolaryngology - Head and Neck Surgery During the COVID-19 Pandemic

Free PMC article

Clinical Evidence Based Review and Recommendations of Aerosol Generating Medical Procedures in Otolaryngology - Head and Neck Surgery During the COVID-19 Pandemic

Andrew Thamboo et al. J Otolaryngol Head Neck Surg. .
Free PMC article


Background: Aerosol generating medical procedures (AGMPs) present risks to health care workers (HCW) due to airborne transmission of pathogens. During the COVID-19 pandemic, it is essential for HCWs to recognize which procedures are potentially aerosolizing so that appropriate infection prevention precautions can be taken. The aim of this literature review was to identify potential AGMPs in Otolaryngology - Head and Neck Surgery and provide evidence-based recommendations.

Methods: A literature search was performed on Medline, Embase and Cochrane Review databases up to April 3, 2020. All titles and abstracts of retrieved studies were evaluated and all studies mentioning potential AGMPs were included for formal review. Full text of included studies were assessed by two reviewers and the quality of the studies was evaluated. Ten categories of potential AGMPs were developed and recommendations were provided for each category.

Results: Direct evidence indicates that CO2 laser ablation, the use of high-speed rotating devices, electrocautery and endotracheal suctioning are AGMPs. Indirect evidence indicates that tracheostomy should be considered as potential AGMPs. Nasal endoscopy and nasal packing/epistaxis management can result in droplet transmission, but it is unknown if these procedures also carry the risk of airborne transmission.

Conclusions: During the COVID-19 pandemic, special care should be taken when CO2 lasers, electrocautery and high-speed rotating devices are used in potentially infected tissue. Tracheal procedures like tracheostomy and endotracheal suctioning can also result in airborne transmission via small virus containing aerosols.

Keywords: Aerosol; Aerosolization; COVID-19; Guideline; Review.

Conflict of interest statement

The authors declare that they have no competing interests.


Fig. 1
Fig. 1
Evidence Based Review Search Strategy. OHNS = Otolaryngology – Head and Neck Surgery

Similar articles

See all similar articles


    1. World Health Organization. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). Published 2020. Accessed April 16, 2020.
    1. Mark A, Hall DO. Mary Anne Bobinski, Nicholas Bagley, I. Glenn Cohen. Health Care Law and Ethics. 9. New York: Wolters Kluwer; 2018.
    1. World Health Organization . Advice on the use of masks in the context of COVID-19. Interim guidance 6 April 2020. 2020.
    1. Bourouiba L. Turbulent gas clouds and respiratory pathogen emissions: potential implications for reducing transmission of COVID-19. JAMA. 2020. [Epub ahead of print]. - PubMed
    1. Van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564–1567. - PMC - PubMed

MeSH terms

Supplementary concepts