Objective Assessment of Aerosolization During Transnasal Endoscopy: A Systematic Review

Otolaryngol Head Neck Surg. 2022 Sep;167(3):417-424. doi: 10.1177/01945998211050632. Epub 2021 Oct 12.


Objective: The goal of this systematic review is to assimilate the literature on objective assessment of particulate aerosolization during transnasal endoscopic procedures.

Data sources: PubMed and hand-searched articles.

Review methods: The PubMed electronic database was searched using Medical Subject Headings and free-text search terms relating to aerosolization and transnasal endoscopic procedures from inception to November 16, 2020. References were hand-searched to identify additional publications for consideration. Inclusion in the systematic review required quantification of aerosol generation during clinic transnasal endoscopic procedures. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and flowchart were followed during the systematic review.

Results: Eight of 900 studies met criteria for inclusion in the systematic review. Five studies tested nasal endoscopy with mixed findings on the risk of aerosol generation during this procedure. Two studies assessed flexible fiberoptic laryngoscopy and also reported mixed findings. Breathing, sneezing, speech, and spray anesthetic/decongestants were found to consistently increase aerosol generation above baseline. A number of studies tested new and general mitigation strategies and were found to be effective in decreasing aerosol generation.

Conclusions: The coronavirus disease 2019 pandemic has informed many considerations regarding patient and provider safety. It is valuable to understand the risk during outpatient otolaryngology procedures through the quantification of aerosolization. There are several effective methods to control aerosolization during these procedures. The findings of this systematic review will inform appropriate precautions to protect against spread of infectious agents by aerosolization.

Keywords: COVID-19; aerosol-generating procedures; outpatient endoscopy; patient safety and quality improvement.

Publication types

  • Systematic Review

MeSH terms

  • COVID-19* / epidemiology
  • Endoscopy / methods
  • Humans
  • Pandemics / prevention & control
  • Respiratory Aerosols and Droplets
  • SARS-CoV-2