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Table 1 Summary of AGMPs, Risks, and Appropriate PPE Considerations

From: CSO (Canadian Society of Otolaryngology – Head & Neck Surgery) position paper on return to Otolaryngology – Head & Neck Surgery Clinic Practice during the COVID-19 pandemic in Canada

Encounter Type Possible Aerosol Generation Risk Patient Mask Physician PPEa Special Considerations
History Minimal Low Yes Surgical Mask,
Eye Protectionb
Consider virtual history to minimize in-person time
Maintain physical distancing in person
Physical Exam Minimal Low Yes (if possible) Surgical Mask,
Eye protectionb,
Gloves
Time with mask off (of patient) should be minimized where possible
Transtympanic Injection Minimal Low Yes Surgical Mask,
Eye Protectionb,
Gloves
Beware Arnold’s reflex
Consider local anesthesia/blocks to reduce coughing for extensive debridement
Use of microscope may be hindered by eye protection
Tympanostomy Tube Placement Minimal Low Yes
Mastoid/EAC Debridement Minimal Low Yes
Cauterization Epistaxis Minimal Low Yes Surgical Mask,
Eye Protection, Gloves,
Gownb
Consider chemical cautery over electrocautery
Rigid Nasal Endoscopy Moderate Low Yes Avoid powered aerosolized anesthetic sprays
Pull mask down to expose nostril or modify mask, keep mouth covered
Consider video system over direct visualization to increase distance from patient
Flexible Nasopharyngo-laryngoscopy Moderate Low Yes
Tracheotomy/Laryngectomy Patient High High Not applicable N95 respirator or
Surgical Mask
Eye Protection, Gloves, Gown
Unable to cover cough
Consider N95 mask, particularly if tube being manipulated or suctioning [27] performed
Rigid Laryngoscopy No consensus No consensus No consensus Consider flexible nasopharyngolaryngoscopy as an alternative
Aesthetic Procedures Minimal Low Yes (if possible) Surgical Mask,
Eye Protection, Gloves,
Gownb
Consider availability of appropriate PPE
Dependent on local health authority recommendations
  1. aminimum recommended personal protective equipment, boptional PPE, at physician discretion