Search strategy
This review was performed in keeping with PRISMA (Preferred Reporting
Items for Systematic Reviews and Meta-Analyses)
guidance.3 Under institutional licensing agreement,
the Ovid (Wolters Kluwer N.V.) portal was used to search the MEDLINE
database (U.S. National Library of Medicine) between 1 December 2020 and
4 March 2021. Search terms used were ”covid-19” OR ”SARS-CoV-2” AND
”sinus surgery” OR ”endonasal” OR ”transnasal” OR ”rhinology” OR ”skull
base” OR ”nasal surgery”. Results were restricted to those in the
English language.
All studies relating to either the assessment or mitigation of
aerosolisation risk, in the setting of rhinological surgery in COVID-19
were included. It was stipulated studies either provide some form of
empirical data or propose a specific novel intervention. Both clinical
and simulation studies were included. Opinion and editorial pieces were
excluded.
In this review, the term “aerosol” is used to refer to both droplets
and smaller airborne particles (<10μm), though they are
referenced separately where possible.
Database searches were performed and screened by both authors with
discrepancies resolved through discussion. Reference lists of included
papers were scrutinised for further studies. The heterogeneous nature of
the studies included precluded meta-analysis and so a qualitative
synthesis was chosen to present the results. Where possible, risk of
bias assessment was performed using ROBINS-I (Risk of Bias In
Nonrandomised Studies) criteria.4 Studies were also
graded as to their level of evidence using the Oxford Centre for
Evidence-Based Medicine criteria.5