BACKGROUND: In patients after total laryngectomies, the trachea and the lung can be easily infected by SARS-CoV-2 because the respiration happens through the tracheostoma.
OBJECTIVE: The aim of our study was to examine whether patients with LaryTube™ can distribute aerosols to a greater extent than without LaryTube™, and to observe whether the surface of different protective instruments can be examined using the thermal camera in total laryngectomees. An important objective was also to confirm the assumption that the use of HME (heat and moisture exchanger) alone does not provide protection during COVID-19 pandemic. Finally, during our tests, we tried to get an answer to our assumption that the sample taken from the inner surface of the HME can be tested for SARS-CoV-2.
METHODS: A total of 23 patients who underwent total laryngectomies were analyzed by velocity measurements and thermal imaging with and without HMEs and laryngeal tubes, using different types of PPEs. COVID-19 PCR testing was performed on patient tracheas and the inner surfaces of the HMEs.
RESULTS: Male patients with laryngeal tubes without HMEs demonstrated an increase in exhaled airflow velocity of more than 43% compared to male patients without laryngeal tubes; in female patients, the same value was more than 39%. Thermal imaging results confirmed that the lowest surface temperature was measured on FFP2 masks. The sent samples can be tested for SARS-CoV-2 using PCR, the presence of the virus was not detected.
CONCLUSIONS: Laryngectomized patients without laryngeal tubes pose a lower risk for spreading viral aerosols due to the reduced velocity of the exhaled airflow caused by the absence of the tube as the narrowing factor. Patients with laryngeal tubes who undergo total laryngectomies during the COVID-19 pandemic should use HMEs with viral filter, if possible, also changing the laryngeal tubes to dermal adhesives for fitting their HMEs seems to be the best option. The surface of the used protective equipment can also be examined with thermal camera in the case of total laryngectomees. COVID-19 PCR testing of the tracheal secretion from the inner HME surfaces should become a routine in clinical practice if deemed necessary. Orv Hetil. 2023; 164(34): 1327-1336.
Bevezetés: A teljes gégeeltávolításon átesett betegeknél a légcső és a tüdő a SARS-CoV-2 közvetlen fertőzésének további helyeként szolgálhat, mivel a légúti áramlás a tracheostomán keresztül történik. Célkitűzés: Tanulmányunk célja volt, hogy megvizsgáljuk, LaryTube™ mellett a betegek képesek-e nagyobb mértékben aeroszolok terjesztésére, mint LaryTube™ nélkül, továbbá az, hogy megfigyeljük, vizsgálható-e különböző védőeszközök felszíne a hőkamera segítségével ebben a betegcsoportban. Fontos célkitűzésként szerepelt az is, hogy megerősítsük a feltételezést, miszerint a HME (heat and moisture exchanger – hő- és nedvességcserélő) használata önmagában nem nyújt védelmet COVID–19-pandémia esetén. Végül vizsgálataink során próbáltunk választ kapni arra a feltételezésünkre, hogy a HME belfelszínéről vett minta tesztelhető-e SARS-CoV-2 irányában. Módszer: Teljes gégeeltávolításon átesett 23 beteg kilélegzett levegőjének sebességét mértük HME-vel és HME nélkül, LaryTube™ használatával, illetve anélkül. Az általunk kiválasztott védőeszközök felszínén hőkamerás vizsgálatot végeztünk, melyeket minden esetben a beteg stomája elé helyeztünk. A HME belfelszínéről és a trachea hátsó faláról vett váladékot az esetleges SARS-CoV-2-pozitivitás miatt PCR-vizsgálatnak vetettük alá. Eredmények: LaryTube™-bal ellátott férfi betegeink HME nélkül 43%-kal gyorsabban fújták ki levegőjüket, mint a LaryTube™ nélküliek. Nők esetében ez az érték 39% fölött volt. A legalacsonyabb felszíni hőmérsékletet az FFP2-es maszk esetében regisztráltuk. A küldött minták PCR segítségével SARS-CoV-2-re tesztelhetők, vírus jelenlétét nem mutatták ki. Következtetés: A teljes gégeeltávolításon átesett betegek LaryTube™ nélkül kisebb eséllyel képesek az aeroszolok terjesztésére, mivel hiányzik a tubus mint a stoma szűkítő tényezője. Ezen betegeknek ajánlott COVID–19-pandémia idején a vírusszűrővel ellátott HME használata, sőt a legracionálisabb megoldás a tubus elhagyása és tapaszra cserélése a HME rögzítése miatt. A használt védőeszközök felszíne hőkamerával vizsgálható laryngectomián átesett betegek esetében is. Szükség esetén bevezethető a klinikai gyakorlatba a HME belfelszínéről vett minta PCR-tesztelése SARS-CoV-2 irányában, mely sokkal biztonságosabb módszernek bizonyult. Orv Hetil. 2023; 164(34): 1327–1336.

OBJECTIVE: Create an aerosol containment mask (ACM) for common otolaryngologic endoscopic procedures which also provides nanoparticle-level protection to patients.
METHODS: Prospective feasibility study.
METHODS: In-person testing with a novel ACM.
METHODS: The mask was designed in Solidworks and 3-dimensional printed. Measurements were made on 100 consecutive clinic patients who underwent medically necessarily endoscopy, 50 rigid nasal and 50 flexible, by 9 surgeons.
RESULTS: Of the 50 patients who underwent rigid nasal endoscopy with the ACM, 0 of 25 patients with the suction off and 0 of 25 patients with the suction on had evidence of leakage of 0.3 μm particles. Of the 50 patients who underwent flexible endoscopy with the ACM, 0 of 25 patients with the suction off and 0 of 25 patients with the suction on had evidence of leakage of 0.3 μm particles. In terms of comfort, 73% of patients found the ACM somewhat or very comfortable without suction, compared to 86% with the suction on. Surgeons were able to visualize all necessary anatomic areas in 98% of procedures. In 97% of procedures, the masks were able to be placed easily.
CONCLUSIONS: ACM can accommodate rigid nasal and flexible endoscopes and may prevent leakage of patient-generated aerosols, thus avoiding contamination of the room and protecting health care workers from airborne contagions.
METHODS: The level of evidence is 2.

OBJECTIVE: To create an aerosol containment mask (ACM) for common otolaryngologic endoscopic procedures that also provides nanoparticle-level protection to patients.
METHODS: Prospective feasibility study .
METHODS: In-person testing with a novel ACM.
METHODS: The mask was designed in Solidworks and 3D printed. Measurements were made on 10 healthy volunteers who wore the ACM while reading the Rainbow Passage repeatedly and performing a forced cough or sneeze at 5-second intervals over 1 minute with an endoscope in place.
RESULTS: There was a large variation in the number of aerosol particles generated among the volunteers. Only the sneeze task showed a significant increase compared with normal breathing in the 0.3-µm particle size when compared with a 1-tailed t test (P = .013). Both the 0.5-µm and 2.5-µm particle sizes showed significant increases for all tasks, while the 2 largest particle sizes, 5 and 10 µm, showed no significant increase (both P < .01). With the suction off, 3 of 30 events (2 sneeze events and 1 cough event) had increases in particle counts, both inside and outside the mask. With the suction on, 2 of 30 events had an increase in particle counts outside the mask without a corresponding increase in particle counts inside the mask. Therefore, these fluctuations in particle counts were determined to be due to random fluctuation in room particle levels.
CONCLUSIONS: ACM will accommodate rigid and flexible endoscopes plus instruments and may prevent the leakage of patient-generated aerosols, thus avoiding contamination of the room and protecting health care workers from airborne contagions.
METHODS: 2.

OBJECTIVE: To create an aerosol containment mask (ACM) that contains aerosols during common otolaryngologic endoscopic procedures while protecting patients from environmental aerosols.
METHODS: Bench testing.
METHODS: Mannequin testing.
METHODS: The mask was designed in SolidWorks and 3-dimensional printed. Mannequins were fitted with a nebulizer to generate aerosols. Commercial particle counters were used to measure mask performance.
RESULTS: The ACM has 2 ports on either side for instruments and endoscopes, a port for a filter, and a port that can evacuate aerosols contained within the mask via a standard suction pump. The mask contained aerosols on a mannequin with and without facial hair when the suction was set to 18.5 L/min. Other types of masks demonstrated substantial aerosol leakage under similar conditions. In a subsequent experiment, the ACM contained aerosols generated by a nebulizer up to the saturation of the particle detector without measurable leakage with or without suction.
CONCLUSIONS: The ACM will accommodate rigid and flexible endoscopes plus instruments and prevent leakage of patient-generated aerosols, thus avoiding contamination of the room and protecting health care workers from airborne contagions.
METHODS: 2.

OBJECTIVE: Our objective was to determine the efficacy of pre-procedural rinsing with chlorhexidine in reducing bacterial aerosol contamination during use of ultrasonic scaler and comparing the efficacy of water, non-tempered chlorhexidine and tempered chlorhexidine in reducing bacterial count in aerosols when used as a pre-procedural rinse.
METHODS: The study was designed to include 30 systemically healthy patients in different age groups. The patients were divided randomly into 3 groups (I, II, III) of 10 patients each to be administered with sterile water, non tempered chlorhexidine and tempered chlorhexidine, respectively, as a pre-procedural rinse. The aerosol produced by the ultrasonic unit was collected at 3° clock, 6° clock and 12° clock positions on blood agar plates within a range of 4 feet in all the three groups. The blood agar plates were incubated for 48 hours and the total number of colony forming units (CFUs) were counted and statistically analyzed.
RESULTS: The results showed that CFU in group III and group II were significantly reduced when compared to group I with F=1084.92, P<0.001 (ANOVA). Also, CFU in group III was significantly reduced when compared to group II with P<0.001.
CONCLUSIONS: Pre-procedural rinse can significantly reduce the viable microbial content of dental aerosols and tempered chlorhexidine was more effective than non-tempered chlorhexidine.