Laser plume containment during flexible transnasal laryngoscopy

Abstract

Objective To evaluate a negative pressure microenvironment designed to contain laser plume during flexible transnasal laryngoscopy. Methods The Negative Pressure Face Shield (NPFS) was previously reported as well tolerated with initial use on 30 patients. Diagnostic transnasal laryngoscopy was performed on an additional 108 consecutive patients who were evaluated by questionnaires and sequential pulse oximetry. Further study addressed operative transnasal potassium‐titanyl‐phosphate (KTP) laser laryngoscopy with biopsy done on four patients employing the NPFS. Results The previously described NPFS version 3 (v.3), a transparent acrylic barrier with two anterior instrumentation ports, was modified by repositioning the side suction port closer to the level of the nose and deepening the lateral sides, squaring off the lower projection. A post‐procedure questionnaire employing a 5‐point Likert scale ranging from no symptoms (rating of 1) to intolerable (rating of 5) identified excellent patient tolerance of the new design (v.4), among 22 patients evaluated and similar in the comparison to the 116 patients using version 3. Among the 138 patients analyzed, only one patient rated the experience as greater than “mild claustrophobia.” 100% of patients answered either “none” or “mild” to the pain and shortness of breath questions. The NPFS (v.4) was then successfully used in four patients for laser laryngoscopy with biopsy of laryngeal papilloma (3/4) and hemorrhagic polyp (1/4). Post‐procedure questionnaire identified no shortness of breath (4/4), no claustrophobia (4/4), no pain (4/4) and no significant changes in pulse oximetry during use. Conclusion Extensive experience in performing diagnostic laryngoscopy with the NPFS directed design changes leading to successful use for transnasal flexible laser laryngoscopy with biopsy in a negative pressure microenvironment. Level of Evidence Level 2b (Cohort Study).

Evaluation of face shields used during aerosol generating procedures

“…The NPFS is a novel control device identified as effective in permitting effective transnasal laryngoscopy for diagnosis and procedures with excellent patient tolerance 13 . To date the effectiveness in controlling bioaerosol had not been tested.…”

Diagnostic and surgical innovations in otolaryngology for adult and paediatric patients during the COVID-19 era

“…Among the few truly innovative devices that were conceived during the lockdown, Hoffman et al tested laser plume containment for diagnostic and operative transnasal potassium-titanyl-phosphate laryngoscopy for biopsy in local anaesthesia 70 . The device – developed by the University of Iowa – consists of a negative-pressure face shield installed on a camera stand with two frontal access ports and a lateral suction port.…”