Respiratory droplet generation and dispersal during nasoendoscopy and upper respiratory swab testing

Respiratory particle generation and dispersal during nasoendoscopy and swab testing is studied with high‐speed video and laser light illumination. Video analysis reveals droplet formation in three manoeuvres during nasoendoscopy ‐ sneezing, vocalization, and nasal decongestion spray. A capillary bridge of mucus can be seen when a nasoendoscope exits wet nares. No droplet formation is seen during oral and nasopharyngeal swab testing. We outline the following recommendations: pull the face mask down partially and keep the mouth covered, only allowing nasal access during nasoendoscopy; avoid nasal sprays if possible; if nasal sprays are used, procedurists should be in full personal protective equipment prior to using the spray; withdrawal of swabs and scopes should be performed in a slow and controlled fashion to reduce potential dispersion of droplets when the capillary bridge of mucus breaks up.