we shoot for as clean as possible for each ENT case but entering a nasal cavity or mouth is never sterile. We sterilize the instruments to make sure that the only contamination on the field is that of the patient's own flora...not someone else's. Gross contamination by the ENT surgeon isn't optimal but an effort should be made to keep things as clean as possible (ie. wearing sterile gloves, providing a sterile field, providing sterile instruments).