Aerosol generation during cadaveric simulation of otologic surgery and live cochlear implantation

Abstract

Objective The risk of SARS‐CoV‐2 transmission to healthcare workers through airborne aerosolization during otologic surgery has not been characterized. The objective of this study was to describe and quantify the aerosol generation during common otologic procedures in both cadaveric surgical simulation and live patient surgery. Methods The number concentrations of generated aerosols in the particle size range of 0.30 to 10.0 μm were quantified using an optical particle sizer during both a cadaveric simulation of routine otologic procedures as well as cochlear implant surgery on live patients in the operating room. Results In the cadaveric simulation, temporalis fascia graft harvest using cold techniques (without electrocautery) (n = 4) did not generate aerosols above baseline concentrations. Tympanoplasty (n = 3) and mastoidectomy (n = 3) both produced statistically significant increases in concentrations of aerosols (P < 0.05), predominantly submicron particles (< 1.0 μm). High‐speed, powered drilling of the temporal bone during mastoidectomy with a Multi Flute cutting burr resulted in higher peak concentrations and greater number of spikes in aerosols than with a diamond burr. In the operating room, spikes in aerosols occurred during both cochlear implant surgeries. Conclusion In the cadaveric simulation, temporalis fascia graft harvest without electrocautery did not generate aerosol levels above baseline, while significant aerosol levels were generated during mastoidectomy and to a much less degree during tympanoplasty. Aerosol spikes were appreciated during cochlear implantation surgery in live patients. Level of Evidence 2.

Otitis Media Practice During the COVID-19 Pandemic

“…COVID-19 emergence required otologists to adopt a changed mindset for otologic office procedures and ear surgery. Otologic surgery, including drilling of the mastoid, is known to cause a substantial dispersion of small and large aerosols (Anschuetz et al, 2021;Chari et al, 2021;Hajiyev and Vilela, 2021;Merven and Loock, 2021;Sharma et al, 2021) and droplets (Sharma et al, 2020;Mohan et al, 2021;Sharma et al, 2021), and is a cause of concern regarding contamination in the operating room (OR). To prevent unnecessary risk of infection, otologic procedures were categorized as urgent versus elective, according to different authors and otolaryngological societies (Kozin et al, 2020;Leboulanger et al, 2020;Pattisapu et al, 2020;Saadi et al, 2020), suggesting that urgent operations should be performed, while all other operations should be postponed, depending on the pathology and the patient's preference.…”

“…PPE can be divided into two categories: 1) respiratory protection (N95 respirator, powered air-purifying respirator [PAPR]), and 2) body protection, including eye protection, sterile and waterproof clothes around the neck, and disposable cap, gown, overshoes, and gloves. PPE is advised for any surgery performed, and especially for procedures with a high aerosol dispersion potential, such as mastoidectomy (Ayache and Schmerber, 2020;Gordon et al, 2020;Kozin et al, 2020;Leboulanger et al, 2020;Sharma et al, 2021).…”

Awake Rhinology Surgery in Response to the COVID-19 Pandemic in Europe

“…When a surgeon is new to performing awake surgery, it may be prudent to first focus on minimally invasive procedures and select patients with less complex disease, expanding to more invasive procedures and more complex patients as the surgeon grows more comfortable. Irrespective of being performed under LA or GA, particular caution should be taken when performing procedures that involve endonasal drilling during the COVID-19 pandemic due to the higher risk of aerosol generation [ 18 , 19 , 20 ]. When using heat energy, including lasers be mindful of the risk of aerosol generation and take appropriate precautions using suction [ 21 ].…”