Demonstration and Mitigation of Aerosol and Particle Dispersion During Mastoidectomy Relevant to the COVID-19 Era

Chen, Jenny; Workman, Alan D.; Chari, Divya A; Jung, David; Kozin, Elliott D.; Lee, Daniel J; Welling, D. Bradley; Bleier, Benjamin S.; Quesnel, Alicia M.

doi:10.1097/mao.0000000000002765

Cited by 67 publications

(118 citation statements)

References 20 publications

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“…The contamination extended for over 2 m from the drill site, which is further than previously reported spread (~1 m) during simulated mastoid drilling. 4,14 The extended reach of contamination in the present study may be attributable to the use of a fluorescent dye as irrigation fluid rather than impregnation into bone. 4 The extent of drilling-induced contamination was substantially reduced with use of the drape tent 9 (Fig.…”

Section: Visualization Of Drill-and Irrigation-induced Droplet Spreadmentioning

confidence: 79%

“…3 COVID-19 is thought to spread not only via droplets, but also through contamination of mucous membranes around the eye during aerosol-generating medical procedures (AGMPs). 3,4 A substantial number of otolaryngology procedures, including mastoidectomy, are considered aerosol generating, 5 and early reports from China and Italy indicate high rates of infection amongst otolaryngologists. [6][7][8] The present study aimed to 1) measure the extent of droplet contamination during mastoid drilling in a preclinical model both with and without a novel commercially designed drape to create a tent over the surgical field, and 2) evaluate various PPE options including a full-face respirator, a modified full-face snorkel mask, and safety goggles or spoggles (foam-lined safety goggles) and a half-face mask.…”

Section: Introductionmentioning

confidence: 99%

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Recommended Personal Protective Equipment for Cochlear Implant and Other Mastoid Surgery During the COVID‐19 Era

et al. 2020

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Objectives/Hypothesis: The overall aim of this study was to evaluate personal protective equipment (PPE) that may facilitate the safe recommencement of cochlear implantation in the COVID-19 era, with the broader goal of minimizing the period of auditory deprivation in prelingually deaf children and reducing the risk of cochlear ossification in individuals following meningitis. Methods: The study design comprised 1) an objective assessment of mastoid drilling-induced droplet spread conducted during simulated cochlear implant (CI) surgery and its mitigation via the use of a protective drape tent and 2) an evaluation of three PPE configurations by otologists while performing mastoid drilling on ex vivo temporal bones. The various PPE solutions were assessed in terms of their impact on communication, vital physiological parameters, visual acuity and fields, and acceptability to surgeons using a systematic risk-based approach. Results: Droplet spread during simulated CI surgery extended over 2 m, a distance greater than previously reported. A drape tent significantly reduced droplet spread. The ensemble of a half-face mask and safety spoggles (foam lined safety goggles) had consistently superior performance across all aspects of clinical usability. All other PPE options were found to substantially restrict the visual field, making them unsafe for microsurgery. Conclusions: The results of this preclinical study indicate that the most viable solution to enable the safe conduct of CI and other mastoid surgery is a combination of a filtering facepiece (FFP3) mask or half-face respirator with safety spoggles as PPE. Prescription spoggles are an option for surgeons who need to wear corrective glasses to operate. A drape tent reduces droplet spread. A multicenter clinical trial to evaluate the effectiveness of PPE should be the next step toward safely performing CI surgery during the COVID-19 era.

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Section: Visualization Of Drill-and Irrigation-induced Droplet Spreadmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Recommended Personal Protective Equipment for Cochlear Implant and Other Mastoid Surgery During the COVID‐19 Era

et al. 2020

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“…Novel draping techniques, such as the 'double-drape' system, have also been suggested in order to reduce droplet spray. 2,7,8 In addition, bespoke surgical shields that attach to the microscope may afford some protection to the surgeon. Sealed, low-profile goggles could potentially provide adequate eye protection with a minimal increase in eye-microscope distance.…”

Section: Discussionmentioning

confidence: 99%

“…1 Mastoidectomy, which utilises high-speed drills within the mastoid air cells, is therefore considered to be an aerosolgenerating procedure; the plume of potentially virus-containing aerosol generated by the drill may pose a risk to the surgeon and operating theatre staff. [2][3][4] The UK government and specialist healthcare bodies currently recommend the use of personal protective equipment (PPE) for all surgery involving the use of high-speed drills. 5,6 This includes, as a minimum, fluid-resistant long-sleeved gowns, gloves, filtering facepiece code 3 (FFP3) respirator masks, and eye and face protection.…”

Section: Introductionmentioning

confidence: 99%

The challenge of performing mastoidectomy using the operating microscope with coronavirus disease 2019 personal protective equipment (PPE)

Clamp

Broomfield

2020

J. Laryngol. Otol.

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Objective Mastoidectomy is considered an aerosol-generating procedure. This study examined the effect of wearing personal protective equipment on the view achieved using the operating microscope. Methods ENT surgeons assessed the area of a calibrated target visible through an operating microscope whilst wearing a range of personal protective equipment, with prescription glasses when required. The distance between the surgeon's eye and the microscope was measured in each personal protective equipment condition. Results Eleven surgeons participated. The distance from the eye to the microscope inversely correlated with the diameter and area visible (p < 0.001). The median area visible while wearing the filtering facepiece code 3 mask and full-face visor was 4 per cent (range, 4–16 per cent). Conclusion The full-face visor is incompatible with the operating microscope. Solutions offering adequate eye protection for aerosol-generating procedures that require the microscope, including mastoidectomy, are urgently needed. Low-profile safety goggles should have a working distance of less than 20 mm and be compatible with prescription lenses.

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“…The latter are associated with a higher risk of infection. 5,12,13 While available evidence suggests that the transmission of SARS-CoV-2 is primarily through respiratory droplets and fomites, there is no consensus. Little research is available on the risk of specific otolaryngological procedures, and conflicting information persists among regulatory bodies as to the degree of protection required for AGPs.…”

Section: Introductionmentioning

confidence: 99%

Minimising aerosol spread during endoscopic sinus and skull base surgery. Experimental model evaluation of the efficacy of the microscope drape method

2020

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Background Endoscopic sinus and anterior skull base surgery is considered particularly high risk for severe acute respiratory syndrome coronavirus-2 transmission in the operating theatre setting. In this context, the use of a microscope drape method is proposed, to minimise aerosol spread in the wider operating theatre environment. Methods The efficacy of the method is assessed with a simulation model, using a CMI Concept Air Trace MK2 smoke generator for aerosol generation and a Fluke 985 air particle counter to measure air particles sized 0.3–10 μm in the operating theatre environment. Results Aerosol spread was contained almost to baseline levels with the application of the drape barrier and the negative pressure created using suction within the drape. Conclusion The method is an efficient adjunct that could reduce the risk of aerosol shedding and viral transmission to the operating theatre team. It potentially allows faster operating theatre turnover and more liberal use of powered instruments during endonasal surgery.

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Demonstration and Mitigation of Aerosol and Particle Dispersion During Mastoidectomy Relevant to the COVID-19 Era

Abstract: Supplemental Digital Content is available in the text

Cited by 67 publications

References 20 publications

Recommended Personal Protective Equipment for Cochlear Implant and Other Mastoid Surgery During the COVID‐19 Era

Recommended Personal Protective Equipment for Cochlear Implant and Other Mastoid Surgery During the COVID‐19 Era

The challenge of performing mastoidectomy using the operating microscope with coronavirus disease 2019 personal protective equipment (PPE)

Minimising aerosol spread during endoscopic sinus and skull base surgery. Experimental model evaluation of the efficacy of the microscope drape method

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