Mastoidectomy and Trans-Corneal Viral Transmission

Abstract

The incidence of chronic middle ear disease is falling in Britain, and in adults, is currently approximately 2.6% (inactive) and 1.5% (active). The incidence of HIV and hepatitis C is, however, rising. With this in mind, the chances of operating on a patient with undiagnosed infection is increasing. Operations involving the drilling or cutting of bone in patients with bloodborne communicable diseases are inherently dangerous to surgeons. In the pre-antibiotic era, many orthopaedic surgeons succumbed to infection and septicemia after being pierced with a spicule of bone during the execution of their duty. With the advent of the antibiotic era, the phenomenon is no longer life threatening where a bacterium is the offending microorganism. The principle, however, may be just as valid today with regard to viral communicable diseases. The world medical literature is full of reports of transmission of HIV from doctor to patient or dentist to patient. Very little is written about the reverse. This study attempted to address the apparent imbalance in the debate over exactly who is most at risk of iatrogenic transmission of potentially lethal viruses. We took fish eyes and held them in place around a mastoid cavity during drilling of a temporal bone. The eyes were then stained with fluorescein and a blue light shone over them to identify any spicules and corneal tears. Also, during this study, the maximum distance of bone dust scatter from an in vivo mastoid operation was measured from the cavity in all directions and documented. The HIV and hepatitis C virus are discussed and the importance of protection to staff highlighted.

Clinical evidence based review and recommendations of aerosol generating medical procedures in otolaryngology – head and neck surgery during the COVID-19 pandemic

“…There was significant heterogeneity among the three studies and only one study was deemed clinically relevant and of adequate quality [49]. The three studies were found describing aerosolization of bone dust and contaminated irrigation fluid (Table 9) [49][50][51]. Aggregated Evidence: Grade D: three experimental studies.…”

Best Practice Recommendations for Pediatric Otolaryngology during the COVID‐19 Pandemic

“…Furthermore, bony microspicules penetrate the cornea in animal models, and transconjunctival spread of COVID-19 has been reported. 57,58 For complicated otitis media or acute mastoiditis, a 24to 48-hour trial of medical management should be attempted prior to surgery. For patients with unknown, suspected, or positive COVID-19 status, myringotomy and tympanostomy tube insertion is preferred to cortical mastoidectomy for uncomplicated acute mastoiditis refractory to medical therapy.…”

Letter: Rongeurs, Neurosurgeons, and COVID-19: How Do We Protect Health Care Personnel During Neurosurgical Operations in the Midst of Aerosol-Generation From High-Speed Drills?

“…Bone scattering from temporal bone drilling can be up to 3.5 feet. 12 Powered instruments had been shown to generate blood-containing aerosols with a concentration of hemoglobin detected in the ambient air. 11 Viruses, including human immunodeficiency virus-1 (HIV-1), was demonstrated to be viable in the aerosols generated by surgical power instruments.…”