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

• Published in: Otology & neurotology Vol. 41; no. 9; pp. 1230 - 1239
• Main Authors: Chen, Jenny X, Workman, Alan D, Chari, Divya A, Jung, David H, Kozin, Elliott D, Lee, Daniel J, Welling, D Bradley, Bleier, Benjamin S, Quesnel, Alicia M
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-10-2020
• Subjects: Aerosols; Betacoronavirus; Cadaver; Coronavirus Infections - prevention & control; COVID-19; Fluorescein; Humans; Mastoid - surgery; Mastoidectomy - adverse effects; Microscopy; Middle Ear and Mastoid Disease; Occupational Exposure - prevention & control; Occupational Health; Operating Rooms; Pandemics - prevention & control; Personal Protective Equipment; Pneumonia, Viral - prevention & control; SARS-CoV-2; Surgeons; Temporal Bone - surgery
• ISSN: 1531-7129; 1537-4505
• DOI: 10.1097/MAO.0000000000002765

COVID-19 has become a global pandemic with a dramatic impact on healthcare systems. Concern for viral transmission necessitates the investigation of otologic procedures that use high-speed drilling instruments, including mastoidectomy, which we hypothesized to be an aerosol-generating procedure.
Mastoidectomy with a high-speed drill was simulated using fresh-frozen cadaveric heads with fluorescein solution injected into the mastoid air cells. Specimens were drilled for 1-minute durations in test conditions with and without a microscope. A barrier drape was fashioned from a commercially available drape (the OtoTent). Dispersed particulate matter was quantified in segments of an octagonal test grid measuring 60 cm in radius.
Drilling without a microscope dispersed fluorescent particles 360 degrees, with the areas of highest density in quadrants near the surgeon and close to the surgical site. Using a microscope or varying irrigation rates did not significantly reduce particle density or percent surface area with particulate. Using the OtoTent significantly reduced particle density and percent surface area with particulate across the segments of the test grid beyond 30 cm (which marked the boundary of the OtoTent) compared with the microscope only and no microscope test conditions (Kruskall-Wallis test, p = 0.0066).
Mastoidectomy with a high-speed drill is an aerosol-generating procedure, a designation that connotes the potential high risk of viral transmission and need for higher levels of personal protective equipment. A simple barrier drape significantly reduced particulate dispersion in this study and could be an effective mitigation strategy in addition to appropriate personal protective equipment.