ABSTRACT
The majority of firework-related injuries in Germany are found at the turn of the year. With regard to hearing, a distinction is made between blast (BT) and explosion trauma (ET). The study examines the prevalence and characteristics of firework-related injuries over the past 11 years on New Year's Eve and compares these with the effects of the pyro ban 2020/21 imposed due to the COVID-19 pandemic. A retrospective chart review of all patients who presented themselves with the diagnosis blast trauma (H 83.3) or explosion trauma (T 70.8) at the Charité emergency service in the last 11 years from December 28 to January 5 was performed. 267 patients were recorded (78 % male). 1/3 each were assigned to the age group 10-19 and 20-29 years. 21 % of the patients were admitted to the hospital. There was an isolated BT of the ear in 66 %, hand injuries in 12 %, head injuries in 8 % and eye injuries in 4 %. 87 % had ear involvement with hearing loss: 83 % with tinnitus, 5.6 % with ET. The tone audiograms of BT and ET show differences only at 6 kHz, but not at 4 kHz. 8.6 % of the patients underwent surgical interventions. The treatment of a tympanic membrane perforation was carried out by: 54 % splinting vs. 38 % tympanoplasty. Therapy with a glucocorticoid was administered i.v. in 48 % and initiated orally in 17 %. Overall, there was a decrease in injuries of almost 90 % in 2020/21 compared to 2017/18. The use of fireworks leads to increased utilization of health care resources. The ban on the sale of pyrotechnics as well as the introduction of pyro ban zones in 2020 led to a relevant decrease in injuries. 2020 was the only year in which there were no injuries in children / adolescents. The BT of the ear is the most common firework-related injury.
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.
ABSTRACT
OBJECTIVE: Microscopic surgery is currently considered the 'gold standard' for middle-ear, mastoid and lateral skull base surgery. The coronavirus disease 2019 pandemic has made microscopic surgery more challenging to perform. This work aimed to demonstrate the feasibility of the Vitom 3D system, which integrates a high-definition (4K) view and three-dimensional technology for ear surgery, within the context of the pandemic. METHOD: Combined approach tympanoplasty and ossiculoplasty were performed for cholesteatoma using the Vitom 3D system exclusively. RESULTS: Surgery was performed successfully. The patient made a good recovery, with no evidence of residual disease at follow up. The compact system has excellent depth of field, magnification and colour. It enables ergonomic work, improved work flow, and is ideal for teaching and training. CONCLUSION: The Vitom 3D system is considered a revolutionary alternative to microscope-assisted surgery, particularly in light of coronavirus disease 2019. It allows delivery of safe otological surgery, which may aid in continuing elective surgery.