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Demonstration and Mitigation of Aerosol and Particle Dispersion During Mastoidectomy Relevant to the COVID-19 Era.
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.
  • Chen JX; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear.
  • Workman AD; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston Massachusetts.
  • Chari DA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear.
  • Jung DH; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston Massachusetts.
  • Kozin ED; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear.
  • Lee DJ; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston Massachusetts.
  • Welling DB; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear.
  • Bleier BS; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston Massachusetts.
  • Quesnel AM; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear.
Otol Neurotol ; 41(9): 1230-1239, 2020 10.
Article in English | MEDLINE | ID: covidwho-197201
Semantic information from SemMedBD (by NLM)
1. Mastoidectomy USES Surgical dril
Subject
Mastoidectomy
Predicate
USES
Object
Surgical dril
2. Drapes (device) USES BARRIER
Subject
Drapes (device)
Predicate
USES
Object
BARRIER
3. GRAP2 gene|GRAP2 compared_with Microscopes
Subject
GRAP2 gene|GRAP2
Predicate
compared_with
Object
Microscopes
4. Mastoidectomy USES Surgical drill, device (physical object)
Subject
Mastoidectomy
Predicate
USES
Object
Surgical drill, device (physical object)
5. Drapes (device) USES BARRIER
Subject
Drapes (device)
Predicate
USES
Object
BARRIER
6. GRAP2 gene|GRAP2 compared_with Microscopes
Subject
GRAP2 gene|GRAP2
Predicate
compared_with
Object
Microscopes
ABSTRACT

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

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.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Occupational Exposure / Coronavirus Infections / Aerosols / Pandemics / Mastoidectomy / Mastoid Type of study: Prognostic study Limits: Humans Language: English Journal: Otol Neurotol Journal subject: Neurology / Otolaryngology Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Occupational Exposure / Coronavirus Infections / Aerosols / Pandemics / Mastoidectomy / Mastoid Type of study: Prognostic study Limits: Humans Language: English Journal: Otol Neurotol Journal subject: Neurology / Otolaryngology Year: 2020 Document Type: Article