When performing ear procedures that generate droplets or aerosols, otolaryngologists and their staff need to use personal protective equipment, including N95 face masks or Powered Air Purifying Respirators (PAPRs) when caring for these patients or cleaning equipment and rooms used for procedures.
This is the recommendation from investigators who found that SARS-Cov-2 can survive in the middle ear and mastoid region behind the ear. The results were published online July 23, 2020, as a research letter in JAMA Otolaryngology—Head & Neck Surgery.
“The presence of SARS-Cov-2 in the middle ear and mastoid mucosa presents safety concerns for clinical staff due to possible viral transmission during ear procedures, both clinic- or operating-based procedures, that generate droplets or aerosols,” said the lead author of the study, Kaitlyn Frazier, MD, a resident of otolaryngology–head and neck surgery at Johns Hopkins University School of Medicine, Baltimore, Md.
Prior to the study, the presence of SARS-Cov-2 in the middle ear and mastoid region was considered possible but wasn’t proven.
The results were based on the assessment of mastoid and middle ear specimens obtained from autopsies of three people who tested positive for and had symptoms of COVID-19 prior to their death. Bone and mucosal specimens from both left and right mastoids and swabs from both ears were obtained avoiding powered instrumentation and using older tools and techniques to avoid spreading infectious aerosols or droplets.
Each sample was assayed for the N1, N2, and internal control target genes. The researchers were able to isolate the virus in all four areas (both mastoid regions and both middle ears) in one person and the right middle ear of another person. No virus was found in the third patient. Despite the variation found, the researchers emphasize that finding the virus in two people warrants caution when performing all elective ear surgery, particularly with the high number of asymptomatic people who have COVID-19.
Dr. Frazier also emphasized the ongoing need to monitor patients for other potential signs and complications of COVID-19. “While it has not yet been shown that SARS-Cov-2 causes hearing or balance symptoms in patients, clinical otolaryngologists should also pay close attention to reports of these symptoms in patients with known COVID-19, as we know the virus can cause other cranial nerve neurological deficits, such as lack of smell,” she said.