Aerosol Generation During Myringotomy With Tympanostomy Tube Insertion: Implications for Otolaryngology in the COVID‐19 Era

Campiti, Vincent J.; Ye, Michael J.; Sharma, Dhruv; Matt, Bruce H.; Mitchell, Ryan M.; Ting, Jonathan Y.; Illing, Elisa A.; Park, Jae Hong; Burgin, Sarah J.

doi:10.1177/0194599821989626

Cited by 6 publications

(6 citation statements)

References 8 publications

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“…Image analysis showed no fluid in the proximal external canal nor the ear speculum following the procedure and suctioning. Unlike first speculations, there was no measured increase in aerosol particle numbers during VTI (Campiti et al, 2021).…”

Section: Changes In Ventilating Tube Surgerycontrasting

confidence: 74%

Otitis Media Practice During the COVID-19 Pandemic

Marom¹,

Pitaro

Shah

et al. 2022

Front. Cell. Infect. Microbiol.

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The global coronavirus disease-2019 (COVID-19) pandemic has changed the prevalence and management of many pediatric infectious diseases, including acute otitis media (AOM). Coronaviruses are a group of RNA viruses that cause respiratory tract infections in humans. Before the COVID-19 pandemic, coronavirus serotypes OC43, 229E, HKU1, and NL63 were infrequently detected in middle ear fluid (MEF) specimens and nasopharyngeal aspirates in children with AOM during the 1990s and 2000s and were associated with a mild course of the disease. At times when CoV was detected in OM cases, the overall viral load was relatively low. The new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative pathogen responsible for the eruption of the COVID-19 global pandemic. Following the pandemic declaration in many countries and by the World Health Organization in March 2020, preventive proactive measures were imposed to limit COVID-19. These included social distancing; lockdowns; closure of workplaces; kindergartens and schools; increased hygiene; use of antiseptics and alcohol-based gels; frequent temperature measurements and wearing masks. These measures were not the only ones taken, as hospitals and clinics tried to minimize treating non-urgent medical referrals such as OM, and elective surgical procedures were canceled, such as ventilating tube insertion (VTI). These changes and regulations altered the way OM is practiced during the COVID-19 pandemic. Advents in technology allowed a vast use of telemedicine technologies for OM, however, the accuracy of AOM diagnosis in those encounters was in doubt, and antibiotic prescription rates were still reported to be high. There was an overall decrease in AOM episodes and admissions rates and with high spontaneous resolution rates of MEF in children, and a reduction in VTI surgeries. Despite an initial fear regarding viral shedding during myringotomy, the procedure was shown to be safe. Special draping techniques for otologic surgery were suggested. Other aspects of OM practice included the presentation of adult patients with AOM who tested positive for SARS-2-CoV and its detection in MEF samples in living patients and in the mucosa of the middle ear and mastoid in post-mortem specimens.

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Section: Changes In Ventilating Tube Surgerycontrasting

confidence: 74%

Otitis Media Practice During the COVID-19 Pandemic

Marom¹,

Pitaro

Shah

et al. 2022

Front. Cell. Infect. Microbiol.

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“…Since otologic procedures such as a myringotomy have been shown to generate aerosol, 4 and since SARS‐CoV‐2 is known to be transmissible by aerosol, 5 we agree with the position that special caution is warranted when performing otologic procedures 6 in patients diagnosed with COVID‐19, or in whom there are reasonable grounds to suspect SARS‐CoV‐2 infection.…”

supporting

confidence: 66%

In Reference to “SARS‐CoV‐2 presence in the saliva, tears and cerumen of COVID‐19 patients”

Cherchi

Yacovino

2021

The Laryngoscope

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In Reference to "SARS-CoV-2 presence in the saliva, tears and cerumen of COVID-19 patients" Dear Editor:We read with interest the study by Hanege et al. 1 that identified SARS-CoV-2 by polymerase chain reaction (PCR) in the cerumen samples of 15 (39.5%) out of 38 patients with a laboratory-confirmed diagnosis of COVID-19. We found it surprising that a subsequent study 2 identified SARS-CoV-2 by PCR in swab samples from the external auditory canal in none (0%) of 60 patients with a laboratory-confirmed diagnosis of COVID-19. Perhaps this discrepancy is the result of different methods of sample collection; one commentary 3 proposed that the apparent discrepancy could be reconciled by, "the hypothesis that SARS-CoV-2 was present in the secretions of the ceruminous glands at the time of secretion."Since otologic procedures such as a myringotomy have been shown to generate aerosol, 4 and since SARS-CoV-2 is known to be transmissible by aerosol, 5 we agree with the position that special caution is warranted when performing otologic procedures 6 in patients diagnosed with COVID-19, or in whom there are reasonable grounds to suspect SARS-CoV-2 infection.We suggest that this extra caution should extend to vestibular evaluations where one may be considering caloric testing, whether with air or water caloric stimulation, as available studies on this topic 7 are too small to provide any reassurance regarding its safety relevant to SARS-CoV-2.Until better safety data are available, instead of performing caloric testing we favor video head impulse testing (vHIT) when medically feasible and absent any contraindications. We recognize that this is an imperfect substitution as vHIT and caloric testing assess different frequencies of the vestibular tuning spectrum [8][9][10] ; nevertheless, in comparison to caloric testing, vHIT is less burdensome to the patient, 11 evaluates not only the horizontal canal but also the posterior and superior canals, and is probably less likely to induce aerosolization that would increase the risk of transmission of SARS-CoV-2. AUTHOR CONTRIBUTIONSD.A.Y. conceived the idea and reviewed the manuscript for content. M.C. drafted the manuscript.

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“…The child can be rescheduled within 3 months of the positive test, without requiring a repeat test if they have no symptoms. In contrast to universal testing, Campiti et al [ 29 ] has forgone routine preoperative testing after symptomatic screening proved negative for patients undergoing myringotomy and tube placement.…”

Section: Discussionmentioning

confidence: 99%

“…From a surgical precautions standpoint, MTT has been shown to have no more aerosolization than the induction of anesthesia [ 29 ]. The biggest consideration is the airway management, where mask ventilation has a higher risk of aerosolization than a supraglottic airway device (laryngeal mask airway) [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Pediatric otolaryngology in the coronavirus disease 2019 pandemic: what have we learned?

Lee

Dedhia

2021

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review Coronavirus disease 2019 (COVID-19) has changed the face of healthcare. The current review is to discuss the major aspects that have changed in pediatric otolaryngology, from surgical operations management, to clinic workflow, to procedural precautions. Recent findings There have been many studies over the past year describing different ways to improve the safety of healthcare delivery in pediatric otolaryngology amidst a global pandemic, as well as ways to improve clinic and surgical logistics along with guidelines for telehealth of a surgical specialty. Summary COVID-19 has forever altered how healthcare is viewed and practiced, and pediatric otolaryngology was not exempt. With an increased focus on provider safety, as well as novel ways of utilizing changes in methods of communication, the practice of pediatric otolaryngology has evolved with the rest of healthcare to take on the new challenges brought on by this global pandemic.

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Aerosol Generation During Myringotomy With Tympanostomy Tube Insertion: Implications for Otolaryngology in the COVID‐19 Era

Cited by 6 publications

References 8 publications

Otitis Media Practice During the COVID-19 Pandemic

Otitis Media Practice During the COVID-19 Pandemic

In Reference to “SARS‐CoV‐2 presence in the saliva, tears and cerumen of COVID‐19 patients”

Pediatric otolaryngology in the coronavirus disease 2019 pandemic: what have we learned?

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