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Which Otologic Procedures Poses the Greatest Risk of Aerosol Generation?

by Linda Kossoff •

What is the nature and quantity of aerosol generation during common otologic procedures in both cadaveric surgical simulation and live patient surgery?

BOTTOM LINE: Significant aerosol levels were generated during cadaveric simulation of mastoidectomy, and aerosol spikes were appreciated during cochlear implantation in live patients.

BACKGROUND: Implementation of prolonged wait times following aerosol-generating procedures (AGP) has important safety implications in medical practice. Although SARS-CoV-2 is believed to be transmitted primarily through respiratory droplets, the risk of aerosolization and airborne transmission is a significant concern in otolaryngology. 

STUDY DESIGN: Randomized controlled trial.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis.

SYNOPSIS: The team used both cadaveric surgical simulation and live patient surgery to assess aerosol generation during specific otologic procedures. One surgeon performed all of the cadaveric simulation procedures (left- and right-sided tympanoplasty and mastoidectomy on the first cadaver head; and left-sided tympanoplasty and mastoidectomy, and first and second left and right temporalis fascia graft harvest (TFGH) procedures on the second cadaver head). A HEPA filtration system was used between experimental conditions to return aerosols back to baseline levels. Results showed that drilling used during mastoidectomy generated high concentrations of aerosols. Aerosol levels during tympanoplasty were lesser but significant, and likely related to suction. Similar increases were not seen during cold TFGH in the simulation. For the two live patient cochlear implant surgeries, baseline aerosol concentrations were measured for 60 seconds prior to the start of each case and then for each second during surgery. Spikes in aerosols occurred during both cases, all associated with mastoid drilling. Study limitations included limited range and parameters in aerosol measurement.

CITATION: Sharma D, Campiti VJ, Ye MJ, et al. Aerosol generation during cadaveric simulation of otologic surgery and live cochlear implantation [published online ahead of print December 16, 2020]. Laryngoscope Investig Otolaryngol. doi:10.1002/lio2.506.