Cadaveric Simulation of Otologic Procedures: An Analysis of Droplet Splatter Patterns During the COVID-19 Pandemic

• Published in: Otolaryngology-head and neck surgery 2020-08, Vol.163 (2), p.320-324
• Main Authors: Sharma, Dhruv, Rubel, Kolin E., Ye, Michael J., Campiti, Vincent J., Carroll, Aaron E., Ting, Jonathan Y., Illing, Elisa A., Burgin, Sarah J.
• Format: Article
• Language: English
• Subjects: Betacoronavirus; Cadaver; Coronavirus Infections - transmission; COVID-19; Disease Transmission, Infectious; droplets; Humans; Mastoidectomy; Middle Ear Ventilation; myringotomy; otologic surgery; Pandemics; Pneumonia, Viral - transmission; SARS-CoV-2; Special Section on COVID-19; splatter
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599820930245

Objective The otolaryngology community has significant concerns regarding the spread of SARS-CoV-2 through droplet contamination and viral aerosolization during head and neck examinations and procedures. The objective of this study was to investigate the droplet and splatter contamination from common otologic procedures. Study Design Cadaver simulation series. Setting Dedicated surgical laboratory. Methods Two cadaver heads were prepped via bilateral middle cranial fossa approaches to the tegmen (n = 4). Fluorescein was instilled through a 4-mm burr hole drilled into the middle cranial fossa floor, and presence in the middle ear was confirmed via microscopic ear examination. Myringotomy with ventilation tube placement and mastoidectomy were performed, and the distribution and distance of resulting droplet splatter patterns were systematically evaluated. Results There were no fluorescein droplets or splatter contamination observed in the measured surgical field in any direction after myringotomy and insertion of ventilation tube. Gross contamination from the surgical site to 6 ft was noted after complete mastoidectomy, though, when performed in standard fashion. Conclusion Our results show that there is no droplet generation during myringotomy with ventilation tube placement in an operating room setting. Mastoidectomy, however, showed gross contamination 3 to 6 ft away in all directions measured. Additionally, there was significantly more droplet and splatter generation to the left of the surgeon when measured at 1 and 3 ft as compared with all other measured directions.