Abstract
Mastoidectomy is considered an aerosol-generating procedure. This study examined the effect of wearing personal protective equipment on the view achieved using the operating microscope. ENT surgeons assessed the area of a calibrated target visible through an operating microscope whilst wearing a range of personal protective equipment, with prescription glasses when required. The distance between the surgeon's eye and the microscope was measured in each personal protective equipment condition. Eleven surgeons participated. The distance from the eye to the microscope inversely correlated with the diameter and area visible (p < 0.001). The median area visible while wearing the filtering facepiece code 3 mask and full-face visor was 4 per cent (range, 4-16 per cent). The full-face visor is incompatible with the operating microscope. Solutions offering adequate eye protection for aerosol-generating procedures that require the microscope, including mastoidectomy, are urgently needed. Low-profile safety goggles should have a working distance of less than 20 mm and be compatible with prescription lenses.
Highlights
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)/coronavirus disease 2019 (Covid-19) pandemic presents several previously unconsidered challenges for otological surgeons, including how to minimise the risk of coronavirus transmission to the surgeon and operating theatre staff during aerosol-generating mastoid surgery.The mastoid air-cell system is lined with respiratory mucosa, and is continuous with the middle ear and nasopharynx via the Eustachian tube
The UK government and specialist healthcare bodies currently recommend the use of personal protective equipment (PPE) for all surgery involving the use of high-speed drills.[5,6]
In order to quantify this concern, this study examined the effect of different forms of PPE on the operator–microscope distance and the surgical view obtained by the operator
Summary
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)/coronavirus disease 2019 (Covid-19) pandemic presents several previously unconsidered challenges for otological surgeons, including how to minimise the risk of coronavirus transmission to the surgeon and operating theatre staff during aerosol-generating mastoid surgery.The mastoid air-cell system is lined with respiratory mucosa, and is continuous with the middle ear and nasopharynx via the Eustachian tube. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)/coronavirus disease 2019 (Covid-19) pandemic presents several previously unconsidered challenges for otological surgeons, including how to minimise the risk of coronavirus transmission to the surgeon and operating theatre staff during aerosol-generating mastoid surgery. The middle ear has been demonstrated to harbour pathogens including coronavirus.[1] Mastoidectomy, which utilises high-speed drills within the mastoid air cells, is considered to be an aerosolgenerating procedure; the plume of potentially virus-containing aerosol generated by the drill may pose a risk to the surgeon and operating theatre staff.[2,3,4]. Whilst some degree of eye protection is conferred by surgical masks with integrated visors or by polycarbonate safety spectacles, current Public Health England guidance recommends a fullface shield or visor for aerosol-generating procedures, to fully protect the eyes from potentially hazardous droplets.[5]
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