Aerosol Dispersion During Mastoidectomy and Custom Mitigation Strategies for Otologic Surgery in the COVID-19 Era. (January 2021)

• Record Type: Journal Article
• Authors: Chari, Divya A.; Workman, Alan D.; Chen, Jenny X.; Jung, David H.; Abdul-Aziz, Dunia; Kozin, Elliott D.; Remenschneider, Aaron K.; Lee, Daniel J.; Welling, D. Bradley; Bleier, Benjamin S.; Quesnel, Alicia M.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 164:Number 1(2021)
• Page Start: 67
• Page End: 73
• Publication Date: 2021-01
• Subjects: mastoidectomy -- COVID-19 -- severe acute respiratory syndrome coronavirus-2 -- SARS-CoV-2 -- virus transmission -- aerosol -- aerosol generating procedure -- aerosolization -- airborne -- otology -- neurotology -- barrier drape -- personal protective equipment -- health care providers -- safety -- OtoTent; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599820941835
• Languages: English
• ISSNs: 0194-5998

Abstract

Objective: To investigate small-particle aerosolization from mastoidectomy relevant to potential viral transmission and to test source-control mitigation strategies. Study Design: Cadaveric simulation. Setting: Surgical simulation laboratory. Methods: An optical particle size spectrometer was used to quantify 1- to 10-µm aerosols 30 cm from mastoid cortex drilling. Two barrier drapes were evaluated: OtoTent1, a drape sheet affixed to the microscope; OtoTent2, a custom-structured drape that enclosed the surgical field with specialized ports. Results: Mastoid drilling without a barrier drape, with or without an aerosol-scavenging second suction, generated large amounts of 1- to 10-µm particulate. Drilling under OtoTent1 generated a high density of particles when compared with baseline environmental levels ( P < .001, U = 107). By contrast, when drilling was conducted under OtoTent2, mean particle density remained at baseline. Adding a second suction inside OtoTent1 or OtoTent2 kept particle density at baseline levels. Significant aerosols were released upon removal of OtoTent1 or OtoTent2 despite a 60-second pause before drape removal after drilling ( P < .001, U = 0, n = 10, 12; P < .001, U = 2, n = 12, 12, respectively). However, particle density did not increase above baseline when a second suction and a pause before removal were both employed. Conclusions: Mastoidectomy without a barrier, even when a second suction was added, generated substantial 1- to 10-µm aerosols. During drilling, large amounts of aerosols above baseline levels were detected with OtoTent1 but not OtoTent2. For both drapes, a second suction was an effective mitigation strategy during drilling. Last, the combination of a second suction and a pause before removal prevented aerosol escape during the removal of either drape.