Open AccessAerosol Dispersion During Mastoidectomy and Custom Mitigation Strategies for Otologic Surgery in the COVID‐19 Era
Author(s) -
Chari Divya A.,
Workman Alan D.,
Chen Jenny X.,
Jung David H.,
AbdulAziz Dunia,
Kozin Elliott D.,
Remenschneider Aaron K.,
Lee Daniel J.,
Welling D. Bradley,
Bleier Benjamin S.,
Quesnel Alicia M.
Publication year - 2021
Publication title -
otolaryngology–head and neck surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.232
H-Index - 121
eISSN - 1097-6817
pISSN - 0194-5998
DOI - 10.1177/0194599820941835
Subject(s) - suction , aerosolization , mastoidectomy , drilling , aerosol , particle (ecology) , medicine , surgery , materials science , biomedical engineering , chemistry , anesthesia , engineering , geology , mechanical engineering , cholesteatoma , metallurgy , oceanography , organic chemistry , inhalation
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.