In newly published research from the Johns Hopkins Department of Otolaryngology–Head and Neck Surgery, in 2 of 3 patients evaluated, investigators found that the virus (SARS-CoV-2) associated with the COVID-19 disease pandemic was found in 5 of 8 middle ear spaces and mastoid cavities examined.
The research was published online on July 23, 2020 in JAMA Otolaryngology-Head & Neck Surgery.
Coronavirus and the Middle Ear
As pointed out in an accompanying commentary, titled “News Flash! SARS-CoV-2 Isolated From the Middle Ear and Mastoid,” Dr. Bradley Kesser states:
“We have known for many years that viruses, including other coronaviruses, have been isolated from the middle ear space in children with acute otitis media and in children undergoing tympanostomy tube placement for chronic otitis media with effusion; but until now, it was unclear if SARS-CoV-2 reached the middle ear space and whether it could be isolated from the middle ear”
While to date there have been no reports of SARS-CoV-2 infection as a direct result of a middle ear or mastoid procedure in a health care worker, aerosols potentially created during some types of surgical procedures of the ear creates potential exposure risk to health care workers.
Study Highlights Exposure Risk; Need for PPE Equipment
According to Dr. Kesser, the study implications are clear: otolaryngologists and otologists/neurotologists are at risk for contracting SARS-CoV-2 with middle ear and mastoid procedures and should don and doff personal protective equipment (PPE) per recommended guidelines, both in the ambulatory setting and in the operating room.
The study, “…documents another potential route of SARS-CoV-2 transmission, and addresses the implications for protection of health care workers caring for patients with ear disease,” said Dr. Kesser.
“The manifestations of COVID-19 most commonly involve the upper and lower respiratory tract since this is the primary target of the virus,” said Dr. Archelle Georgiou, Starkey’s Chief Health Officer, who has been involved in researching and tracking COVID-19. “However, this report which identified SARS CoV-2 (the virus causing COVID-19) in the mastoid and middle ear of patients is not particularly surprising since this invasive and highly elusive virus has been detected in other organs including the kidney, heart, nervous and gastrointestinal systems.”
“COVID-19 can be highly infectious even in the absence of symptoms and this article is an important reminder to all hearing professionals to remain diligent about the use of personal protective equipment when interacting with patients.”
–Dr. Archelle Georgiou
Given the high asymptomatic rate of COVID-19 cases, the researchers state that caution is warranted for all elective ear surgery and recommend testing to verify negative status of patients. Droplet precautions (including eye protection and proper N95 level mask) are “warranted for outpatient procedures involving the middle ear due to proximity to these potentially infectious spaces”.
- Frazier KM, Hooper JE, Mostafa HH, Stewart CM. SARS-CoV-2 Virus Isolated From the Mastoid and Middle Ear: Implications for COVID-19 Precautions During Ear Surgery. JAMA Otolaryngol Head Neck Surg. Published online July 23, 2020. doi:10.1001/jamaoto.2020.1922
- Kesser BW. News Flash!—SARS-CoV-2 Isolated From the Middle Ear and Mastoid. JAMA Otolaryngol Head Neck Surg. Published online July 23, 2020. doi:10.1001/jamaoto.2020.2067
Source: JAMA Otolaryngology