Introduction
The SARS-CoV-2 / COVID-19 pandemic presents a number of previously
unconsidered challenges for otological surgeons. Not least of these is
how to perform aerosol generating mastoid surgery whilst minimising the
risk of coronavirus transmission to the surgeon and theatre staff.
Mastoid surgery involves the use of high-speed drills within the mastoid
air-cell system and as such is considered to be an aerosol generating
procedure (AGP). The mastoid air-cells are lined with respiratory
mucosa, continuous with the middle ear and nasopharynx via the
Eustachian tube. The middle ear has been demonstrated to harbour
pathogens including coronavirus1. The plume of
potentially virus-containing aerosol generated by the high-speed drill
poses a risk to the surgeon and operating theatre
staff2,3.
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 drills4,5. This includes, as a
minimum, fluid-resistant long-sleeved gowns, gloves, filtering facepiece
(FFP-3 rated) respirator masks and eye/face protection. Whilst some
degree of eye protection is conferred by surgical masks with integrated
visors or by polycarbonate safety spectacles, current Public Health
England (PHE) guidance specifically recommends the use of a full-face
shield or visor for AGPs4.
The challenge specific to the otological surgeon is the need to use an
operating microscope when performing mastoidectomy. The full-face shield
recommended for AGPs introduces a physical barrier, increasing the
distance between the surgeon’s eyes and the operating microscope
eyepieces. This may reduce the microscopic view of the surgical field,
making surgery more difficult and potentially increasing the risk of
surgical error.
In order to quantify this concern, we undertook a study designed to
examine the effect of different forms of PPE on the operator-microscope
distance and the effect this has on the surgical view obtained by the
operator.