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Published on: May 18, 2022
Middle Ear Viral Load Considerations in the COVID-19 Era: A Systematic Review
Jeffrey Liaw1, Robert Saadi1, Vijay A Patel2
1Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey.
Objective:
To systematically review the available medical literature to investigate the viral load in the middle ear and mastoid cavity and the potential risk of exposure to airborne viruses during otologic surgery.
Data Sources:
PubMed, MEDLINE, and Cochrane databases.
Study Selection:
This review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocol.
Data Extraction:
Using the Boolean method and relevant search term combinations for terms "mastoid," "middle ear," "virus," "exposure" "COVID-19" "SARS-CoV-2." PubMed, MEDLINE, and Cochrane databases were queried. A total of 57 abstracts were identified and screened by two independent reviewers. Following inclusion and exclusion criteria, 18 studies were selected for the final analysis.
Data Synthesis:
Due to the heterogeneity of clinical data, a meta-analysis was not feasible.
Results:
Rhinovirus, followed by respiratory syncytial virus are reported to be the most prevalent viruses in MEF samples but formal statistical analysis is precluded by the heterogeneity of the studies. Drilling was identified to have the highest risk for aerosol generation and therefore viral exposure during otologic Surgery.
Conclusions:
The medical literature has consistently demonstrated the presence of nucleic acids of respiratory viruses involving the middle ear, including SARS-CoV2 in a recent postmortem study. Although no in vivo studies have been conducted, due to the likely risk of transmission, middle ear and mastoid procedures, particularly involving the use of a drill should be deferred, if possible, during the pandemic and enhanced personal protective equipment (PPE) used if surgery is necessary.
Insights
Respiratory viruses are present in the middle ear, posing an airborne exposure risk during otologic surgery. Drilling significantly increases this risk, necessitating precautions like enhanced personal protective equipment (PPE).
Area of Science:
- Otolaryngology
- Virology
- Infectious Disease
Background:
- The presence and viral load of airborne pathogens in the middle ear and mastoid cavity remain incompletely understood.
- Otologic surgery carries a potential risk of viral transmission to healthcare professionals.
- The specific risks associated with different surgical techniques require systematic investigation.
Purpose of the Study:
- To systematically review the medical literature on viral presence in the middle ear and mastoid.
- To assess the risk of airborne virus exposure during otologic surgical procedures.
- To identify surgical factors contributing to increased viral exposure risk.
Main Methods:
- Systematic literature review adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
- Searches conducted on PubMed, MEDLINE, and Cochrane databases using terms related to "mastoid," "middle ear," "virus," "exposure," "COVID-19," and "SARS-CoV-2."
- Screening of 57 abstracts by two independent reviewers, with 18 studies selected for final analysis.
Main Results:
- Rhinovirus and respiratory syncytial virus were the most frequently detected viruses in middle ear fluid (MEF) samples.
- Surgical drilling was identified as the procedure with the highest risk of aerosol generation and subsequent viral exposure.
- Formal meta-analysis was not feasible due to significant heterogeneity in the included studies' clinical data.
Conclusions:
- Respiratory viruses, including SARS-CoV-2, have been detected in the middle ear, confirming their presence.
- Otologic procedures, especially those involving drilling, pose a significant risk of viral transmission.
- Recommendations include deferring elective procedures during pandemics and utilizing enhanced personal protective equipment (PPE).
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