Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe, Japan; Hearing Research Division, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Japan; Foundation for Biomedical Research and Innovation at Kobe, Kobe, Japan.
Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Auris Nasus Larynx. 2023 Apr;50(2):285-291. doi: 10.1016/j.anl.2022.07.007. Epub 2022 Jul 29.
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a novel coronavirus, causes coronavirus disease 2019 (COVID-19). Otologic surgeries with drilling by powered instruments induce significant aerosols, which may induce SARS-CoV-2 transmission to medical staff if SARS-CoV-2 exists in the middle ear and mastoid cavity. During a COVID-19 pandemic, therefore, confirming a negative COVID-19 test prior to otologic surgery is recommended. However, previous coronavirus studies demonstrated that coronavirus was detected in the middle ear in some patients even though the polymerase chain reaction (PCR) test using their nasopharyngeal swab was negative. This study aimed to elucidate the probability of a positive SARS-CoV-2 PCR test in the middle ear or mastoid specimens from otologic surgery patients in whom SARS-CoV-2 was not detected by preoperative PCR test using a nasopharyngeal swab.
We conducted a prospective, multicenter clinical study. Between April 2020 and December 2021, during the COVID-19 pandemic, 251 ears of the 228 participants who underwent otologic surgery were included in this study. All participants had no symptoms suggesting COVID-19 or close contact with a confirmed COVID-19 patient two weeks prior to the surgery. They were also negative in the SARS-CoV-2 PCR tests using a nasopharyngeal swab before surgery. We collected mucosa, granulation, bone dust with mucosa or fluid from the middle ear or mastoid for the SARS-CoV-2 PCR tests during each otologic surgery.
The median age of the participants at surgery was 31.5 years old. Mastoidectomy using a powered instrument was conducted in 180 of 251 otologic surgeries (71.8%). According to intraoperative findings, active inflammation in the middle ear or mastoid cavities was evident in 20 otologic surgeries (8.0%), while minor inflammation was observed in 77 (30.7%). All SARS-CoV-2 PCR tests of otologic specimens showed a negative result. No patient suffered from COVID-19 within two months after otologic surgery. Furthermore, no hospital-acquired infections associated with otologic surgery occurred in our institutions CONCLUSIONS: Our results showed that PCR testing did not detect SARS-CoV-2 in middle ear and mastoid specimens, suggesting that the risk of transmission of SARS-CoV-2 is not high in otologic surgeries even using powered instruments when both clinical and laboratory tests are confirmed to be negative for COVID-19.
新型冠状病毒（SARS-CoV-2）是一种新型冠状病毒，可引起 2019 年冠状病毒病（COVID-19）。使用动力仪器进行的耳部手术会产生大量气溶胶，如果中耳和乳突腔中存在 SARS-CoV-2，可能会导致 SARS-CoV-2 传播给医务人员。因此，在 COVID-19 大流行期间，建议在耳部手术前确认 COVID-19 检测结果为阴性。然而，之前的冠状病毒研究表明，即使使用鼻咽拭子的聚合酶链反应（PCR）检测结果为阴性，一些患者的中耳中也检测到冠状病毒。本研究旨在阐明在术前使用鼻咽拭子的 PCR 检测未检测到 SARS-CoV-2 的耳部手术患者的中耳或乳突标本中 SARS-CoV-2 PCR 检测呈阳性的概率。
我们进行了一项前瞻性、多中心临床研究。在 2020 年 4 月至 2021 年 12 月 COVID-19 大流行期间，纳入了 228 名参与者的 251 只耳朵进行了这项研究。所有参与者在手术前两周内均无 COVID-19 症状或与确诊 COVID-19 患者密切接触。他们在手术前也使用鼻咽拭子进行的 SARS-CoV-2 PCR 检测均为阴性。我们在每次耳部手术中收集来自中耳或乳突的粘膜、肉芽组织、带粘膜的骨尘或液体，用于 SARS-CoV-2 PCR 检测。
参与者手术时的中位年龄为 31.5 岁。251 例耳部手术中有 180 例（71.8%）使用动力仪器进行乳突切除术。根据术中发现，20 例耳部手术中有 20 例（8.0%）中耳或乳突腔有明显炎症，77 例（30.7%）有轻微炎症。所有耳部标本的 SARS-CoV-2 PCR 检测结果均为阴性。术后两个月内，无患者患 COVID-19。此外，我们机构未发生与耳部手术相关的医院获得性感染。
我们的结果表明，PCR 检测未在中耳和乳突标本中检测到 SARS-CoV-2，这表明在 COVID-19 临床和实验室检测均为阴性时，即使使用动力仪器进行耳部手术，SARS-CoV-2 的传播风险也不高。
