Mastoid surgery: a high-risk aerosol generating surgical procedure in COVID-19 pandemic


  • Santosh Kumar Swain Department of Otorhinolaryngology, IMS and SUM hospital, Siksha “O” Anusandhan University, K8, Kalinga Nagar, Bhubaneswar, Odisha
  • Rohit Agrawala Department of Otorhinolaryngology, IMS and SUM hospital, Siksha “O” Anusandhan University, K8, Kalinga Nagar, Bhubaneswar, Odisha



COVID-19, Mastoid surgery, Otologic surgery, Safety precautions


Corona virus disease 2019 (COVID-19) is highly contagious disease occurred by the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) which spreads human to human through respiratory secretions. It was declared as public health emergency all over the world. There is lack of data in relation to the otologic or mastoid surgery during COVID-19 pandemic. Aerosolization of the novel corona virus SARS-CoV-2 is associated with middle ear and mastoid surgery. So, the safety precautions are important parts in this present pandemic time for preventing transmission of the infections to the surgeon and team members of the surgery. Preoperative screening for COVID-19 is must for safety of the surgeon and team members. The mastoid surgery on the positive, suspected or unknown status for COVID-19 patients need protection with adequate Personal protection equipment (PPE) such as disposable cap, N95 respirator and sealed eye protection or Powered air-purifying respirator (PAPR), disposable gown and gloves. In the mastoid surgery, there is scarcity of the medical literature related to the transmission of the novel corona virus SARS-CoV-2and its prevention during present COVID-19 pandemic. So, the aim of this review article is to increase awareness among the otolaryngologists for preventing the viral exposure during the mastoid surgery.


Givi B, Schiff BA, Chinn SB, Clayburgh D, Iyer NG, Jalisi S et al. Safety recommendations for evaluation and surgery of the head and neck during the COVID-19 pandemic. JAMA Otolaryngology- Head & Neck Surgery. 2020;146(6):579-84.

Swain SK, Nahak B, Mohanty JN. Pediatric tympanoplasty: Our experiences in a tertiary care teaching hospital of Eastern India Medical Journal of Dr. DY Patil Vidyapeeth. 2020;13(3):229.

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J. A novel coronavirus from patients with pneumonia in China, 2019. New England Journal of Medicine. 2020;382(8):727-33.

He F, Deng Y, Li W. Coronavirus disease 2019: What we know?. Journal of medical virology. 2020;92(7):719-25.

Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L et al. Presumed asymptomatic carrier transmission of COVID-19. Jama. 2020;323(14):1406-7.

Zhang W, Du RH, Li B, Zheng XS, Yang XL, Hu B et al. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerging microbes & infections. 2020;9(1):386-9.

Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y et al. Early transmission dynamics in Wuhan, China, of Novel Coronavirus-infected pneumonia. N Engl J Med. 2020;382:1199-20.

China News Weekly. Restore the infection path of “Super Communicator” Wuhan Doctor: the epidemic just started. Article in Chinese (simplified). 2020. Last accessed on April 2020

Pitkäranta A, Jero J, Arruda E, Virolainen A, Hayden FG. Polymerase chain reaction-based detection of rhinovirus, respiratory syncytial virus, and coronavirus in otitis media with effusion. J Pediatr. 1998;133:390-4.

World Health Organization. Coronavirus Disease 2019 (COVID-19): situation report e 66. 2019/situation-reports. Last accessed on

Chan KW, Wong VT, Tang SC. COVID-19: An update on the epidemiological, clinical, preventive and therapeutic evidence and guidelines of integrative Chinese–Western medicine for the management of 2019 novel coronavirus disease. The American journal of Chinese medicine. 2020;48(03):737-62.

Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. Jama. 2020;323(13):1239-42.

Swain SK, Samal R, Pani SK. Effect of smoking on outcome of tympanoplasty.Indian Journal of Otology. 2011;17(3):120.

Swain SK, Pradhan C, Mohanty S, Sahu MC. Comparative study between selective nerve blocks and the intravenous opioids in mastoid surgery. Egyptian Journal of Ear, Nose, Throat and Allied Sciences. 2017;18(2):121-5.

Shi Y, Wang Y, Shao C, Huang J, Gan J, Huang X et al. COVID-19 infection: the perspectives on immune responses. Shi Cell Death Differ. 2020;27:1451-54.

Wu JT, Leung K, Bushman M, Kishore N, Niehus R, de Salazar PM et al. Estimating clinical severity of COVID-19 from the transmission dynamics in Wuhan, China. Nature Medicine. 2020;26(4):506-10.

Topsakal V, Van Rompaey V, Kuhweide R, Garin P, Barbara M, Li Y et al. Prioritizing otological surgery during the COVID-19 Pandemic. B-ENT. 2020;16:55-8.

Hu Z, Song C, Xu C, Jin G, Chen Y, Xu X et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Science China Life Sciences. 2020;63(5):706-11.

Wong J, Goh QY, Tan Z, Lie SA, Tay YC, Ng SY et al. Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2020;11:1-4.

Jones R, Brosseau L. Aerosol Transmission of Infectious Disease. Journal of Occupational and Environmental Medicine. 2015;57(5):501-8.

Jewett DL, Heinsohn P, Bennett C, Rosen A, Neuilly C. Blood-containing aerosols generated by surgical technique: a possible infectious hazard. Am Ind Hyg Assoc J. 1992;53:228-31.

Zhang W, Du RH, Li B, Zheng XS, Yang XL, Hu B et al. Molecular and serological investigation of 2019-nCov infected patients. Emerg Microbes Infect. 2020;9:386-89.

Ito T, Mochizuki H, Watanabe T, Kubota T, Furukawa T, AKoike T et al. Safety of ultrasonic bone curette in ear surgery by measuring skull bone vibrations. Otol Neurotol. 2014;35:135-9.

Hilal A, Walshe P, Gendy S, Knoles S, Burns H. Mastoidectomy and trans-corneal viral transmission. Laryngoscope. 2005;115(10I):1873-76.

Xia J, Tong J, Liu M, Shen Y, Guo D. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS‐CoV‐2 infection. Journal of medical virology. 2020;92(6):589-94.

Hilal A, Walshe P, Gendy S, Knowles S, Burns H. Mastoidectomy and Trans-Corneal Viral Transmission. The Laryngoscope. 2005;115(10):1873-1876.

Chen JX, Workman AD, Chari DA, Jung DH, Kozin E, Lee DJ et al. Demonstration and mitigation of aerosol and particle dispersion during mastoidectomy relevant to the COVID-19 era. Otology & Neurotology. 2020;41(9):1230-39.

Carron JD, Buck LS, Harbarger CF, Eby TL. A simple technique for droplet control during mastoid surgery. JAMA Otolaryngology–Head & Neck Surgery. 2020;146(7):671-72.

Swain SK, Das S, Padhy RN. Performing tracheostomy in intensive care unit-A challenge during COVID-19 pandemic. Siriraj Medical Journal. 2020;5:72.






Review Articles