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News Flash!—SARS-CoV-2 Isolated From the Middle Ear and Mastoid

Educational Objective
To understand the implications of COVID-19 being isolated in the Middle Ear and Mastoid
1 Credit CME

Otolaryngologists (especially otologists and/or neurotologists) around the globe have been waiting 6 months for this study.1 Given the anatomic connection from the nasopharynx, site of initial infection and virus isolation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to the tympanic cavity through the eustachian tube, could the virus responsible for the coronavirus disease 2019 (COVID-19) and the current global pandemic gain access to the middle ear space and mastoid cavity, and thus put health care workers at additional risk of contracting the virus?

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Article Information

Corresponding author: Bradley W. Kesser, MD, University of Virginia Department of Otolaryngology–Head and Neck Surgery, Charlottesville, VA 22903 (bwk2n@hscmail.mcc.virginia.edu).

Published Online: July 23, 2020. doi:10.1001/jamaoto.2020.2067

Conflict of Interest Disclosures: None reported.

References
1.
Frazier  KM , Hooper  JE , Mostafa  HB , 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.2020.1922Google Scholar
2.
Bulut  Y , Güven  M , Otlu  B ,  et al.  Acute otitis media and respiratory viruses.   Eur J Pediatr. 2007;166(3):223-228. doi:10.1007/s00431-006-0233-xPubMedGoogle ScholarCrossref
3.
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(3):390-394. doi:10.1016/S0022-3476(98)70276-8PubMedGoogle ScholarCrossref
4.
CDC. Real-Time RT-PCR Panel for Detection 2019-Novel Coronavirus Centers for Disease Control. Centers for Disease Control. https://www.who.int/docs/default-source/coronaviruse/uscdcrt-pcr-panel-for-detection-instructions.pdf?sfvrsn=3aa07934_2. Accessed June 14, 2020.
5.
Workman  AD , Welling  DB , Carter  BS ,  et al.  Endonasal instrumentation and aerosolization risk in the era of COVID-19: simulation, literature review, and proposed mitigation strategies.   Int Forum Allergy Rhinol. Published online April 3, 2020. doi:10.1002/alr.22577PubMedGoogle Scholar
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CDC. Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html. Accessed June 14, 2020.
7.
Lammers  MJW , Lea  J , Westerberg  BD .  Guidance for otolaryngology health care workers performing aerosol generating medical procedures during the COVID-19 pandemic.   J Otolaryngol Head Neck Surg. 2020;49(1):36. doi:10.1186/s40463-020-00429-2PubMedGoogle ScholarCrossref
8.
Saadi  RA , Bann  DV , Patel  VA , Goldenberg  D , May  J , Isildak  H .  A commentary on safety precautions for otologic surgery during the COVID-19 pandemic.   Otolaryngol Head Neck Surg. 2020;162(6):797-799. doi:10.1177/0194599820919741PubMedGoogle ScholarCrossref
9.
Chen  JX , Workman  AD , Chari  DA ,  et al.  Demonstration and mitigation of aerosol and particle dispersion during mastoidectomy relevant to the COVID-19 era.   Otol Neurotol. 2020. doi:10.1097/MAO.0000000000002765PubMedGoogle Scholar
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CDC. COVIDView: A Weekly Surveillance Summary of U.S. COVID-19 Activity. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html. Accessed June 14, 2020.
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