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Head and Neck Surgery

SARS-CoV-2 Virus Isolated From the Mastoid and Middle EarImplications for COVID-19 Precautions During Ear Surgery

Educational Objective
To understand the necessary precautions needed before undertaking middle ear and mastoid surgery during COVID-19

1 Credit CME

JAMA Otolaryngology–Head & Neck Surgery

Published Online: July 23, 2020

Research Letter

Article Information and Disclosures

Kaitlyn M. Frazier, MD¹;

Jody E. Hooper, MD²;

Heba H. Mostafa, MBBCh, PhD, D(ABMM)²;

C. Matthew Stewart, MD, PhD¹

Author Affiliations

¹Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
²Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and associated coronavirus disease 2019 (COVID-19) disease pandemic have rapidly spread around the world since December 2019. The high rate of droplet spread can endanger health care workers during procedures of the aerodigestive tract,¹ particularly affecting otolaryngologists. Although there are no human data relating to the SARS-CoV-2 virus in the middle ear, the recommendations to mitigate these risks include precautions for middle ear and mastoid surgery¹^,2 because middle ear effusions have been shown to contain some non–SARS-CoV-2 coronaviruses.³ We present confirmation of SARS-CoV-2 colonization of the middle ear and mastoid in 2 of 3 patients.

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Article Information

Accepted for Publication: June 2, 2020.

Corresponding Author: C. Matthew Stewart, MD, PhD, Johns Hopkins Outpatient Center, 601 N Caroline St, 6th floor, Baltimore, MD 21287 (cstewa16@jhmi.edu).

Author Contributions: Dr Stewart had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Mostafa, Stewart.

Critical revision of the manuscript for important intellectual content: All authors.

Administrative, technical, or material support: All authors.

Supervision: Mostafa, Stewart.

Conflict of Interest Disclosures: Dr Hooper reported grants from the National Institutes of Health during the conduct of the study. No other disclosures were reported.

Published Online: July 23, 2020. doi:10.1001/jamaoto.2020.1922

Correction: This article was corrected on September 3, 2020, to fix a missing acknowledgement of funding from the National Institutes of Health. This article was corrected online.

Funding: Dr Frazier’s research is supported by the National Institutes of Health (NIH NIDCD 2T32DC000027).

Role of the Funder/Sponsor: National Institutes of Health had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank Michael Forman, MS, for his molecular virology laboratory and PCR expertise (uncompensated) as well as the families who granted consent for autopsy.

References

Givi B , Schiff BA , Chinn SB , et al. Safety recommendations for evaluation and surgery of the head and neck during the COVID-19 pandemic. [published online ahead of print, 2020 Mar 31]. JAMA Otolaryngol Head Neck Surg. 2020. doi:10.1001/jamaoto.2020.0780 PubMed Google Scholar

Carron JD , Buck LS , Harbarger CF , Eby TL . A simple technique for droplet control during mastoid surgery. JAMA Otolaryngol Head Neck Surg. 2020;e201064. doi:10.1001/jamaoto.2020.1064 PubMed Google Scholar

Seppanen EJ , Thornton RB , Corscadden KJ , et al. High concentrations of middle ear antimicrobial peptides and proteins and proinflammatory cytokines are associated with detection of middle ear pathogens in children with recurrent acute otitis media. PLoS One. 2019;14(12):e0227080. Published online December 26, 2019. doi:10.1371/journal.pone.0227080 PubMed Google Scholar

Duregon E , Schneider J , DeMarzo AM , Hooper JE . Rapid research autopsy is a stealthy but growing contributor to cancer research. Cancer. 2019;125(17):2915-2919. doi:10.1002/cncr.32184 PubMed Google Scholar Crossref

Uhteg K , Jarrett J , Richards M , et al. Comparing the analytical performance of three SARS-CoV-2 molecular diagnostic assays. [published online ahead of print, 2020 Apr 26]. J Clin Virol. 2020;127:104384. doi:10.1016/j.jcv.2020.104384 PubMed Google Scholar

Sharma D , Rubel KE , Ye MJ , et al. Cadaveric simulation of otologic procedures: an analysis of droplet splatter patterns during the COVID-19 pandemic. [published online ahead of print, 2020 May 19]. Otolaryngol Head Neck Surg. 2020;194599820930245:194599820930245. Accessed May 28, 2020. doi:10.1177/0194599820930245 PubMed Google Scholar

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.