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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

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
1.
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.2020.0780PubMedGoogle Scholar
2.
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.2020.1064PubMedGoogle Scholar
3.
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.0227080PubMedGoogle Scholar
4.
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.32184PubMedGoogle ScholarCrossref
5.
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.2020.104384PubMedGoogle Scholar
6.
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:10.1177/0194599820930245PubMedGoogle Scholar
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