Aerosol Generation During Otologic Surgery

Abstract

Objective: To assess whether aerosol generation occurs during otologic surgery, to define which instruments are aerosol generating, and to identify factors that enhance safety in protection against airborne pathogens, such as severe acute respiratory syndrome coronavirus 2.

Study design: An observational prospective study on aerosol measurements during otologic operations recorded between August and December 2020.

Setting: Aerosol generation was measured with an Optical Particle Sizer as part of otologic operations with anesthesia. Particles with a size range of 0.3 to 10 μm were quantified. Aerosol generation was measured during otologic operations to analyze aerosols during drilling in transcanal and transmastoid operations and when using the following instruments: bipolar electrocautery, laser, suction, and cold instruments. Coughing is known to produce significant concentration of aerosols and is commonly used as a reference for high-risk aerosol generation. Thus, the operating room background concentration and coughing were chosen as reference values.

Patients: Thirteen otologic operations were included. The average drilling time per surgery was 27.00 minutes (range, 2.00-71.80 min).

Intervention: Different rotation speeds during drilling and other instruments were used.

Main outcome measures: Aerosol concentrations during operations were recorded and compared with background and cough aerosol concentrations.

Results: Total aerosol concentrations during drilling were significantly higher than background ( p < 0.0001, d = 2.02) or coughing ( p < 0.0001, d = 0.50). A higher drilling rotation speed was associated with higher particle concentration ( p = 0.037, η2 = 0.01). Aerosol generation during bipolar electrocautery, drilling, and laser was significantly higher than with cold instruments or suction ( p < 0.0001, η2 = 0.04).

Conclusion: High aerosol generation is observed during otologic surgery when drill, laser, or bipolar electrocautery is used. Aerosol generation can be reduced by using cold instruments instead of electric and keeping the suction on during aerosol-generating procedures. If drilling is required, lower rotation speeds are recommended. These measures may help reduce the spread of airborne pathogens during otologic surgery.