SARS-CoV-2 Virus Isolated From the Mastoid and Middle Ear: J
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Autopsies of two of three patients who died with COVID-19 tested positive for SARS-CoV-2 in the mastoid or middle ear, with virus isolated from two of six mastoids and three of six middle ears, reported doctors of Johns Hopkins Outpatient Center in Baltimore.

"Similar to procedures of the nose, mouth, and airway, droplet precautions during ear surgery are warranted for patients with COVID-19 owing to risk of infection to health care personnel," they wrote. "Droplet precautions (including eye protection and proper N95 level mask) are warranted for outpatient procedures involving the middle ear due to proximity to these potentially infectious spaces."

"Otolaryngologists (especially otologists and/or neurotologists) around the globe have been waiting 6 months for this study," he wrote. "The jury is now in."

While no report has documented COVID-19 infection in a healthcare worker as a result of a middle ear or mastoid procedure, "mastoidectomy clearly generates aerosols and exposes health care workers," said researchers.

"Suctioning the middle ear through a tympanic membrane perforation, intratympanic injections, and mastoid cavity debridement (especially if the cavity is exposed to the eustachian tube) may carry the risk of aerosolization and transmission of SARS-CoV-2," they wrote.

Doctors examined three deceased patients -- a woman in her 80s and a man and woman in their 60s. Autopsies were conducted 48 hours and 16 hours after death in the patients who tested positive, and 44 hours after death in the patient who tested negative.

Future studies with in vivo samples during routine ear surgery could help quantify the incidence of viral colonization in living COVID-19-positive and COVID-19-negative patients.

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