Recommended personal protective equipment for cochlear implant and other mastoid surgery during the COVID-19 era.

Lawrence, Rachael J; O'Donoghue, Gerard; Kitterick, Pádraig; O'Donoghue, Kevin; Hague, Richard; Mitchell, Laura; Lycett-Ranson, Zoe; Hartley, Douglas E H

OBJECTIVE(S) The overall aim of this study was to evaluate personal protective equipment (PPE) that may facilitate the safe recommencement of cochlear implantation in the COVID-19 era with the broader goal of minimising the period of auditory deprivation in prelingually deaf children and reducing the risk of cochlear ossification in individuals following meningitis. METHODS Using a preclinical model, an objective assessment of drill induced droplet spread was undertaken during simulated cochlear implant (CI) surgery and mitigated via the use of a protective drape 'tent'. A subsequent study of various PPE solutions assessed impact on communication, vital physiological parameters, visual acuity and fields, and acceptability to surgeons using a systematic risk-based approach. RESULTS Droplet spread during simulated CI surgery extended over 2 meters, a distance greater than previously reported. A drape 'tent' significantly reduced droplet spread. The ensemble of a half-face mask and safety spoggles (foam lined safety goggles) had consistently superior performance across all aspects of clinical usability. All other PPE options were found to substantially restrict the visual field, making them unsafe for microsurgery. CONCLUSION The results of this preclinical study indicate that the most viable solution to enable the safe conduct of CI and other mastoid surgery is a combination of an FFP3 mask or half-face respirator with safety spoggles as PPE. Prescription spoggles are an option for surgeons who need to wear corrective glasses to operate. A drape 'tent' reduces droplet spread. A multi-centre clinical trial to evaluate the effectiveness of PPE should be the next step towards safely performing CI surgery during the COVID-19 era. This article is protected by copyright. All rights reserved.