Mastoid and temporal bone surgery
The mastoid and middle ear mucosa may carry the same risk of viral
aerosolization as sinus and nasal surgery due to the connection with the
nasopharynx through the Eustachian tube. At a minimum, N95 mask is
required for mastoid surgery. PAPR is required for the surgeon and OR
staff in patients with SARS-CoV-2 positive status, and this equipment
can interfere with the use of an operative microscope. Using an exoscope
is an alternative, but this equipment might not be widely available.
- Low-Grade and/or slow growing intermediate grade
- Defer
- Benign disease
- Delay surgery for uncomplicated benign disease (e.g. uncomplicated
cholesteatoma).
- Complicated benign disease (e.g. coalescent mastoiditis) might
require surgical drainage limited to cortical mastoidectomy.
Cholesteatoma with progressive facial paralysis generally requires
surgical treatment to avoid progression to complete paralysis. This
benefit needs to be weighed against the potential hazard and risk to
the surgeon and operating room personnel in a COVID positive
patient.
- Malignant disease
- For early stage malignant disease of the ear canal, consider
delaying for 4-6 weeks.
- For advanced stage malignant disease of the ear canal and temporal
bone, consider neoadjuvant chemotherapy or immunotherapy.