Draping Technique for Major Ear Surgery during Pandemic!!!

Covid -19 Pandemic has changed the way we provide our healthcare services to our patients. ENT / Otolaryngology is one of the high risk speciality for contracting Covid infection. We as  professionals has to take maximum precautions not only to protect our patients but also all our healthcare staff working with us in to minimise the risk of contracting the virus ((Krajewska).

Unfortunately our patients do need appropriate necessary treatment for their otological problems during this pandemic. Drilling mastoid bone will generate significant aerosol during the procedure, putting everyone in the operating theatre at risk (Prof P Rae). Though every patient who undergoes any surgical procedure should have Covid test, self isolate and free from Covid symptoms. There is risk of contracting Covid infection from asymptomatic patient or staff. We should try and take every step to minimise the risk of  contracting Covid infection either from Covid positive / negative Or symptomatic / asymptomatic patient or staff.

There are few techniques been tried by our colleagues around the world to minimise aerosol during major ear surgery.  We tried to use of the technique proposed by our colleagues in UK ( W. Hellier), as it was too cumbersome during the procedure, we propose the modified technique to drape the surgical site during major ear surgery to reduce the aerosol.

Surgical management of keratosis obturans

Keratosis obturans is a condition of the external auditory canal (EAC) characterised by formation and accumulation of desquamated keratin resulting in varying symptoms. Clinically presents as otalgia, conductive hearing loss and recurrent infection. Typically seen in younger age group and can occur bilaterally. Extension to adjacent structures can occur and result in further complications. The proposed theory is that there is a defect in epithelial in migration resulting in widening / osteitis of  external canal bone.

Condition was first described by Toynbee in 1850, and named by Wreden in 1874. Pipergerdes in 1980 distinguished keratosis obturans as separate disease from external auditory canal cholesteatoma. Ever since various treatment regime has been recommended but none of them have been curative. Michael M Paparella was first to propose surgical treatment in 1966 and he then modified the surgical technique in 1981.

Because the defect is in epithelial migration, canaloplasty with or without graft, without obliterating the bony canal defect will not restore epithelial migration. Hence, M. M Paparella’s surgical technique was NOT popularized.

Mr Basavaraj proposes novel technique which not only clears the diseased bone but obliterates the bony defect, and grafts the ear canal to bring it back to normal shape and size to encourage normal epithelial migration.

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