This brief guidance updates that previously provided by the British Society of Otology (BSO), related to the use of micro-suction in outpatients during the COVID pandemic. A number of factors have been considered in producing this guidance.

1. While there has now been a publication identifying COVID virus in the middle ear of cadavers who, in life, were COVID positive (Frazier et al 2020), as far as we are aware there have been no cases of confirmed transmission of COVID via the middle ear either during surgery or throughout patient micro-suction.

2. As far as we are aware, there are no studies assessing the aerosol-generating tendency of external or middle ear micro-suction. However, it is likely that the suction of air from the
environment within the external auditory canal into the suction tip during micro-suction will prevent the formation of significant aerosol within the clinic environment during microsuction. If wall-mounted suction is used, then the air and any aerosolised material evacuated during micro-suction will be vented externally, therefore minimising exposure to aerosolised material. If portable suction is used, the aerosolised material evacuated during micro-suction may be vented back in to the clinic environment.

3. The majority of the UK population has now been vaccinated against COVID-19, therefore reducing the risk of transmission of the virus.

4. The majority of clinicians carrying out micro-suction have been vaccinated against COVID-19.

Following on from the above statements, the BSO recommends that micro-suction can be safely performed in outpatients, even in the presence of a tympanic membrane perforation or middle ear infection, irrespective of whether the suction tip is fenestrated or not. It is likely to be safe for this to be undertaken in the consultation room. The clinician should wear a surgical mask. If portable suction is used, then an appropriate HEPA filter should be applied to the machine to prevent recycling of the evacuated air and associated aerosolised material back in to the clinic environment. There is no requirement for fast air turnover within the room in which micro-suction is being undertaken, although it is preferable for the room to be well ventilated.

Frazier K. et al. ‘SARS-Co-V-2 virus isolated from the mastoid and middle ear: Implications for COVID19 precautions during ear surgery’.

Prof Peter Rea and Prof Simon Lloyd