Posted on Authorea 19 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.158990752.24382560 — This a preprint and has not been peer reviewed. Data may be preliminary. atietm.Tefl-aesil eomne o Gsitoue hsclbrir nraigthe increasing barrier, physical performing when a microscope introduces operating AGPs an for use to recommended need shield the full-face is or surgeon The visors otological the mastoidectomy. AGPs integrated to for with specific visor masks challenge recommends or The surgical specifically shield guidance by full-face (PHE) eye/face conferred a England of is and Health use Public protection masks current the eye respirator spectacles, drills of safety rated) protective polycarbonate high-speed degree (FFP-3 personal by some of facepiece of Whilst use filtering use the gloves, the protection. involving staff recommend gowns, theatre surgery currently long-sleeved operating has all fluid-resistant bodies and ear for healthcare surgeon middle (PPE) the specialist The to equipment and is risk government such a tube. UK respiratory poses as Eustachian The with drill and the high-speed lined via the system are coronavirus by nasopharynx air-cell air-cells including generated and pathogens mastoid aerosol mastoid harbour ear The the to (AGP). middle demonstrated within procedure the been drills generating with aerosol continuous high-speed an mucosa, of minimising be use whilst to staff. surgery the considered theatre mastoid involves and generating surgeon surgery aerosol oto- the perform Mastoid for to to challenges transmission how unconsidered coronavirus is previously of these of risk of number the least a Not presents surgeons. pandemic logical COVID-19 / SARS-CoV-2 The Introduction surgeons that so required urgently are that Solutions surgery cases. mastoid most during in is drill visible visor transmission. and field full-face COVID-19 and surgical microscope from mask the operating FFP-3 protected of the an adequately 10% of of are than consisting less use PPE with concurrent Conclusion: microscope, for 16%). operating allow – the 4 respectively; the of (range to -0.894 use 4% surgical with eye and was the incompatible visor the -0.983 full-face of from coefficient and area Distance mask correlation visible FFP-3 (Pearson scores. the the In visible target-view calculate PPE. area and to of and eye-microscope used range diameter 51 p were a with generating scores wearing the correlated part, surgeon target; Using inversely took the the microscope surgeons Methods: with of between Eleven distance measured visibility The microscope. Results: subsequently the this field. operating and scored field. of operating the recorded surgeons entire aim the was using condition, filled The achieved microscope PPE it view that the each visor. so and the target to full-face eye on a workers view surgeon’s and PPE to healthcare the mask asked wearing were requires of FFP-3 surgeons era ENT effect an microscope, COVID-19 the recommend operating the examine guidelines in to UK was mastoidectomy (PPE); study (AGP), equipment procedure protective generating personal aerosol wear an As Objective: Abstract 2020 19, May 1 Clamp (PPE) Philip equipment protective personal operating COVID-19 the with using microscope mastoidectomy performing of challenge The < nvriyHsiasBitladWso H onainTrust Foundation NHS Weston and Bristol Hospitals University .0) s fPEicesdteeemcocp itneadrdcdtesria iw h einae iil wearing visible area median The view. surgical the reduced and distance eye-microscope the increased PPE of Use 0.001). 1 n tpe Broomfield Stephen and 4 1 . 1 1 h lm fptnilyvirus-containing potentially of plume The . 4,5 hsicue,a minimum, a as includes, This . 2,3 . Posted on Authorea 19 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.158990752.24382560 — This a preprint and has not been peer reviewed. Data may be preliminary. ee )rdcdteae ftesria iwt eino %(ag 16%). – 4 (range 4% (PPE of visor median full-face a a to of view use surgical The the field/target view. of protection, surgical surgical eye area the in bulky the of progressively reduction with reduced view resultant mask, (100%) E) a FFP-3 full level with an 11 of a distance between use achieve working was The to the A). A), able level level increased (PPE were as PPE surgeons (defined any Table wearing All PPE not in of when 13mm). shown use (median are the mm calculations without 18 visibility distance, working and target eye-microscope and normal measurements The eye-microscope of 2. range visibility and target median highly and p The correlated distance respectively; eye-microscope target -0.894 the on the and of PPE of -0.983 area percentage of and coefficient a Effect diameter correlation as Both (Pearson expressed and distance 3. score eye-microscope Figure of each in the for total demonstrated to calculated A are was target Results PPE visible target. glasses). the defined overall of or the area and protection of diameter eye The all no covering visibility. with collected target mask and were distance (FFP3 scores and Eye-microscope B operating, target for level E). and glasses PPE to distance prescription (A at wore eye-microscope categories surgeons tested operating of 11 the be measures the using not of 51 ranged in Four could distance experienced Inter-pupillary 64mm). such and consultant. (median as senior comfortable 75mm to were registrar to All ST3 58mm from study. from ranged surgeon the of in Grade part microscope. took surgeons with ENT full glasses, Eleven a normal study, representing their this E wear of and to purposes PPE continued Results the no surgery 1). For representing for (Figure A glasses 2. eye/face microscope with prescription Figure of E, PPE. wear the and additional to forms who 1 of Table A Surgeons various side in from and visor. for outlined categorised the face recorded mask were is were to FFP-3 PPE trialled distance secured of eye-microscope PPE an avoid and combinations ruler The to wearing visible) taken a condition. ring surgeon care complete PPE of cornea the (outer-most with each surgeon’s aid view with millimetre, for the the repeated from nearest Scores of with calculated then the protection. aspect was to done was anterior visible measured a was process most for was target represented This This allowed eyepiece the of ring) that between microscope percentage white error. view the distance The (outer parallax of restricted The the 1 only. edge more at of area). target the a staring score and and the indicating whilst A (diameter of scores vision, scores portion higher peripheral position. these central progressively their neutral a with in usual of see target, the surgeons could visualisation the The in they of inter-pupillary view. target head the view comfortable the adjusted their full and of surgeon optimal with much Each an point how ensure that 1). centre to state posture (Figure angle comfortable to microscope period a asked view). and extended with were chair surgical view an microscope, the the the the for of the of and height of using operate perimeter distance, entirety 300mm for to the the themselves of them matching filled position allow target length target to would the focal asked the of were and a that edge spaced surgeons ensure surgery with outer equally ENT to the ear set 10, adjusted (with was for has were microscope target microscope position the zoom This The normal by and 1). afforded the microscope (Figure zones. the in archery coloured of up world 5 position competitive set in with was used circles, microscope target institution concentric our The scaled throughout a theatres Germany). on operating in Jena, focused used the AG, microscope, by S88 Zeiss Vario obtained OPMI (Carl Zeiss view a forms surgical utilised different study the This of on effect has the this examine effect to Method the designed and study error. distance a surgical operator-microscope of undertook risk the operator. we the on concern, increasing PPE this potentially of quantify and difficult to more order microscopic surgery the In reduce making may field, This surgical eyepieces. the microscope operating of the view and eyes surgeon’s the between distance 2 < 0.001). Posted on Authorea 19 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.158990752.24382560 — This a preprint and has not been peer reviewed. Data may be preliminary. rlgiac.Concprgt eso .Udtd2 pi 2020. April con- 27 and Updated prevention infection 2. Version COVID-19: copyright. England. Crown Health Public guidance. transmission. viral trans-corneal and trol Mastoidectomy H. Burns 4. S, Knowles S, Gendy P, dispersion Walshe Laryngoscope particle and A, Neurotol aerosol Hilal Otol of mitigation era. 3. and COVID-19 Demonstration the al. to reaction. et relevant DA, chain mastoidectomy Chari polymerase during AD, Workman transcriptase JX, syncytial reverse Chen respiratory by 2. rhinovirus, media of otitis Detection FG. acute Hayden in E, Pediatrics infections Arruda coronavirus J, Jero and A, virus, Virolainen A, Pitkaranta viral 1. from protection adequate References surgeon Urgent and the microscope cases. affording operating most the whilst in of surgery, 10% use era. below mastoid concurrent COVID-19 for to for the allow of reduced in required that use was transmission with solutions are field incompatible to that surgical is given the drill visor be of full-face to and view needs mask the consideration FFP-3 mind. microscope; an in including operating this PPE the with that interpreted demonstrates be be may study in should study This confidence and this of institute in level our obtained their in Data judge used view. Conclusion to PPE in need and a may reductions microscope least complete minor surgeons almost the at even Individual preserving preserve to with less to specific more). or surgery likely or 15mm otological is of (90% 20mm safe distance field around working performing surgical ideal of an the distance with of working field, a view microscopic study, the this of in view obtained 70% PPE data strict the unhindered fulfil on relatively must Based allowing drilling, also eyepieces. mastoid whilst microscope by eyes) shield the surgeon’s generated to to designed the aerosol access devices, with the or contact from modification droplet face Any (preventing and approaches, requirements surgeon. alternative eyes the of surgeon’s to suggested number protection otological been A some the also afford otological have exoscopes). may system 3-D microscope for (such “double-drape” or the microscope environment to the loupes operating of surgical the operating technique surgery, use and surgical is safe ear as drilling in endoscopic such mastoid action Variations a of high-speed Urgent care. providing of use surgical use the of simultaneous COVID-19. safe as for effective, aim of need deliver the era the to obviate ability the may with the in challenge, preserving surgeons whilst this this drilling. otological surgeons at address mastoid facing microscope to challenges as most operating the in needed such the visible highlights of AGPs view use study for microscope the This the recommended with of incompatible PPE 10% PPE than of AGP less level with recommended time. severe, the makes is This satisfies view surgical cases. visor PPE in COVID-19 full-face reduction UK that the a current However, noted of by be should use recommended It fit protection The on distance. droplet depended eye-microscope the This in provides view. increase levels on resultant guidelines PPE effect and glasses variable these face safety highly surgeon’s of polycarbonate a the slimline neither produced to or D) PPE glasses level the prescription (PPE own over-glasses of correlation surgeon’s or inverse the C) with level an masks (PPE shows FFP-3 analysis of Data use the surgeon. The view. reduces the target PPE to and of available use distance field that eye-microscope microscopic concern between operating our supports the surgeons, of ENT view practicing involving study, workplace This Discussion 4 . . 1998;102:291-295. . 2005;115:1873-1876. 3 2,6,7 . epk ugclsilsta attach that shields surgical Bespoke . 2020. Posted on Authorea 19 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.158990752.24382560 — This a preprint and has not been peer reviewed. Data may be preliminary. h hleg fuigoeaigmcocpswt ulCVDPE-Fgr 3.docx Figure - PPE COVID full equipment-ppe with at microscopes mastoidectomy-using-the-operating-microscope-with-covid-19-personal-protective- operating using able of challenge The 2.docx file Figure Hosted - PPE COVID full equipment-ppe with at microscopes mastoidectomy-using-the-operating-microscope-with-covid-19-personal-protective- operating using able of challenge The 1.docx file Table Hosted - PPE COVID full equipment-ppe with at microscopes mastoidectomy-using-the-operating-microscope-with-covid-19-personal-protective- operating using able of challenge The 1.docx file Figure Hosted - PPE COVID full equipment-ppe with at microscopes mastoidectomy-using-the-operating-microscope-with-covid-19-personal-protective- operating using able of challenge visibility. The target and distance eye-microscope on file and PPE Hosted (3a) different diameter of of Effect calculations – versus 2 parentheses measurements Table eye-microscope in visible. of Value target results of of (3b) glasses. plots area scatter prescription 1. – Table with 3 in surgeon Figure defined show surgeon PPE show of 6-9 1-5 Pictures level Pictures to glasses. prescription corresponds without wearers) glasses. and with spectacle prescription surgeons prescription in without tested for conditions modifications measurement. PPE – (including eye-microscope 2 tested and Figure PPE position of surgeon’s Levels demonstrating – up, 1 set Table study and Target Mastoid – During 1 Control Figure Droplet for Technique Simple Drape A legends Microscope TL. Figure during Surg Eby Neck 2 2020. CF, Head The Harbarger Otolaryngol procedures LS, JAMA March – Buck Surgery. Era JD, otological 23 Carron COVID 2020. 7. the undertaking April Updated 15 in Updated 2020. 13, Website. Mastoidectomy for Otology May S. of Accessed Society Otology. Thomas Guidance British and T, ENTUK https://www.entuk.org/sites/default/files/Mastoidectomy%20in%20the%20COVID%20Era%20%E2%80%93%20The%202.pdf. of D. Mitchell Aerosolization. Reduce W, to Society Method Jenkins Hellier British S, 6. and 2020. Lloyd 13, ENTUK May Accessed P, Rea https://www.entuk.org/sites/default/files/ENTUK%20Guidance%20For%20Covid%2019%20for%20otology%20procedures%20%28v8%29.pdf. pandemic. COVID-19 5. 2020. 13, data/file/881489/COVID-19 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment https://authorea.com/users/323848/articles/452313-the-challenge-of-performing- https://authorea.com/users/323848/articles/452313-the-challenge-of-performing- https://authorea.com/users/323848/articles/452313-the-challenge-of-performing- https://authorea.com/users/323848/articles/452313-the-challenge-of-performing- Infection prevention . 2020. and 4 control guidance opeepf cesdMay Accessed complete.pdf. - avail- avail- avail- avail- Posted on Authorea 19 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.158990752.24382560 — This a preprint and has not been peer reviewed. Data may be preliminary. h hleg fuigoeaigmcocpswt ulCVDPE-Tbe2.docx Table - PPE COVID full equipment-ppe with at microscopes mastoidectomy-using-the-operating-microscope-with-covid-19-personal-protective- operating using able of challenge The file Hosted https://authorea.com/users/323848/articles/452313-the-challenge-of-performing- 5 avail-