WHO declared COVID–19 outbreak as pandemic in March, 2020, which was started from Wuhan of china. During this pandemic, (every person or patient has chance of being infected with corona virus,) nobody is immune of being infected with coronavirus or being asymptomatic career of this 1.
Mastoidectomy is an important surgical procedure in which all the accessible mastoid air cells are accenterated with an aim to make the ear safe 2, 3, 4. CSOM with extracranial and intracranial complications are indications of emergency or urgent mastoidectomy. The indications of urgent or emergency mastoidectomy are a bit changed recently 5,6. In the last few decades brain abscess due to CSOM was advocated and practised to be treated in two stage, at first incision and drainage of brain abscess, then 2–4 weeks later mastoid exploration. But, recently single stage urgent otological procedure is advocated (and it is without any delay) for minimizing mortality and morbidity. In a developing country- like Bangladesh, lot of patients present to the hospitals at advanced stage usually with complications, like mastoiditis (not responsive to conservative treatment), facial palsy, labyrinthitis, extradural abscess, brain abscess, meningitis, lateral sinus thrombosis, otitic hydrocephalus which warrants urgent surgery.5,6,7. In our context, emergency mastoidectomy is not uncommon, especially in our centre, i.e. Dhaka Medical College Hospital, a tertiary level hospital 8.
Mastoidectomy is an aerosol generating procedure. If a patient of COVID–19, either confirmed, suspected or asymptomatic career, requires mastoidectomy for any of those indications, it’s a critical and alarming issue for the health care professionals, including doctor, nurse, other OR (operating room) staff for the highly contagious nature of this virus 9.
In current situation prior to any (routine) surgery report of RT-PCR test for coronavirus is mandatory. Negative results do not preclude SARS-CoV–2 infection and should not be used as the sole basis for patient management decisions. Negative results must be combined with clinical observations, patient history, and epidemiological information 10. In a developing country- like Bangladesh, patient presents to the hospitals at advanced stage usually with complications, like mastoiditis, facial palsy, labyrinthitis, extradural abscess, brain abscess, meningitis, lateral sinus thrombosis, otitic hydrocephalus 8,11.
RT-PCR test for detection of coronavirus is not available throughout the country, due to lack of laboratory facility, kit, technologist and other support. Due to partial or complete lockdown state mobility for the patient is also not easy rather very difficult. So confirmation of COVID–19 by RT-PCR test can’t be done instantly everywhere. Prior to surgery it’s recommended to do a CT scan of chest to find clue regarding COVID–19 12. But sometimes situation is unfavourable for doing it also. Few days or even hours are demarcating line between life and death or overall morbidity.
For this reason health care professionals should take maximum protections for their own safety within lots of limitation, seeming every patient as a COVID–19 patient.
Though the government, local authorities, personally all HCPs are trying to provide or collect adequate personal protective equipment (PPE) or other measures, throughout the world there is deficiency of it. In a resource constraint country, like us, we need to have cheap, affordable, easily available measures for protection.
Here, some simple, but novel and very effective measures will be discussed for protection of all health care providers (HCPs) in this aerosol generating procedure. Polythene and Povidone Iodine are the change makers in this novel technique of mastoidectomy, mentioned in this article. So, we named the technique as ‘POLIDON technique’ of mastoidectomy.