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Professional body response to Covid middle ear research

A Daily Mail article (23 July) states that "Scientists discover coronavirus in the EARS of two dead Covid-positive patients as studies suggest hearing loss may be a rare symptom of the infection".

The article is based on a research letter published by the JAMA Otolaryngology - Head & Neck Surgery, in which the authors report that two of three patients tested positive for SARS-CoV-2 virus in the mastoid or middle ear, with viral isolation from two of six mastoids and three of six middle ears.
The authors state: "This study confirms the presence of SARS-CoV-2 virus in the middle ear and mastoid, with significant implications for otolaryngology procedures. Similar to procedures of the nose, mouth, and airway, droplet precautions during ear surgery are warranted for patients with COVID-19 owing to risk of infection to health care personnel."
The researchers advise: "Droplet precautions (including eye protection and proper N95 level mask) are warranted for outpatient procedures involving the middle ear due to proximity to these potentially infectious spaces."
These findings do not necessitate a change to the Joint Guidance issued by audiology professional bodies in the UK published on 30 June as the guidance already advises stepping up PPE for procedures on wet ears.
The guidance states: "Tympanometry, air calorics and wax removal should be considered a potential AGP ONLY when there is a known wet perforation present; wax removal or tympanometry should be delayed if possible. If a wet perforation is discovered during a procedure, the procedure should be stopped immediately, and appropriate medical referral made for treatment of the cause. If tympanometry or wax removal is required on a wet perforation, this should be undertaken using increased levels of PPE, as detailed by Government guidance for PPE required during an aerosol generating procedure available here (Link)”
Audiology & Otology Guidance during COVID-19 Pandemic, 30 June 2020
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