Introduction: The presence of new coronavirus in middle ear cleft can have significant safety implications on ENT practice
(e.g., viral shedding during ENT procedures including middle ear/mastoid surgery, ear micro-suction or intratympanic injections).
Objective: This review aims to analyse all available studies providing objective evidence about the presence or absence of
coronavirus (SARS-CoV-2) in the middle ear.
Methods: Standard search methodology was used to retrieve all studies dealing with the testing for the presence of coronavirus
(SARS-CoV-2) in the middle ear. Databases searched were PubMed, CINAHL, Cochrane Library and Embase. Only articles providing
objective evidence of SARS-CoV-2 in middle ear cleft were included i.e., where confirmation of viral presence was available through
a diagnostic test. Studies merely reporting middle ear symptoms without a diagnostic test were excluded. Results: A total of 167 articles were obtained during the literature search, out of which a final 6 studies were included and
analysed. The presence of SARS-CoV-2 in the middle ear cleft was reported in 4 out of the 6 studies (10 out of a total of 20 patients
tested). Surprisingly, in one patient SARS-COV-2 was identified in the middle ear by PCR testing with a negative oropharyngeal swab
and no systemic features of SARS-CoV-2. Conclusion: SARS CoV-2 was reported in the middle ear cleft of 50% (n=10/20) of patients included in our study. Based on our
study findings, SARS-CoV-2 should be suspected in every patient undergoing ontological procedure during covid-19 until proven
otherwise. The virus can be present in the middle ear in asymptomatic patients or/and patients with a negative oropharyngeal/
nasopharyngeal swab. Hence all necessary precautions must be undertaken during the otological procedures.