The prevention instructions against COVID-19 given by The World Health Organization (WHO) as well as the Center of Disease Control (CDC) and other governmental organization around the world have left out a very important route of transmission of the coronavirus: ear-pharynx-larynx-lungs. Read this recent article by a professor of Medicine.

Dr. Michael M. Nikoletseas, Retired medical anatomist

 DOI: 10.13140/RG.2.2.15227.26407


This is a brief report the purpose of which is to inform the appropriate agencies (e.g. WHO, CDC and governmental health departments worldwide) of a serious omission in the published  prophylactic measures against the COVID-19  pandemic. The current list of personal hygiene measures  includes hand-washing and avoidance of touching three of the head openings (ostia, orifices, or other): mouth,  nose, eyes. This list omits another most important opening, the ear. This is even more important an omission since the ear is known to be associated with upper respiratory infections.

The World Health Organization (WHO) scientists as well as their counterparts in the USA agency CDC, apparently omitted the ear as a possible entry for coronavirus on the traditional assumption that the tympanic membrane (TM)  is impermeable. However, there is ample evidence to indicate that  TM is permeable in a substantial number of the population (3-4% in children). Traumatic TM perforation incidence is  6.80/1000 person. There is a scarcity of data regarding TM patency in adults. One finding reported  150,000 tympanoplasties are performed per year in a population of 280 million. This indicates a vastly greater percentage, since it leaves out subjects with TM puncture or patency that never seek medical treatment.

A second less known fact is that TM is permeable to small size entities  either by active transport or  paracellular tight-junctions as receptors in cases of small molecules such as glucose, drugs and viruses.

The omission of the ear-pharynx- larynx-lungs route will cause coronavirus infection in millions of people. I therefore recommend that WHO, CDC and all governmental health agencies worldwide  to urgently revise their prophylactic recommendation to include the ear. Such prophylaxis may include ear plugs where possible, and frequent disinfection of the ear opening (external accoustic meatus) with 4% alcool borique (not to be used in case of TM perforation or patency).


 Wani A, Rehman A, Lateef S, Malik R, Ahmed A, Ahmad W, et al. Traumatic tympanic membrane perforation:An overview. Indian J Otol. 2016;22(2):100–104.

What is the medical treatment for tympanic membrane perforation (TMP)?
Updated: Apr 23, 2018
 Matthew L Howard, MD, JD; Chief Editor: Arlen D Meyers, MD, MBA  more...

Mechanism of Active Transport through the Tympanic Membrane to the Middle Ear.
  Arwa Kurabi, Kwang K. Pak, Marlen Bernhardt, Andrew Baird & Allen F. Ryan
Scientific Reports volume 6, Article number: 22663 (2016)

Trans-Tympanic Drug Delivery for Treatment and Prophylaxis of Otitis Media
Yang, Rong  
Boston Children's Hospital, Boston, MA, United States