Prions and the otolaryngologist

Abstract

Much scientific and general media interest has developed regarding the potential threat to the public health posed by prion diseases. The likely transmissible agents responsible for these diseases have been shown to accumulate in high levels in central nervous and, in the case of variant Creutzfeldt–Jakob disease, lymphoid tissues. They demonstrate profound resistance to standard sterilization methods used in surgical practice. There are therefore substantial implications regarding the safety of multiple-use surgical instruments in otolaryngology and other surgical disciplines. The departments of health in England and Scotland have now insisted that all adenotonsillectomy instruments be disposed of after each procedure. This review outlines the history of our understanding of prion diseases, the development of pre mortem diagnostic tools for Creutzfeldt–Jakob disease (including pharyngeal tonsil biopsy), and the issues concerning the risk to public health by the possible iatrogenic transmission of Creutzfeldt–Jakob disease by surgical instruments.