CC BY
7
УДК 616.21
Petkov D.P., MD Grigorova Ts.A.
Chief of ward Medical resident UMHAT Burgas Bulgaria, Burgas
COVID-19 OTOLARYNGOLOGICAL SYMPTOMS
Abstract. Introduction: We detect, analyze and discuss the different ear nose throat (ENT) manifestations those were reported in COVID19 hospitalised patients in the university hospital of Burgas. [1]
Aim: The aim of the study is to find common ENT symptoms for developing the disease in COVID19 positive patients. [2]
Materials and methods: We made a questionnaire among the hospitalized patients and a research in the PubMed databases, Web of Science and others.
Results: Within the included 98 COVID-19 laboratory - confirmed positive patients, the most common ENT manifestations of COVID-19 was sore throat (15%). Other common otorhinolaryngological manifestations of the disease were - pharyngeal erythema, runny nose, nasal congestion, enlargement of the tonsils, infection of the upper respiratory tract.
Conclusions: As a conclusion we can say that ENT manifestations for COVID-19 are not common as fever and cough. Nevertheless the disease is still spreading and with all the mutations we should continue the evaluation of the clinical manifestation. [3]
Key words: COVID19, ENT, symptoms, manifestations, ear, nose, throat.
Introduction
The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), firstly known as the 2019 novel Coronavirus (2019-nCoV), started in Wuhan in China at December 2019. Since that moment, the new virus, also known as COVID-19, has dramatic spread all over the world crossing all countries' borders till the World Health Organization (WHO) confirmed it as a pandemic disease on March 11, 2020 [4]. The COVID-19 is part of the species of the SARS-related coronaviruses that have led to previous epidemics over the last two decades as SARS-CoV in 2002-2003 in China and the Middle East Respiratory Syndrome (MERS-CoV) in 2012-2013 in Saudi Arabia [5]. The COVID-19 is presented mainly by lower respiratory tract related symptoms such as fever, cough, dyspnea and chest tightness that could progress rapidly to acute respiratory distress syndrome (ARDS). However, COVID-19 causes also different upper respiratory tract related symptoms including nasal congestion, sore throat and smell dysfunction [6]. The available data on the ear nose throat
(ENT) manifestations of COVID-19 is sparsely published and out of the best of our knowledge, no previous review study to collect and describe the ORL manifestation in COVID-19 positive patients. Thus, the aim of the current work was to detect and discuss the different otorhinolaryngology (ORL) manifestations those were reported in COVID-19 positive patients in the reviewed and published literatures and according to the patients hospitalised in infectious disease ward in UMHAT Burgas.
Materials and methods
We made a questionnaire that was given to all patients positive for COVID 19 and hospitalised in the infectious disease ward for a period of 8 months (03.2020 - 09.2020). We searched several medical databases, including PubMed databases, Web of Science and Cochrane Library.
Results
Within the included 98 COVID-19 laboratory - confirmed positive patients, the most common ENT manifestations of COVID-19 was sore throat (15%). Other common otorhinolaryngological manifestations of the disease were - pharyngeal erythema, runny nose, nasal congestion, enlargement of the tonsils, infection of the upper respiratory tract. In the analyzed studies we found that non-ENT manifestation were the main and much more common than the ENT manifestations including fever (73%), cough (61%), expectoration (24%). No reported sneezing, epistaxis, post nasal discharge, facial edema or tenderness, diminution of hearing, vertigo, hoarseness, or stridor. So the most common ENT manifestations for COVID-19 were sore throat (11.3%) and headache (10.7%). It was found that the incidence of the ENT manifestation in COVID-19 patients is not as high as fever and cough. But, it was reported that nasal congestion (4.1%) and pharyngeal erythema (5.3%) were reported to occur in nearly similar incidence to the occurrence of diarrhea in those patients (4.2%).
Discussion
The widespread distribution and infectivity of COVID-19 make it an important pathogen with an unrestricted health threat [7]. COVID-19 manifests with a wide clinical spectrum ranging from no symptoms to septic shock and multi-organs dysfunctions [8]. Despite its rapid spread worldwide, the clinical characteristics of COVID-19 remain to a large extends vague [9]. The nasal, nasopharyngeal and/or the orpharyngeal tissue is one of the main harbor sites of the infection, main site of taking the sample for testing and a main source of transmission of infection. However, most published COVID-19 researches are focused on the lower respiratory tract manifestation and sequels due to their life-threatening nature. While, the literature on ENT manifestation during COVID-19 infection is still sparse, thus, there is value in studying ENT manifestations of such novel virus and there is a need to identify the defining ENT epidemiological and clinical characteristics with more precision. All the reported ENT manifestations in COVID-19 patients are nonspecific and so could be easily missed and no emergency ENT symptoms as bleeding per nose or throat
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or stridor was reported in COVID-19 cases. Post viral anosmia is one of the chief reasons of smell dysfunction in adults (40% of cases of anosmia).[10] We made a study that was not completely objective about the result if there any correlation between the severity of the COVID 19 infection and the anosmia. Conclusion
ENT manifestations for COVID-19 are not common as fever and cough. But, a universal questionnaire using well-defined COVID-19 manifestations is needed to make the COVID-19 data precisely defined, complete and homogenous.
References:
[1] Mohammad Waheed El-Anwar, Saad Elzayat, Yasser Ahmed Fouad, ENT manifestation in COVID-19 patients, https://pubmed.ncbi.nlm.nih.gov/32586739/
[2] Geng Ju Tuang, Adi Farhan Abdul Wahab, Salina Husain, Otolaryngology manifestations of COVID-19: a contemporary viewpoint
https ://pmj.bmj.com/content/early/2021/04/19/postgradmedj -2021-140169
[3] Priyanka Chaurasia, Vaibhav Kuchhal, ENT manifestations in Covid-19 positive patients, https://www.ijhcr.com/index.php/ijhcr/article/view/391
[4] W Xia, J Shao, Y Guo, X Peng, Z Li, D HuClinical and CT features in pediatric patients with COVID-19 infection: different points from adults. Pediatr Pulmonol, 55 (5) (2020 May), pp. 1169-1174
[5] E de Wit, N van Doremalen, D Falzarano, VJ Munster SARS and MERS: recent insights into emerging coronaviruses.Nat Rev Microbiol, 14 (8) (2016 Aug), p. 523
[6] AJ Rodriguez-Morales, JA Cardona-Ospina, E Gutierrez-Ocampo, R Villamizar-Pena, Y Holguin-Rivera, JP Escalera-Antezana, et al. Clinical, laboratory and imaging features of COVID-19: a systematic review and metaanalysis. Travel Med Infect Dis (2020 Mar 13), Article 101623
[7] SA Hassan, FN Sheikh, S Jamal, JK Ezeh, A Akhtar Coronavirus (COVID-19): a review of clinical features, diagnosis, and treatment. Cureus, 12 (3) (2020)
[8] M Cascella, M Rajnik, A Cuomo, SC Dulebohn, R Di Napoli Features, evaluation and treatment coronavirus (COVID-19) InStatpearls [internet], StatPearls Publishing (2020) Mar
[9] WJ Guan, ZY Ni, Y Hu, WH Liang, CQ Ou, JX He, et al.Clinical characteristics of 2019 novel coronavirus infection in China MedRxiv (2020)
[10] MM Speth, T Singer-Cornelius, M Obere, I Gengler, SJ Brockmeier, AR Sedaghat. Olfactory dysfunction and sinonasal symptomatology in COVID-19: prevalence, severity, timing, and associated characteristics. Otolaryngol Head Neck Surg. (2020)
