During the current nascent pandemic, anosmia has been increasingly reported among patients with coronavirus disease-2019 (COVID-19) (1). While postviral olfactory loss secondary to nasal congestion or conductive pathway alteration is a known sequela of sinonasal viral infections (2), anosmia of COVID-19 is less commonly associated with rhinorrhea or nasal congestion (3). This may indicate sensory neural loss as the underlying cause of the olfactory dysfunction rather than the conductive mechanism in most cases of postviral olfactory loss. We have recently reported normal morphology of the olfactory bulb on magnetic resonance imaging in anosmia of COVID-19 (4). Whether there is decreased neural activity in olfactory pathways despite normal morphology is unknown. We sought to assess the neural metabolic activity in anosmia of COVID-19 by 18fluoro-2-deoxy-d-glucose (18FDG) positron emission tomographyÀcomputed tomography (PET-CT). We included a 27-year-old healthy, right-handed woman, diagnosed with COVID-19 by polymerase chain reaction assay. The patient had persistent isolated anosmia for 6 weeks. She had no history of alcohol intake or tobacco smoking and no background of psychiatric problems. The patient was asked to fast for 6 hours prior to imaging. We performed 18FDG-PET/CT in a neutral environment using 5 ml of aerosolized 0.9% NaCl delivered with O 2 at 3.5 ml/min via facial mask for 9 minutes. The patient was instructed to breath normally without sniffing. After 3 minutes, the patient received intravenous 18FDG (4.6 Megabecquerel/kg, Masih Daneshvari Hospital, Tehran), and the neutral olfactory condition continued for another 6 minutes. The patient laid down in a semi-darkened,
Background Manifestations of the coronavirus disease 2019 in ENT include sore throat, rhinorrhoea, anosmia and dysgeusia. Whether coronavirus disease 2019 causes otitis media is not known. Objective To assess the presence of otitis media in a series of patients with confirmed coronavirus disease 2019 and ENT symptoms. Methods The study included patients with coronavirus disease 2019, confirmed on polymerase chain reaction assay, who had otological (e.g. otalgia, otorrhoea, hearing loss) or other ENT (e.g. anosmia, dysgeusia) manifestations of coronavirus disease 2019, in two tertiary referral hospitals in Iran. Patients were excluded if they had a background of otological problems including previous acute otitis media, chronic otitis media, otological surgery, and trauma or radiotherapy to the head and neck. Results Otitis media was found in eight patients with coronavirus disease 2019 and no background of otological problems. Six patients had middle-ear effusion, three had typical signs of acute otitis media, and one had a tympanic membrane perforation. Most patients had hearing loss; conductive hearing loss and mild sensorineural hearing loss at high frequencies were the underlying mechanisms. Conclusion Otitis media should be considered a manifestation or associated symptom of coronavirus disease 2019 during the current pandemic.
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