A systematic review and meta-analysis of otorhinolaryngological manifestations of coronavirus disease 2019 in paediatric patients

Abstract

Background This meta-analysis provides a quantitative measure of the otorhinolaryngological manifestations of coronavirus disease 2019 in children. Methods A structured literature review was carried out using PubMed, Embase and Cochrane Central, employing pertinent search terms. The statistical analysis was performed using Stata version 14.2 software, and the analysed data were expressed as the pooled prevalence of the symptoms with 95 per cent confidence intervals. Results The commonest symptoms noted were cough (38 per cent (95 per cent confidence interval = 33–42; I2 = 97.5 per cent)), sore throat (12 per cent (95 per cent confidence interval =10–14; I2 = 93.7 per cent)), and nasal discharge (15 per cent (95 per cent confidence interval = 12–19; I2 = 96.9 per cent)). Anosmia and taste disturbances showed a pooled prevalence of 8 per cent each. Hearing loss, vertigo and hoarseness were rarely reported. Conclusion Cough, sore throat and nasal discharge were the commonest otorhinolaryngological symptoms in paediatric patients with coronavirus disease 2019. Compared with adults, anosmia and taste disturbances were infrequently reported in children.

Audiological and vestibular symptoms following SARS-CoV-2 infection and COVID-19 vaccination in children aged 5–11 years

“…Hijazi et al found that the only otologic symptoms in 660 pediatric patients with COVID-19 were otalgia and ear fullness, reported in 1.8 % and 0.5 % of cases, respectively [16] . A recent systematic review and meta-analysis of otorhinolaryngological manifestations of COVID-19 in pediatric patients confirmed that hearing loss and vertigo were rarely reported [17] . A study by Tufatulin et al that evaluated 87 children in three cities in Russia found no cases of hearing loss or central auditory processing disorders after SARS-CoV-2 infection [18] .…”

“…The present study assessed the prevalence of audiological and vestibular symptoms following SARS-COV-2 infection or COVID-19 vaccination among children aged 5–11 years who attended a third-level referral audiological center. While several studies have described audio-vestibular disorders, such as sudden sensorineural hearing loss, tinnitus, and vertigo, as possible manifestations following SARS-CoV-2 infection [11] , [12] and COVID-19 vaccines in adults [13] , [14] , [15] , there are very few reports concerning the pediatric population [16] , [17] , [18] , [19] .…”

Prevalence of Olfactory Dysfunction with the Omicron Variant of SARS-CoV-2: A Systematic Review and Meta-analysis

“…Taking into account the omicron-caused prevalence of hyposmia for the different major ethnicities, and the total population size of these major ethnicities (obtained from the WHO website: https://www.worldometers.info/geography/7-continents/), and using the estimated numbers of COVID cases from the Institute for Health Metrics and Evaluation [6], we can estimate the number of adults in different ethnic populations that can be expected to experience olfactory dysfunction due to omicron infection (Table 3). Since children make up approximately 25% of the world population, we subtracted 25% from each of the population sizes to account for children – which are not included in our review, because there are too few studies reporting on olfactory dysfunction in omicron-infected children, and children with COVID are known to have much less olfactory dysfunction than adults [25]. Assuming a COVID infection of 90% among populations [6], we predict for people of European ancestry a total number of 71.1 million adults with hyposmia out of 0.6 billion (11.7% prevalence), 23.2 million adults with hyposmia out of 0.5 billion Latinos/Hispanics (4.9% prevalence), 29.3 million adults with hyposmia out of 0.9 billion Africans (3.1% prevalence), 32.1 million adults with hyposmia out of 1.7 billion East Asians (1.9% prevalence), 37.8 million adults with hyposmia out of 1.3 billion South Asians (2.8% prevalence), and 7.4 million adults with hyposmia out of 0.3 billion in the Middle East (2.2% prevalence), adding to a total of 200.9 million adult people with olfactory dysfunction, as summarized in Table 3.…”

“…Polymorphisms in the enzyme may account for inter-individual variability in olfactory perception [16]. Furthermore, UDP glycosyltransferases are expressed differentially with aging [110] which could explain the increased olfactory dysfunction seen in young adults (but less in children or older people [25,99]), and expression of UDP glycosyltransferase also differs between genders [111], which may explain the higher female susceptibility to olfactory dysfunction [99].…”

“…Studies which were deemed eligible for the systematic review met all of the following inclusion criteria: (1) studies reporting the numerical prevalence of olfactory dysfunction in humans infected with the omicron variant (B.1.1.529) and any of the omicron subvariants, BA.1, BA.2, BA.1.1, BA.2.2, BA.2.10, BA.2.38, BA.2.75, BA.5, BQ.1, XBB. Report of an odds ratio only was not sufficient for inclusion [24]; (2) studies on adults or adolescents (when a small number of children was included, this was considered acceptable), but studies that focused entirely on children were not included, because it is known that children with COVID have a significantly lower prevalence of olfactory dysfunction than adults with COVID [25]; (3) evidence of infection with SARS-CoV-2; genomic proof of variant type was not deemed necessary when it was known that the vast majority of infections during the period and in the region of data collection were omicron cases rather than cases caused by another virus variant; (4) olfactory dysfunction was monitored through subjective recall, and all members of the cohort were specifically asked about changes in smell, changes in smell or taste, or changes in smell and taste; review of medical records for entries about loss of smell, but without universal and specific questioning of patients, was not acceptable (e.g., [26]); (5) the olfactory dysfunction occurred during the acute phase of infection – long-term studies inquiring about changes of smell persisting for weeks or months after the infection were not included. Comparison with variants other than omicron was not a required inclusion criterion.…”