COVID‐19 swab‐related skull base injury

Mistry, Sandeep; Walker, Wallace; Earnshaw, James; Cervin, Anders

doi:10.5694/mja2.51082

Cited by 14 publications

(23 citation statements)

References 2 publications

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“…The same scenario was also reported later by Rajah et al [ 8 ] emphasizing the role of previous skull base defect. In three other cases of CSF leak after Covid‐19 nasopharyngeal swab, the authors did not state a reason for the observed adverse event [ 7 , 9 , 10 ]. In our case, the patient only had deviated nasal septum and a nasal spur.…”

Section: Discussionmentioning

confidence: 99%

“…Up to today, there have been 7 adverse events reported in the literature. There are 3 cases that the swab broke during the procedure, 1 case of severe epistaxis needing medical help, and 5 cases of cerebrospinal fluid leak requiring endoscopic surgical repair [ [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] ]. Herein, we describe the second case of cerebrospinal fluid (CSF) leak after nasal testing for Covid-19.…”

Section: Introductionmentioning

confidence: 99%

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CSF rhinorrhea after nasopharyngeal swab testing for COVID-19: A case report and review of literature

Samadian

Maroufi

Taheri

et al. 2021

Otolaryngology Case Reports

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Background There are more than 206 million confirmed cases of Covid-19 infection globally. Nasopharyngeal swab testing is one of the widely used diagnostic methods for the initial diagnosis of such cases. With the growing diagnostic testing capacity, it is expected to observe an increased number of adverse events due to nasopharyngeal testing. Clinical presentation A middle-aged woman presented with unilateral rhinorrhea, started after nasopharyngeal swab test for Covid-19. She had no prior medical issues. Thorough examination and imaging showed the presence of cerebrospinal fluid leakage. Conclusion Nasopharyngeal swab testing may lead to serious complications and taking a brief history might be helpful. Also, patients should be educated on different complications of nasopharyngeal swab testing and their associated symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

CSF rhinorrhea after nasopharyngeal swab testing for COVID-19: A case report and review of literature

Samadian

Maroufi

Taheri

et al. 2021

Otolaryngology Case Reports

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“…1A ). 45 The angle of nasopharyngeal swab insertion into the nasal passage should be within 30°, a safe angle, from the nasal floor for safe testing ( Fig. 1A ).…”

Section: Procedural References For Safe Nasopharyngeal Swabmentioning

confidence: 99%

“…Upward swab insertion with angles greater than 30° not only results in inadequate sample collection but also can damage the skull base, including the cribriform plate and sphenoid, which can lead to CSF leakage. 3 12 45 Clinicians could predict the horizontal plane of the nasal floor and full depth of insertion by the line and length between the nostril and the external ear canal, respectively. 45 Clinicians need to hold the swab in an appropriate way for safe insertion just above the nasal floor, which requires delicate pressing in the lower direction ( Fig.…”

Section: Procedural References For Safe Nasopharyngeal Swabmentioning

confidence: 99%

“… 3 12 45 Clinicians could predict the horizontal plane of the nasal floor and full depth of insertion by the line and length between the nostril and the external ear canal, respectively. 45 Clinicians need to hold the swab in an appropriate way for safe insertion just above the nasal floor, which requires delicate pressing in the lower direction ( Fig. 1B and C ).…”

Section: Procedural References For Safe Nasopharyngeal Swabmentioning

confidence: 99%

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Complications of Nasopharyngeal Swabs and Safe Procedures for COVID-19 Testing Based on Anatomical Knowledge

Kim

Moon

et al. 2022

J Korean Med Sci

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Nasopharyngeal swabs have been widely to prevent the spread of coronavirus disease 2019 (COVID-19). Nasopharyngeal COVID-19 testing is a generally safe and well-tolerated procedure, but numerous complications have been reported in the media. Therefore, the present study aimed to review and document adverse events and suggest procedural references to minimize preventable but often underestimated risks. A total of 27 articles were selected for the review of 842 related documents in PubMed, Embase, and KoreaMed. The complications related to nasopharyngeal COVID-19 testing were reported to be rarely happened, ranging from 0.0012 to 0.026%. Frequently documented adverse events were retained swabs, epistaxis, and cerebrospinal fluid leakage, often associated with high-risk factors, including severe septal deviations, pre-existing skull base defects, and previous sinus or transsphenoidal pituitary surgery. Appropriate techniques based on sufficient anatomical knowledge are mandatory for clinicians to perform nasopharyngeal COVID-19 testing. The nasal floor can be predicted by the line between the nostril and external ear canal. For safe testing, the angle of swab insertion in the nasal passage should remain within 30° of the nasal floor. The swab was gently inserted along the nasal septum just above the nasal floor to the nasopharynx and remained on the nasopharynx for several seconds before removal. Forceful insertion should be attempted, and alternative examinations should be considered, especially in vulnerable patients. In conclusion, patients and clinicians should be aware of rare but possible complications and associated high-risk factors. The suggested procedural pearls enable more comfortable and safe nasopharyngeal COVID-19 testing for both clinicians and patients.

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