Sinonasal complications of severe acute respiratory syndrome coronavirus‐2: A single center case series

Abstract

Background The emergence of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) has resulted in an unprecedented global pandemic. Most infected patients are either asymptomatic or have mild upper respiratory infection symptoms. However, life‐threatening sequelae have been observed. In this report, we reviewed nine cases of patients with severe complications from sinonasal disease in the setting of acute SARS‐CoV‐2 infection. Methods IRB approval was obtained prior to study initiation. A retrospective chart review was performed of patients admitted to a tertiary hospital with complex sinonasal symptoms that required otolaryngologic evaluation and management in the setting of concomitant SARS‐CoV‐2 infection. Results Nine patients, ranging from ages 3 to 71 years, with sinonasal disease and simultaneous SARS‐CoV‐2 infection were identified. Initial presentations ranged from asymptomatic infection to mild/moderate disease (nasal obstruction, cough) or more severe sequelae including epistaxis, proptosis, or neurologic changes. SARS‐CoV‐2 tests were positive from one to 12 days after symptom onset, with three patients receiving SARS‐CoV‐2‐directed treatment. Complex disease presentations included bilateral orbital abscesses, suppurative intracranial infection, cavernous sinus thrombosis with epidural abscess, systemic hematogenous spread with abscess development in four distinct anatomic locations, and hemorrhagic benign adenoidal tissue. Eight of nine patients (88.8%) required operative intervention. Patients with abscesses also required prolonged, culture‐directed antibiotic courses. Conclusion Though most SARS‐CoV‐2 infections are asymptomatic and/or self‐limited, there is significant morbidity and mortality in patients with severe disease sequela as outlined in our reported cases. This suggests early identification and treatment of sinonasal disease in this patient population is critical to minimizing poor outcomes. Further research on the pathophysiology of these atypical presentations is needed. Level of Evidence 4 (Case Series).

Intracranial complications of sinogenic and otogenic infections in children: an ESPN survey on their occurrence in the pre-COVID and post-COVID era

“…The second hypothesis concerns the impairment of the respiratory microbiota. Once again, a certain evidence about the role of the quality of oropharyngeal colonization in enhancing the COVID-19 virulence has been found in adults [ 39 ] while the role of the respiratory tract microbiota composition in children remains speculative [ 40 , 41 ]. Controversial remains also the role of COVID-19 in influencing the occurrence of sinusitis and otitis because, on the one hand, COVID infection can favor bacterial superinfection and immune dysregulation (thus favoring sinusitis/otitis) [ 42 ] while, on the other hand, lockdown, masking, and vaccination could have contributed to their reduction [ 43 ].…”